Figure 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Trial Consolidated Standards of Reporting Trials diagram. CT-PTSD, cognitive therapy for post-traumatic stress disorder; TAU, treatment as usual. on July 2, 2021 by guest. Protected by copyright.
Source publication
Background
Post-traumatic stress disorder (PTSD) is a distressing and disabling condition that affects significant numbers of children and adolescents. Youth exposed to multiple traumas (eg, abuse, domestic violence) are at particular risk of developing PTSD. Cognitive therapy for PTSD (CT-PTSD), derived from adult work, is a theoretically informed...
Context in source publication
Similar publications
Introduction:
Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition that affects a significant minority of young people exposed to traumatic events. Effective face-to-face psychological treatments for PTSD exist. However, most young people with PTSD do not receive evidence-based treatment. Remotely delivered digital interventi...
Citations
... The present study was a cross-sectional design comprising of analysis of the baseline data from the Delivery of Cognitive Therapy for Young People after Trauma (DECRYPT) trial (Allen et al., 2021), a randomised controlled trial of cognitive therapy for PTSD in youth exposed to multiple traumatic stressors. Measures were selected from the battery of selfreport and parent/caregiver-report interviews and questionnaires to assess PTSD symptom severity, prevalence of sexual trauma, and negative post-traumatic cognitions for the primary analysis. ...
... The sample size of 120 participants was determined by the primary outcome of the DECRYPT trial (Allen et al., 2021). Participants were drawn from Child and Adolescent Mental Health Services (CAMHS) and Youth Services in Cambridgeshire, Cardiff, Essex, Hertfordshire, Kent, Norfolk, South London, and Suffolk. ...
Background: PTSD is comorbid with a number of other mental health difficulties and the link between voice hearing and PTSD has been explored in adult samples.
Objective: To compare the trauma history, symptomatology, and cognitive phenotypes of children and adolescents with a PTSD diagnosis following exposure to multiple traumatic events presenting with voice hearing with those who do not report hearing voices.
Methods: Participants (n = 120) were aged 8–17 years and had PTSD following exposure to multiple traumas. Three primary analyses were conducted, comparing PTSD symptom severity, prevalence of sexual trauma, and level of negative post-traumatic cognitions between the voice hearing and non-voice hearing groups. Participants were allocated to the voice hearing group if they reported hearing voices in the past two weeks. A range of mental health and cognitive–behavioural factors were considered in exploratory secondary analyses. All analyses were pre-registered.
Results: The voice hearing group (n = 50, 41.7%) scored higher than the non-voice hearing group (n = 70, 58.3%) for negative post-traumatic cognitions, but not PTSD symptom severity or prevalence of sexual trauma. In secondary analyses, the voice hearing group had more sensory-based and fragmented memories and higher scores for panic symptoms than the non-voice hearing group. When participants whose voices were not distinguishable from intrusions or flashbacks were removed from the voice hearing group in a sensitivity analysis, the voice hearing group (n = 29, 24.2%) scored higher on negative post-traumatic cognitions and trauma memory quality, with similar effect sizes to the original analysis.
Conclusions: Voice hearing is common among youth exposed to multiple traumas with PTSD and is related to cognitive mechanisms proposed to underpin PTSD (appraisals, memory quality) and more panic symptoms. Further research should seek to investigate the underlying mechanisms and directionality for these relationships.
... This qualitative study was embedded within a UK randomised controlled trial (RCT) 'DECRYPT' (Delivery of Cognitive Therapy for Young People After Trauma; Allen et al., 2021). The primary objective of DECRYPT was to evaluate whether Cognitive-Therapy for PTSD (CT-PTSD) was an effective treatment for children and young people aged between 8 and 17 years old presenting with PTSD symptoms who had experienced multiple traumatic experiences, in comparison to treatment-as-usual provided by Child and Adolescent Mental Health Services (CAMHS). ...
... The main inclusion criteria for the DECRYPT trial were young people who had experienced multiple traumatic events and were experiencing high levels of PTSD symptoms (as defined by scoring 17 or above on the Children's Impact of Event Scales, CRIES-8, Horowitz et al., 1979) and met a diagnosis for DSM-5 PTSD (DSM-5;American Psychiatric Association, 2013). Full inclusion and exclusion criteria and further information regarding CT-PTSD are detailed in the DECRYPT Protocol paper (Allen et al., 2021). It is worth noting the complexity of the young people involved in this study, with high levels of co-morbidities including complex PTSD. ...
Objectives and Design
This qualitative study aimed to explore the treatment experiences of children and young people with Post‐traumatic Stress Disorder (PTSD) symptoms, participating in a randomised controlled trial evaluating the effectiveness of Cognitive‐Therapy for PTSD (CT‐PTSD).
Methods
Thirteen participants aged between 12 and 18 years old, who had all experienced multiple trauma and had undertaken CT‐PTSD, were interviewed.
Results
Using thematic analysis, three key themes were identified: ‘ Desire for difference ’, ‘ Journey of becoming able to talk about trauma ’ and ‘ Positive changes and increased ability to cope’ . Prior to the study, participants described experiencing difficult emotions and avoided talking about their traumatic experiences. Participants reported wanting to get the right help and valued the opportunity to help others. Talking about trauma during treatment was perceived as difficult and emotionally draining, however participants reported a sense of relief and that it became easier over time, helping them to make sense of their traumatic experiences. This was facilitated by the therapeutic relationship, their involvement in decision making and the use of written tasks. All participants reported positive changes, both in themselves and in their ability to talk to others about their traumatic experiences.
Conclusion
Engaging in CT‐PTSD and talking about traumatic experiences can be empowering for young people and allows them the opportunity to process their trauma leading to increased ability to cope.
Children and adolescents exposed to traumatic events are at high risk of developing post-traumatic stress disorder (PTSD). With the rare exception of young children, their PTSD presentations at the symptom level are similar to those of trauma-exposed adults, as are their patterns of psychiatric comorbidity, particularly for adolescents. Untreated, at least a significant proportion will carry on with symptoms at or above the diagnostic threshold or at sub-threshold levels that are still clinically impairing. The presence of untreated or poorly treated PTSD symptoms leaves the young person at significantly increased risk of developing other psychiatric disorders, a worsening of any pre-existing conditions, and with greater long-term impairments in education, family, and peer functioning. Fortunately, evidence-based treatments exist with the first-line recommendation being trauma-focused cognitive behavioural therapies, with a growing body of evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR). This chapter provides an update on the state of the literature with respect to the evidence base for trauma-focused cognitive behavioral therapy (CBT), and in particular, for an explicitly cognitive approach, originally developed for use with adults and successfully adapted for use with children and adolescents across the age range. The chapter describes the theoretical underpinning for this approach, guidance on reliving (a form of exposure to update the trauma memory) and the modification of trauma-related beliefs (two primary targets in treatment), parental involvement in treatment, dealing with comorbidity, and a case example.
Background
Effective face‐to‐face treatments for Post‐Traumatic Stress Disorder (PTSD) are available, but most young people with PTSD do not receive effective treatment. Therapist‐supported online Cognitive Therapy has the potential to improve accessibility of effective treatment. This early‐stage trial gathered data on the feasibility, acceptability, and initial signal of clinical efficacy of a novel online Cognitive Therapy program for young people with PTSD.
Methods
A two‐arm, parallel‐groups, single‐blind, early‐stage feasibility RCT compared online Cognitive Therapy to a waitlList condition. Participants were N = 31 adolescents (12–17 years‐old) with a diagnosis of PTSD, randomised in a 1:1 ratio using minimisation. Thresholds for progression to a larger trial were set a priori for recruitment rate, data completeness, and the initial signal of clinical efficacy. The primary clinical outcome was PTSD diagnosis at 16 weeks post‐randomisation. Secondary clinical outcomes were continuous measures of PTSD, depression, and anxiety at 16 weeks; and at 38 weeks in the online Cognitive Therapy arm.
Results
All pre‐determined feasibility thresholds for progression to a larger trial were met. We recruited to target at a rate of 1–2 participants/month. No patient dropped out of therapy; 94% of all participants were retained at 16 weeks. At 16‐weeks, the intention‐to‐treat (ITT) effect adjusted odds ratio was 0.20 (95% CI, 0.02, 1.42), indicating that the odds of meeting PTSD caseness after online therapy were 80% lower than after the waitlist (10/16 participants met PTSD caseness after therapy compared to 11/13 after WL). Effect‐size estimates for all secondary clinical outcomes were large‐moderate; improvements were sustained 38 weeks after online Cognitive Therapy.
Conclusions
Therapist‐supported online Cognitive Therapy for PTSD is acceptable to young people and has potential for meaningful and sustained clinical effects. A larger trial appears feasible to deliver. Further work is needed to refine the intervention and its delivery and to evaluate it in a larger confirmatory trial.
Background
Complex PTSD (CPTSD) is a relatively new diagnosis. The objective of the present study was to investigate how trauma characteristics, comorbid psychopathology and cognitive and social factors experienced by children and adolescents with a posttraumatic stress disorder (PTSD) diagnosis following exposure to multiple traumatic events differs between those who meet the criteria for CPTSD and those who do not.
Method
The present research used baseline data from the DECRYPT trial (BMJ Open, 2021, 11, e047600). Participants (n = 120) were aged 8–17 years and had exposure to multiple traumas and a PTSD diagnosis. The data collected comprised self‐report and parent/caregiver‐report questionnaires and interviews. Three primary analyses were conducted, comparing number of trauma types, prevalence of sexual trauma and prevalence of intrafamilial abuse between the CPTSD and PTSD‐only groups. A range of comorbid psychopathology and cognitive and social factors were compared between the groups in an exploratory secondary analysis. All analyses were preregistered.
Results
The CPTSD group (n = 72, 60%) had a significantly higher frequency of sexual trauma than the PTSD‐only group (n = 48, 40%). The groups did not significantly differ on number of trauma types or prevalence of intrafamilial abuse. From the secondary analysis, the CPTSD group were found to have significantly higher scores on measures of negative post‐traumatic cognitions, depression and panic. These results were replicated in correlation analyses using a continuous measure of CPTSD symptoms.
Conclusions
A large proportion of youth exposed to multiple traumatic events met criteria for CPTSD. Sexual trauma appears to be related to CPTSD symptoms. Youth with CPTSD appear to have greater severity of comorbid depression and panic symptoms, as well as more negative post‐traumatic cognitions. Further investigation could focus on the directionality and mechanisms for these associations.
Purpose of the review:
We review treatment outcome studies and systematic reviews for childhood and adolescent posttraumatic stress disorder (PTSD) between January 2020 and August 2022, including studies involving younger children and different treatment delivery methods and models. We address predictors, moderators, treatment engagement, and attrition.
Recent findings:
Recent randomised controlled trials corroborate earlier trials documenting trauma-focused cognitive behaviour therapy (TF-CBT) as a highly efficacious treatment for PTSD. Evidence for treatment effects in complex PTSD in youth is still sparse. Research on moderators and predictors of treatment continues to be hampered by multiple factors, including a lack of sufficiently large homogeneous trauma samples.
Summary:
TF-CBT is a very effective treatment for children and adolescents with PTSD. Further work is needed to (i) demonstrate that task-shifting models utilising lay community health counsellors and peer counsellors can effectively and cost-effectively close the mental health treatment gap that exists world-wide in children and adolescents diagnosed with PTSD, but particularly within low- and middle income countries, and (ii) better understand moderators and predictors of treatment which remains a priority.
