Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial

Kings College London, Institute of Psychiatry, UK.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 09/2007; 46(8):1051-61. DOI: 10.1097/CHI.0b013e318067e288
Source: PubMed


To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people.
Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks.
Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD.
Individual trauma-focused CBT is an effective treatment for PTSD in children and young people.

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    • "traumainterventiot ja narratiivinen altistusterapia (NEt) Traumaan keskittyvää kognitiivis-behavioraalista terapiaa pidetään kansallisissa hoitosuosituksissa ensisijaisena traumaperäisten stressioireiden hoitona (NICE – National Institute for Health and Clinical Excellence, 2005; Ponteva ym., 2009). Useat meta-analyysit ovatkin osoittaneet sen vaikuttavaksi interventioksi traumatisoituneiden lasten ja aikuisten hoidossa (Bisson & Andrew, 2007; Gillies, Taylor, Gray, O'Brien & D'Abrew, 2012; Roberts, Kitchiner, Kenardy & Bisson, 2009), ja sen on todettu lieventävän traumaperäisen stressihäiriön oireiden ohella masennus-ja ahdistus oireita (Bisson & Andrew, 2007; Smith ym., 2007). Suurin osa kognitiivis-behavioraalisista terapioista sisältää hoito elementteinä ainakin psykoedukaatiota ja normalisointia, kognitioiden muuttamista, altistusta sekä ahdistuksen säätelykeinojen opettelua (Pine & Cohen, 2002). "
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    ABSTRACT: Suurin osa ihmisistä kokee jossakin elämänsä vaiheessa potentiaalisesti traumatisoivan tapahtuman. Useille traumatisoiville tilanteille altistuminen eli kompleksinen traumatisoituminen lisää erilaisten mielenterveysongelmien todennäköisyyttä. Vallalla olevien traumateorioiden mukaan traumatisoiva tilanne johtaa mielenterveysongelmiin kognitiivisten prosessien vääristymisen kautta. Kompleksiseen traumatisoitumiseen on kehitetty interventio nimeltä narratiivinen altistusterapia, jonka tarkoituksena on vaikuttaa sekä traumamuistojen laatuun että henkilön autobiografisen muistin palautumiseen. Tässä tapaustutkimuksessa tarkasteltiin useita traumaattisia tapahtumia kokeneen nuoren psyykkistä oireilua, traumamuistojen laatua, traumaan liittyvää tiedonkäsittelyä ja elämäkertamuistia sekä niiden muutoksia narratiivisen altistusterapian aikana suhteessa vallalla oleviin traumateorioihin. Ennen interventiota tutkittavalla todettiin traumaperäinen stressihäiriö sekä huoltajan raportoimia käytösoireita, yliaktiivisuutta, kaverisuhteiden ongelmia sekä psyykkistä kokonaisoireilua. Tutkittavan traumaan liittyvät kognitiot olivat vääristyneitä, traumamuistot hajanaisia ja autobiografinen muisti heikentynyttä. Intervention aikana ja jälkeen muutosta parempaan oli tapahtunut kaikilla mitattavilla osa-alueilla. Tulokset vaikuttaisivat olevan yhdenmukaisia vallitsevien teorioiden kanssa. It is estimated that most peopleexperience at least one potentially traumatic event during their lifetime. People exposed to multiple traumatic events (referred to as complex trauma) are more susceptible to various mental disorders such as depression, anxiety disorders and posttraumatic stress disorder. According to prevalent trauma theories, a traumatic event leads to mental disorders through the distortion of cognitive processes. An intervention by the name of Narrative Exposure Therapy (NET) has been developed to treat people exposed to complex trauma. NET aims to improve the quality of trauma memories and restore autobiographical memory function. The purpose of this case study was to examine, first, the mental health symptoms, the quality of trauma memories, the trauma cognitions and the autobiographical memory of an adolescent exposed to complex trauma, and, second, the effect of NET on the aforementioned variables. Before the intervention, the examinee suffered from posttraumatic stress disorder, fragmented trauma memories, distorted trauma cognitions and weakness of autobiographical memory, as well as from other mental health symptoms as reported by her parent. During and after the intervention there was a decrease in mental health symptoms as reported By both the examinee and her parent and a change for the better in trauma memories, cognitions and autobiographical memory. The results seemed to be in concordance with current trauma models.
    • "The current study did not take into account the comorbidity of PTSD of the participants such as depression and other anxiety disorders. Previous controlled studies that demonstrated the efficacy of CBT in young participants also showed the improvement in depression (Smith et al., 2007; Stein et al., 2003) and anxiety (March, Amaya-Jackson, Murray and Schulte, 1998; Smith et al., 2007). There was a suggestion from the previous research that depression and anxiety often developed secondarily to PTSD and successful treatment of PTSD should lead to improvement in other emotional symptoms. "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10–15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.
    Behavioural and Cognitive Psychotherapy 09/2015; 43(05):549-561. DOI:10.1017/S1352465813001197 · 1.69 Impact Factor
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    • "Treatment with medication is not usually recommended for children and young people with PTSD (The National Institute of Mental Health (NIMH)). Individual trauma-focused CBT is an effective treatment for PTSD in children and young people (Smith et al., 2007). "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is a complex mental disorder with psychological and emotional components, caused by exposure to single or repeated extreme traumatic events found in war, terrorist attacks, natural or man-caused disasters, and by violent personal assaults and accidents. Recently, research attention has been focused on the types of memory processes involved in PTSD and hypothesized neurobiological processes. Complicating this exploration, and the treatment of PTSD, are underlying comorbid disorders, such as depression, anxiety, and substance use disorders. Treatment of PTSD has undergone. Despite clinical studies and improved understanding of the mechanisms of cellular damage, prevention and treatment strategies for patients with PTSD remain unsatisfactory. Posttraumatic stress disorder is a prevalent mental health problem associated with substantial psychiatric morbidity. Three major treatment approaches are currently available for PTSD patients: cognitive behavioral therapy, pharmacotherapy, and more traditional individual and group dynamic psychotherapy. To develop an improved plan for treating and impeding progression of PTSD, it is important to identify underlying biochemical changes that may play key role in the initiation and progression of these disorders.
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