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EMDR With Children and Adolescents After Single-Incident Trauma An Intervention Study
Journal of EMDR Practice & Research
Abstract
This study used a naturalistic design to investigate the effectiveness of eye movement desensitization and reprocessing (EMDR) with children and adolescents who were exposed to single-incident trauma. Participants were 36 children and adolescents ranging in age from 1 year 9 months to 18 years 1 month who were referred consecutively to the author's private practice. Assessments were conducted at intake, post-waitlist/pretreatment, and at follow up. EMDR treatment resulted in significant improvement (Cohen's d = 1.87). Follow-ups after 6 months revealed stable, further slight improvement. It was shown that children younger than 4 years of age can be treated using EMDR and that the group of preschool children had the same benefit from the treatment as the school-age children.
... However, only two non-controlled studies examined the treatment efficacy of EMDR in young children. Hensel [19] conducted a study (N = 32, age range 1.9-18 years old) to compare the effectiveness of EMDR in 18 young children (< 8 years old) versus 14 older children who were exposed to single-incident trauma. He found no evidence of a differential treatment effect in younger and older children, suggesting that EMDR may be equally effective for different age groups in reducing parent-reported PTSD symptoms post-treatment and at 6-month follow-up. ...
... The second study that focused on EMDR in young children is a pilot study by Lempertz et al. [20], comparing pre and post intervention PTSD symptoms (15 items from the Child Behavior Check List) to assess EMDR-based group therapy for traumatized refugee preschoolers (N = 10, age range 4-6 years old). This study has the same limitations as the study by Hensel [19]. Additionally, attrition was high (40% for the parents, 20% for the teachers) and no follow-up measurement was included. ...
... However, replicating the experiment nine times in a randomized multiple baseline design, to differentiate between time effects and effects of the intervention, increases the power considerably [21]. Since participants enrolled at different dates during 1 year, Randomly allocated start of the intervention (day [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Baseline phase (at least 10 days) ...
To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.
... Die meisten Interventionen und Studien stammten aus den USA (k = 8). Aus dem deutschsprachigen Raum konnten eine EMDR-Intervention aus Deutschland (Hensel, 2009) und zwei frühzeitige psychologische Interventionen aus der Schweiz Kramer & Landolt, 2014) eingeschlossen werden. ...
... war diese teilweise schwer ersichtlich. Während einige Manuale lediglich fundamentale Elemente jeder Einheit beinhalteten (Graham-Bermann et al., 2015), wurden andere Interventionen durch stringentere Manuale mit konkreten Arbeitsschritten geleitet (Kramer & Landolt, 2014;Hensel, 2009;Liebermann et al., 2005Liebermann et al., , 2006Cohen & Mannarino, 1996). Außerdem waren zwei Interventionen bereits in bestehenden (Familien-)Hilfsprogrammen integriert oder stellten erweiterte Bausteine dieser dar (Love & Fox, 2019;Southwell, 2016). ...
... Obwohl die Messinstrumente aller Studien standardisiert waren und über gute psychometrische Eigenschaften verfügten, waren diese teilweise für die Altersgruppe, welche in den Studien untersucht wurde, noch nicht validiert. So wurde bei Hensel (2009) ...
Traumatic exposure can lead to symptoms of posttraumatic stress disorder or further psychosocial consequences in preschool children. The aim of this review is to systematically analyze international evidence-based interventions for young children (0 – 6 years old) exposed to traumatic events. We systematically searched the literature in the data bases PsycInfo, Psyndex, Web of Science as well as registers for evaluation studies. In a next step, we analyzed the efficacy of interventions to reduce symptoms in children and the quality of the included studies. The systematic review identified 13 interventions for treatment of young children exposed to traumatic events. Quality of evaluation studies was moderate to low. Effective interventions were based on heterogeneous methods – trauma-focused cognitive behavioral therapy, EMDR as well as expressive methods. The findings show that less cognitive challenging methods as well as trauma-focused cognitive behavior therapy can successfully reduce symptoms of young children exposed to traumatic events. Furthermore, interventions that involved parents in the therapeutic process had good efficacy. The results of the literature review emphasize the necessity of further high-quality studies of the efficacy and effectiveness of trauma treatments for preschool children.
... During the second decade of EMDR, 13 studies of EMDR in individual psychotherapy with children and adolescents were presented in journal publications using single case designs, controlled studies, comparative studies, and qualitative studies (Adler-Tapia & Settle, 2009;Ahmad et al., 2007;Chemtob, et al., 2002;de Roos & de Jongh, 2008;de Roos et al., 2009;Fernandez, 2007;Hensel, 2009;Jaberghaderi et al., 2004;Oras, Cancela De Ezpeleta, & Ahmad, 2004;Rubin et al., 2001;Soberman, Greenwald, & Rule, 2002;Tufnell, 2005;Wanders, Serra, & de Jongh, 2008). One additional book was published on the use of EMDR with children (Adler-Tapia & Settle, 2008). ...
... The research design could be a single case design, clinical trial, or qualitative study. Nineteen published studies met these criteria (Adler-Tapia & Settle 2009;Ahmad et al., 2007;Chemtob et al., 2002;Cocco & Sharpe, 1993;de Roos & de Jongh, 2008;de Roos et al., 2009;Fernandez, 2007;Greenwald, 1994;Hensel, 2009;Jaberghaderi et al., 2004;Muris et al., 1997;Muris et al., 1998;Oras et al.,2004;Pellicer, 1993;Puffer et al., 1998;Rubin, et al., 2001;Soberman, et al., 2002;Tufnell, 2005;Wanders et al., 2008). ...
... The use of treatment manuals (GS5) to provide manualized replicable, specifi c treatment EMDR programs to the participants was reported in nine studies (Adler-Tapia et al., 2009;Ahmad et al., 2007;Chemtob et al., 2002;de Roos et al., 2009;de Roos et al., 2008;Greenwald, 1994;Hensel, 2009;Rubin et al., 2001;Wanders et al., 2008). ...
Research on psychotherapy with children is generally underrepresented in the empirical literature. Currently, there are four randomized clinical trials (RCT) evaluating EMDR in individual psychotherapy with traumatized children—two for children diagnosed with PTSD and two for
children presenting with symptoms of posttraumatic stress. Since the first case studies of EMDR with children were published in 1993, 19 studies were identified that met the inclusion criteria for this review. The gold standards identified by Foa and Meadows (1997) to assess the methodology
of studies designed to treat trauma were applied to the research on EMDR with children. This analysis discusses the challenges to conducting research on psychotherapy with children including the debate regarding the assessment and diagnosis of PTSD in children. Recommendations for future studies
designed with methodological rigor are suggested to investigate the efficacy of EMDR with children who have experienced trauma and other mental health symptoms and diagnoses.
... Especially rare are studies of children under 5 years of age. Hensel (2009), however,showed that age-modified EMDR can be used with preschool-age children (n= 14) just as effectively as with school-age children. On average, three 50-minute sessions were conducted and resulted in significant improvements (Hensel, 2009). ...
... Hensel (2009), however,showed that age-modified EMDR can be used with preschool-age children (n= 14) just as effectively as with school-age children. On average, three 50-minute sessions were conducted and resulted in significant improvements (Hensel, 2009). Joan Lovett developed a new strategy for the use of EMDR, one that incorporates storytelling along with play therapy (Lovett, 1999). ...
... It was also found that EMDR produced these improvements in significantly fewer sessions, and it was therefore concluded that although both interventions can significantly improve the functioning of children exposed to Type I traumas, EMDR appeared to be more efficient in achieving these developments. Hensel (2009) recently showed that, following EMDR treatment, the improvements among 36 children and adolescents aged 1-18 years, all of whom had suffered a Type I trauma, not only remain stable at 6-month follow-up, but may even increase slightly. His study was also the first to recruit a sample of children younger than 4 years old, and he successfully demonstrated that children as young as 1 year and 9 months can be treated with EMDR with the same benefits as older school-age children. ...
... Although various authors have suggested that EMDR can be modified for younger children (Adler-Tapia & Settle, 2009;Ahmad & Sundelin-Wahlsten, 2008;Cocco & Sharpe, 1993;Tufnell, 2005), there has only been one study that directly investigated this factor. Hensel (2009) showed that children as young as 1 year and 9 months received the same benefits as older school-age children. ...
This article provides a summary of all the studies that have investigated eye movement desensitization and reprocessing (EMDR) treatment of traumatized children and adolescents. The effectiveness of the treatment is revealed in more than 15 studies. This article considers the differences
between Type I and Type II traumas and specifically examines the effects of EMDR on traumatic stress experienced by children and youth following Type I and Type II traumas. There is a considerable body of research evaluating EMDR treatment of Type I traumas, showing strong evidence for its
efficacy, but there are few studies that have specifically investigated EMDR treatment of Type II traumas. The effect of EMDR on various symptoms and problem areas is also examined. Recommendations are made for the clinical application of EMDR and for further research.
... For EMDR, 10 randomized controlled trials (RCTs) investigating its efficacy for children aged 4-18 years have been published (Matthijssen et al., 2020). Although children between 4 and 8 years old were included in some RCTs (De Roos et al., 2011;Meentken et al., 2020) or in a non-controlled EMDR study (Hensel, 2009, age range 1.9-18 years), data analysis was only conducted for the total sample and not for young children separately. A non-controlled study with a pre-school sample only assessed the effect of EMDR-based group therapy for 10 traumatized refugee preschoolers aged 4-6 years and found a reduction in PTSD symptoms post-intervention and at threemonth follow-up (Lempertz et al., 2020). ...
Background: Trauma exposure is common in (pre) school-aged children and around one-fifth of exposed children meet the criteria for post-traumatic stress disorder (PTSD). These symptoms can cause severe impairment to a child’s functioning and, if left untreated, have negative long-term consequences. Therefore, there is an urgent need for effective treatment to reduce the acute and long-term effects of trauma. However, currently, there are no established empirically validated treatments for PTSD in young children.
Objective: To assess the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for improving PTSD symptoms, behavioural and emotional problems in young children aged 1.5–8 years, and parenting stress in their parents.
Method: A non-concurrent, multiple baseline experimental design was combined with standardized measures across 19 mostly chronically trauma-exposed children fulfilling DSM-5 PTSD diagnosis. Primary outcomes included effects on the severity of PTSD symptoms and the rate of diagnostic remission from PTSD. Secondary outcomes included emotional and behavioural problems and parenting stress at each assessment point (baseline, pre-treatment, post-treatment, and three-month follow-up). Participants received six 1-hour EMDR sessions.
Results: At post-treatment 79% of the children no longer met the diagnostic criteria for PTSD. Further, a significant decline in the severity of PTSD symptoms, emotional and behavioural problems in children was found post-treatment (all effect sizes > 1.20), as well as a significant reduction of parenting stress in their parents (Cohen’s d effect size 0.45). All gains were maintained at the three-month follow-up, including a 79% loss of PTSD diagnosis. There was no dropout (0%) and no adverse events were reported.
Conclusions: The findings provide preliminary evidence of the safety, feasibility, and efficacy of six sessions of EMDR therapy for reducing paediatric PTSD and comorbidity in young children aged 1.5–8 years and, at the same time, decreasing parenting stress. Further trials are warranted.
Trial Registration: International Clinical Trial Registry Platform (before National Trial Register, trial search/who/int: identifier: NL8426, EMDR for young children with PTSD).
... Over the past few years, EMDR has gained support as a protocol for treating childhood trauma, especially in studies that involve young children and older children (de Roos et al., 2011;Hensel, 2009;Meentken et al., 2020Meentken et al., , 2021, but also in studies with preschool children in group practice (Lempertz et al., 2020). Salloum, explain that EMDR could have been provided as a short intervention in ...
Context: Treatments for posttraumatic stress disorder (PTSD) in young children (ages 0–6) should be adapted to their developmental characteristics: to their cognitive, social, and emotional abilities, to their specific trauma reactions and adjustments, and finally, to their degree of dependency on adults. Due to the lack of official recommendations for the treatment of PTSD in young children and considering the high prevalence of PTSD among this population, there is a growing need for targeted psychological interventions and psychotherapies for the youngest children with PTSD or posttraumatic symptoms.
Objective: To provide an update on effective psychological interventions available for the treatment of PTSD and posttraumatic symptoms in young children (under the age of 6).
Design: Systematic review of automated searches conducted using the search engines Google Scholar, Science Direct, PsycInfo, and PubMed.
Results: This review identified 17 articles reporting on the efficacy of an individual therapy for treating PTSD or posttraumatic stress symptoms in young children. The therapies identified are TF-CBT, CPP, PCIT, DET, early pathway, EMI and EMDR.
Conclusion: No treatment can currently be identified as a level-one evidence-based treatment (Well-Established Treatment) in children younger than 6 years old with PTSD or posttraumatic symptoms. Further research is essential to validate existing findings on the effectiveness of trauma-focused therapies in young children in order to establish internationally recognized recommendations.
... Ahmad and Sundelin-Wahlsten Hensel (2009) ...
La thérapie de désensibilisation et de retraitement par les mouvements oculaires (EMDR) est considérée comme un traitement fondé sur des données probantes pour le traitement du trouble stress post-traumatique (TSPT) chez l’adulte, mais il y a des différences dans la façon dont les diverses directives internationales de traitement jugent la solidité de cette base de preuves. En outre, dans des domaines autres que le TSPT de l’adulte, les principales lignes directrices diffèrent encore davantage quant à la solidité de ces preuves et quant au moment où on utilisera l’EMDR. En 2019 a été lancée la Commission de chercheurs sur l’avenir de la thérapie EMDR ( Council of Scholars : The Future of EMDR Therapy Project ). Plusieurs groupes de travail ont été créés dans cette commission, l’un d’entre eux étant centré sur la recherche. Le présent article a été produit par ce groupe de travail. Le groupe a tout d’abord conclu qu’il y avait cinq domaines pour lesquels il existait une certaine base factuelle indiquant que l’EMDR était efficace, mais que davantage de données étaient nécessaires pour augmenter la probabilité qu’elle soit prise en compte dans les futures directives internationales de traitement. Ces domaines couvraient le TSPT chez les enfants et les adolescents, les interventions EMDR précoces, les TSPT liés aux conflits armés, la dépression unipolaire et la douleur chronique. Les recherches portant sur le rapport coût-efficacité de la thérapie EMDR ont été en outre identifiées comme l’une des priorités à aborder. Nous avons employé un système de hiérarchisation pour classer et évaluer les preuves dans les différents domaines abordés. Après avoir évalué les 120 études de résultats relatives à ces domaines, nous concluons ici que pour deux d’entre eux (le TSPT chez l’enfant et l’adolescent, et les recherches portant sur les interventions EMDR précoces), la force des preuves est évaluée au niveau le plus élevé, tandis que les autres domaines obtiennent le deuxième niveau le plus élevé. Nous formulons également quelques recommandations générales pour améliorer la qualité des futures recherches sur l’efficacité de la thérapie EMDR.
... When EMDR is used on children and adolescents, the eight-phase standard protocol is adapted depending on their age and stage of development (Tinker & Wilson, 1999). Until ID:p0155 now, the effectiveness of EMDR in preschool children has been examined only in a very small number of studies worldwide (Beer, 2018, Hensel, 2009. A systematic analysis of the literature on approaches to treating traumatized refugees revealed no studies dealing with EMDR preschool refugee children (Lambert & Alhassoon, 2015). ...
Background
Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children.
Methods
These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children.
Results
PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed.
Conclusion
Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted.
... Studies have provided evidence on the effectiveness of EMDR in recovering from the effects of sexual abuse in children (Jaberghaderi, Greenwald, Rubin, Zand & Dolatabadi, 2004). EMDR is also found to be beneficial in significant improvement in children and adolescent who have experienced single-incident trauma (Hensel, 2009). On the basis of accumulating research evidence, EMDR is recommended as an effective treatment for trauma in children by American Psychiatric Association (2004) and World Health Organization (2013). ...
Sexual abuse is a serious social issue with adverse psychosocial consequences in the person who is victimized. High prevalence rate of abuse in both children and adults, no matter female or male, indicate that anyone can be a victim of this hazard. The manifestation of mental-health outcomes is diverse in nature and different across individuals and is determined by complex array of factors. This calls for the application of intervention techniques that are well-established by empirical research to be effective among victims of sexual abuse. This chapter is an attempt to discuss treatment methods established as effective and also other methods that are in use, though with limited research literature on its effectiveness or efficacy, for Posttraumatic Stress Disorder (PTSD) and other prominent and debilitating psychological and interpersonal effects of sexual abuse. Further, special issues concerning research and practice as well as future directions are outlined.
... Ahmad et al. (2007) observed a significant decrease in the children's re-experiencing symptoms as a result of their randomized controlled study conducted on two groups of children diagnosed with PTSD. In the study conducted by Hensel (2009) with 36 children and adolescents between the ages of 1-18, it was observed that there was a positive and rapid change in children as a result of six-month follow-up after EMDR. In addition, difference was not found between the responses of preschool and school-aged children to treatment in this study. ...
The purpose of the present study is to examine the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with post-traumatic stress disorder (PTSD). For this purpose, a framework was determined by using findings of the research and explanations at the conceptual level. PTSD is a mental disorder that is experienced after traumatic events, affects individuals cognitively, emotionally, and behaviorally and threatens the integrity of an individual's life. EMDR therapy is a therapy that imaginatively reveals the past or traumatic experiences of the client through eye movements and other bilateral stimuli (two-way sound or tactile stimulus), facilitates information processing processes. Whereas EMDR was initially an approach developed for adults, it was later used for children and adolescents. The fact that it gives positive results in a short time and these positive results continue in follow-up studies has increased the interest in using EMDR for children and adolescents with PTSD. The use of EMDR for children and adolescents has allowed their problems to be resolved in a timely manner and reduced PTSD symptoms. This situation has drawn attention to the importance of using EMDR in the practice of psychological counselors working in school environments, leading places where they work with children and adolescents, and where the first preventive and interventional studies are carried out. Therefore, it is considered that the use of EMDR will be functional in overcoming these negative life experiences of many students who have been directly or indirectly exposed to traumatic experiences during the COVID-19 epidemic period.
... Young (preverbal) children can develop PTSD with comparable symptoms to adults (Gaensbauer & Siegel, 1995;Egger & Angold, 2006;Coates & Gaensbauer, 2009;Fleming, 2012;Coates, 2016). Although EMDR was initially developed for adults, the technique has been found to be effective in treating adolescents, (younger) children, children with mental and physical impairments and children who do not have a formal PTSD diagnosis, but show PTSD-like symptoms (Adler-Tapia & Settle, 2009;Hensel, 2009;Kemp et al., 2010;Lichtenstein & Brager, 2017). For children the protocol to conduct EMDR is less focused on verbally induced cognition and emotions, and more on imagery and sensations to induce the traumatic memory and establish a positive memory that will replace it (Fleming, 2012). ...
Fear and anxiety disorders are prevalent in dogs. Current interventions do not resolve adequately this common behavioural problem. This urges exploration of additional, effective interventions for fear and anxiety disorders in dogs. In humans, fear and anxiety disorders such as post-traumatic stress disorder (PTSD), are effectively treated by Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a non-invasive and non-pharmacological intervention that involves bilateral sensory stimulation. Here we argue that EMDR might be applied as an intervention for fear and anxiety disorders in dogs, adding to the presently available interventions for the field of Clinical Ethology. Particularly nonverbal EMDR protocols used in preverbal children can be applied and the setup can be adapted for dogs. Future research should focus on the development of nonverbal EMDR protocols including proper controls, and on clinical effectiveness of such EMDR protocols for dogs. Apart from behavioural measures, psychophysiological variables should be incorporated as well.
... Young (preverbal) children can develop PTSD with comparable symptoms to adults (Gaensbauer & Siegel, 1995;Egger & Angold, 2006;Coates & Gaensbauer, 2009;Fleming, 2012;Coates, 2016). Although EMDR was initially developed for adults, the technique has been found to be effective in treating adolescents, (younger) children, children with mental and physical impairments and children who do not have a formal PTSD diagnosis, but show PTSD-like symptoms (Adler-Tapia & Settle, 2009;Hensel, 2009;Kemp et al., 2010;Lichtenstein & Brager, 2017). For children the protocol to conduct EMDR is less focused on verbally induced cognition and emotions, and more on imagery and sensations to induce the traumatic memory and establish a positive memory that will replace it (Fleming, 2012). ...
Fear and anxiety disorders are prevalent in dogs. These disorders are not adequately resolved by current interventions, which urges exploration of additional interventions. In humans, fear and anxiety disorders such as post-traumatic stress disorder (PTSD), are effectively treated by Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a non-invasive and non-pharmacological intervention involving bilateral sensory stimulation while memorizing the traumatic event, resulting in decreased emotionality of the memory. We argue EMDR might be applied as an intervention for fear and anxiety disorders in dogs, adding to the currently available interventions for the field of Clinical Ethology. Particularly nonverbal EMDR protocols used in preverbal children can be applied and the setup can be adapted for dogs. Future research should focus on the development of nonverbal EMDR protocols including proper controls, and on clinical effectiveness of such EMDR protocols for dogs. Apart from behavioural measures, psychophysiological variables should be incorporated as well.
... Özgül fobiler travmatik deneyimlerin neticesinde ortaya çıkabildikleri gibi, aynı zamanda bireylerin korktukları nesne ile bağlantılı uyaranlara maruz kalmaları da başlı başına travmatik bir deneyim olabilmektedir (Demirci ve ark., 2015). Bu nedenle, travma belirtilerinde etkili bir tedavi olarak ortaya konan EMDR yönteminin fobiler için de kullanılabileceği belirtilmektedir (Demirci ve ark., 2015;Hensel, 2009). Ancak çocuklarda örümcek fobisinin tedavisinde, EMDR yöntemi ile gerçek hayatta maruz bırakma yöntemlerinin etkililiğinin karşılaştırıldığı bir çalışmada; maruz bırakma yöntemi EMDR tedavisine kıyasla örümcekten kaçınma davranışında daha fazla azalma sağlamıştır (Muris ve ark., 1997). ...
EMDR in children and adolescents: A review about its effectiveness in the treatment of post-traumatic stress disorder EMDR is a treatment method that combines the techniques of many different psychotherapy ap-proaches and provides a multifaceted intervention to the adverse impacts of traumatic experiences by matching mental information processing and physical stimulation. Although EMDR was ini-tially developed to be administered to adults individually, it has become a wide-ranging treatment application with the use of children, adolescents, and group studies. This paper aimed to review the theoretical framework and past studies on the use of EMDR in the treatment of children with traumatic experiences and post-traumatic stress symptoms. Traumatic experiences during child-hood can lead to many psychological disorders and behavioral problems in adulthood and disrupt a child's normal development process. EMDR studies with children have shown that it is an effec-tive method in reducing PTSD symptoms and supporting psychological well-being, even in short-term applications. Therefore, it has been thought that it may be beneficial to extend the use of EMDR for the treatment of trauma in children. From the perspective of individual and social mental health, the EMDR method is considered as a valid, effective, and efficient treatment method in terms of minimizing the negative experiences of children and being a protective inter-vention for their future lives.
... Differences between these two studies could however also be because of the higher number of EMDR sessions (12) in the study by Farkas et al. (2008) or the small sample size in the Jaberghaderi et al. (2004) study. EMDR was only used with adolescent CSA victims, even though previous research showed that EMDR with age-appropriate adaptations can be just as effective with pre-school children as with school-aged children and adolescents (Hensel, 2009). ...
Childhood sexual abuse (CSA) can have major implications for child mental health on the short-term, but also for developmental outcomes later in life, especially when left untreated. Yet, there is no consensus about best practices in psychotherapy for child and adolescent CSA-victims. In this study, we therefore systematically reviewed existing literature on the effectiveness of different types of psychotherapy, as well as specific treatment components, for improving CSA-victims’ mental-health outcomes. We searched databases (PsycINFO, PubMed, Scopus, Web of Science) for randomized controlled trials (RCTs) examining effectiveness of psychotherapy for child or adolescent victims of CSA. This search yielded 32 RCTs testing effectiveness of cognitive behavioral therapy (with and without adaptation to CSA), trauma-focused cognitive behavioral therapy, group therapy, prolonged-exposure treatment, eye movement desensitization and reprocessing, and play therapy. For each type of psychotherapy, some studies demonstrated evidence for its effectiveness in improving CSA-victims’ mental health, but other studies did not. We also found some evidence that certain therapy approaches might be specifically effective for specific groups of clients, i.e., TF-CBT for highly vulnerable and traumatized clients, group therapy for girls, and briefer approaches for younger children. Regarding treatment components, trauma narration and pharmacotherapy appeared to enhance effectiveness of psychotherapy. A thorough comparison between studies was difficult, because control-groups and measured outcomes differed greatly. Therefore, the field needs more rigorous large-scale RCTs, with long-term follow-up and more uniformity in outcome measures, investigating the effectiveness of specific treatment components, to be able to draw evidence-based conclusions about best practices for CSA-victims.
... When EMDR is used on children and adolescents, the eight-phase standard protocol is adapted depending on their age and stage of development (Tinker & Wilson, 1999). Until ID:p0155 now, the effectiveness of EMDR in preschool children has been examined only in a very small number of studies worldwide (Beer, 2018, Hensel, 2009. A systematic analysis of the literature on approaches to treating traumatized refugees revealed no studies dealing with EMDR preschool refugee children (Lambert & Alhassoon, 2015). ...
Cross culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensiti-zation and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4-6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2-4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 1½-5), pre-and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers' perspective , the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.
... Although EMDR therapy is approved for PTSD in adults (World Health Organisation, 2013), there is limited knowledge about its efficacy in young people. Several studies show that EMDR is an effective treatment method for children and adolescents with PTSD (Diehle, Opmeer, Boer, Mannarino, & Lindauer, 2015;Hensel, 2009;Kemp, Drummond, & McDermott, 2010;Mevissen, Didden, Korzilius, & de Jongh, 2017). A meta-analysis and a systematic review also suggest that EMDR therapy is effective in reducing symptoms reported both by the children and parents in children with PTSD and other related difficulties like depressive and anxious symptoms (Chen et al., 2018;Moreno-Alc azar et al., 2017). ...
Objectives: The purpose of this study is to explore whether eye movement desensitisation and reprocessing (EMDR) is an effective therapy and to investigate whether EMDR affects anxiety levels for children and adolescents.
Methods: We conducted this study with 30 clients. The clients completed self-administered questionnaires Child Post-Traumatic Stress Reaction Index Scale and The State-Trait Anxiety Inventory. The questionnaires were conducted before the therapy and 6 weeks after the completion of the therapy.
Results: Nineteen clients (63%) had only one traumatic event, but 11 clients (37%) had more than one traumatic event. While the mean score on the PTSD symptom scale was 60 (±8.7), this rate decreased to 24 (±10.1), whereas the mean STAI-T scale was 59 (±8.9) before treatment and 41 (±11.5) after treatment. We found a statistically significant difference between symptom scores as quantified by both questionnaires before and after EMDR therapy (p < .05).
Conclusions: As a result, we have shown that EMDR is an effective method for children and adolescents with PTSD in terms of both post-traumatic and anxiety symptom levels; however, we recommend a larger sample size with a control group to further establish the effectiveness of EMDR therapy in children.
• KEY POINTS
• PTSD is a common disorder in children and adolescents.
• Additional psychiatric disorders such as anxiety and depression are common in children and adolescents with PTSD.
• In PTSD cases applying for psychiatric treatment, trauma associated with sexual abuse is more pronounced and complex.
• EMDR is an effective therapy in children and adolescents as well as in adults.
• There is a statistically significant decrease at anxiety and PTSD symptom scores as quantified by questionnaires in patients with PTSD after EMDR therapy.
... With regard to predictors of treatment effect of EMDR in children, the literature is scarce. Hensel (2009) found that increasing age, higher pretreatment severity of PTSS and longer time since the traumatic event positively influenced the treatment effect of EMDR for children and adolescents with diverse single-incident trauma. Moreno-Alcázar et al. (2017) suggested that gender might play a role in predicting treatment effect, stating that the effect size for EMDR was nearly zero in studies that included mostly boys. ...
Background: Three in every 10 children and adolescents admitted to a hospital or undergoing medical treatment develop subthreshold symptoms of posttraumatic stress disorder (PTSD). When untreated, subthreshold PTSD can have a serious impact on psychosocial functioning, quality of life and long-term psychopathology. However, research investigating subthreshold PTSD and its treatment following paediatric medical interventions and/or hospitalization is scarce. Eye Movement Desensitization and Reprocessing (EMDR) is a fast and non-invasive psychosocial treatment for posttraumatic stress complaints. However, the effectiveness of EMDR in paediatric patients with subthreshold PTSD has not previously been systematically investigated.
Objective: Describing the design of a randomized controlled trial (RCT) set up to evaluate the effectiveness of EMDR in children with subthreshold PTSD after hospitalization.
Method: Children aged 4–15 years who have undergone a one-time (trauma type I) or repeated (trauma type II) hospitalization up to five years ago will be included. Participating children will be first screened with a standardized questionnaire for PTSD-symptoms. Subsequently, children with subthreshold PTSD will be randomly assigned to (1) approximately six sessions of standardized EMDR or (2) care as usual (CAU). Children with full diagnostic PTSD do not participate in the RCT, but are referred for direct treatment. Follow-up measurements will take place after eight weeks and eight months.
Discussion: Considering the scarce evidence for the effectiveness of EMDR in children with medically related trauma, clinicans, researchers and children treated in hospitals can benefit from this study. Potential strengths and limitations of this study are discussed.
Trial Registration: Netherlands Trial Register NTR5801
... With a particular focus on specific presenting issues (listed below), the clinical research team found minimal evidence as it relates to short-term therapy approaches. Three controlled trials indicated support for using EMDR/image exposure for traumatic stress (Ahmad, Larsson, & Sundelin-Wahlsten, 2007;Berkowitz, Stover, & Marans, 2011;Chemtob, Nakashima, & Carlson, 2002;Hensel, 2009), and for using exposure for specific phobias (Andersson et al., 2013;Ollendick et al., 2009;Öst, Svensson, Hellström, & Lindwall, 2001). Two controlled trials were noted for a number of interventions for anger, including the age group of transitional-aged youth (Snyder, Kymissis, & Kessler, 1999;Wanders, Serra, & de Jongh, 2008). ...
Although effective treatments exist for transitional-aged youth presenting with dysphoria, treatment protocols are often much longer than the typical length of psychotherapy that clients receive. The current authors proposed a three-session treatment protocol with an emphasis on the process of externalizing and shifting problem-focused identities using concrete metaphors. Trained clinicians from four post-secondary student counselling centers in Ontario, Canada, implemented EMT to fifty (50) participants, who presented with anxiety and/or depression. Participating clients completed two self-report measures of dysphoria (DASS-21, STAI) before beginning, and at the end of treatment. The results were then compared to a small sample of participants who engaged in Treatment as Usual (TAU). Differences on the DASS-21 between baseline and post-intervention revealed significant reductions in self-reported stress, depression, and anxiety. Additionally, data showed a significant and large reduction in trait anxiety on the STAI. No statistical significant differences were found between EMT and TAU, with limitations discussed.
... Several research studies have shown that EMDR is efficacious in the treatment of children who developed symptoms of posttraumatic stress following large-T traumatic events (see Adler-Tapia & Settle, 2009;Fleming, 2012;Rodenburg, Benjamin, de Roos, Meijer, & Stams, 2009). The types of traumas include abuse, accidents (e.g., Kemp, Drummond, & McDermott, 2010), disasters (e.g., de Roos et al., 2011), and single incidents (e.g., Hensel, 2009). There is also a case series with four children, in which EMDR was effective in eliminating trauma-related choking phobia (de Roos & de Jongh, 2008). ...
This case study reports the use of eye movement desensitization and reprocessing (EMDR) and family therapy for a 10-year-old boy with severe separation anxiety disorder (SAD). It illustrates how the use of the standard EMDR protocol for the boy and his mother combined with family therapy,
led to symptom alleviation and restored appropriate developmental functioning as evidenced by behavioral outcomes. The participant initially presented with severe anxiety about separating from his mother, several years after his parents went through a painful divorce. Treatment focused on
processing the boy's disturbing memories of past nontraumatic events in 14 EMDR sessions; his mother received 4 EMDR sessions to address her perceived marital failure and guilt about the effects of her ensuing depression on him. Eight family therapy sessions were used to help the family spend
positive time together. Prior to treatment, the child had been unable to play outside, checked on his mother frequently, and could not attend activities without her. At the end of treatment, he was able to play with friends outside, ride his bike around town, engage in after school activities,
and sleep over at his friends' houses. Gains were maintained at 6-month follow-up. Treatment did not include instruction in parenting skills or psychoeducation for the mother, or any exposure therapy for the child.
... Si divers auteurs ont suggéré qu'on pouvait modifier l'EMDR pour les enfants plus jeunes (Adler-Tapia & Settle, 2009 ;Ahmad & Sundelin-Wahlsten, 2008 ;Cocco & Sharpe, 1993 ;Tufnell, 2005), une seule étude a abordé directement ce facteur. Hensel (2009) a montré que des enfants d'un an et neuf mois tiraient les mêmes bénéfices du traitement que des enfants d'âge scolaire. ...
On trouvera ici un résumé de tous les articles qui ont étudié le traitement par l'EMDR d'enfants et d'adolescents traumatisés. L'efficacité du traitement est établie par plus de quinze études. Le présent article examine
les effets de l'EMDR sur le stress traumatique d'enfants et d'adolescents après des traumas de type I et II. Si un nombre considérable d'études évaluent le traitement des traumas de type I par l'EMDR, apportant des preuves solides de son efficacité, rares
sont celles qui ont investigué spécifiquement le traitement EMDR des traumas de type II. L'auteur examine aussi l'effet de l'EMDR sur divers symptômes et difficultés. Elle donne enfin des recommandations pour l'application clinique de l'EMDR, et pour des recherches
futures.
... A number of studies have found EMDR decreases post traumatic stress related symptoms in adolescents (Ahmad et al., 2007;Chemtomb et al., 2002;Fernandez, 2007, Greenwald, 1994Hensel, 2009;Oras et al., 2004;Tufnell, 2005;Adler Nevo and Manassis 2005). It would be presumed that since CSA survivors demonstrated such stress related symptoms, studies would have examined how EMDR benefited youth who have experienced CSA. ...
Abstract
Child sexual abuse (CSA) is frequent, with rates for
significant abuse estimated at 15‐20% of the female
population and 8‐10% of the male population. Such CSA
frequently leads to significant short‐term and long‐term
sequalae including a multitude of psychiatric conditions
such as post‐traumatic stress disorder, anxiety disorder, and
depression. However, treatment of CSA remains uncertain,
with even the most widely recommended types of treatment,
cognitive behavioural therapy (CBT) and trauma‐focused
cognitive behavioural therapy (TF‐CBT), having not always
been found to be statistically beneficial in studies of adult
survivors. Furthermore, treatment of children and youth has
been even less well researched. Many types of treatment
have been recommended, including CBT, TF‐CBT, eye
movement desensitization and reprocessing (EMDR), play
therapy, art therapy, and pet therapy. The aim of this review
is to examine the various treatments recommended for CSA
to date, and determine whether one specific treatment or a
combination of treatments may be the most appropriate
therapeutic approach for child and youth victims of CSA.
... No follow-up was undertaken. Hensel (2009) reported on the treatment outcome of 36 children aged 1 year 9 months to 18 years 1 month who had each been exposed to a single-incident traumatic event. The criterion measure was the PROPS (Greenwald & Rubin, 1999), a parent report instrument. ...
Eye movement desensitization and reprocessing (EMDR) was used with 11 children who developed posttraumatic stress disorder (PTSD) after road traffic accidents. All improved such that none met criteria for PTSD on standardized assessments after an average of only 2.4 sessions. Significant
improvements in PTSD, anxiety, and depression were found both immediately after treatment and at follow-up. Attentional, memory, and attributional processes associated with PTSD were assessed and their relationship to therapeutic change examined. Treatment was associated with a significant
trauma-specific reduction in attentional bias on the modified Stroop task, with results apparent both immediately after therapy and at follow-up.
In the first 6 years of life, children undergo rapid emotional, cognitive, and social development which influences the way they experience traumatic events and cope with them. Symptoms of posttraumatic stress disorder (PTSD) manifest differently at this early age compared to later childhood and adolescence. Consequently, it is crucial to adopt an age-appropriate approach to identify and treat PTSD during early childhood. This chapter provides an overview of symptom manifestation, diagnostic criteria for PTSD, assessment tools, and treatment approaches for infants and young children. Promising treatments for trauma-related disorders are available, including age-appropriate adaptations of treatments recommended for older populations, such as trauma-focused cognitive behavioural therapy. Additionally, there are interventions specifically developed to address the unique needs of young children, such as dyadic attachment-based interventions. While there are growing efforts to understand, assess, and treat trauma in young children, we still know little about infants and toddlers. Further research is needed in this area to improve our understanding of trauma for the youngest children and develop effective interventions.
Eye movement desensitization and reprocessing (EMDR) is an evidence-based psychotherapy approach for the treatment of adults, adolescents, and children suffering from symptoms and problems related to single-incident or complex trauma. EMDR therapy is a three-pronged protocol that brings past trauma to adaptive resolution, eliminates present-day triggers, and develops positive templates for future functioning. It involves eight standardized phases that include the application of bilateral eye movements or other forms of bilateral stimulation. It can address a wide range of experiences, including single incident traumas, trauma-related to war or natural disasters, abuse, and adverse experiences such as rejection, marginalization, and discrimination. Because it is a client-centered approach and can be integrated with other therapies as needed, EMDR can be adapted to engage children and adolescents, including children with special challenges such as complex trauma, high-risk behaviors, autism, intellectual disability, and family system issues. Possible adaptations include simplified instructions, playful methods of bilateral stimulation, expression of thoughts and feelings through drawing or sand tray, use of a trauma narrative, and integration with family therapy.
ZET Amaç: Bu çalışmanın amacı özgül fobi tedavisinde katılımcılara EMDR (Eye Movement Desensitization and Reprocessing) terapisi uygulaması ve etkisinin deneysel olarak araştırılmasıdır. Materyal ve Metot: Çalışma deneysel desenlerden deneme öncesi deneysel desen tekniği ile gerçekleştirilmiş olup, çalışmanın ön-test aşamasına 18-65 yaş arasında ve özgül fobi için DSM-5 ölçütlerini karşılayan 25'i (%83,3) kadın, 5'i (%16,7) erkek olmak üzere toplam 30 vaka alınmıştır. Araştırmanın son-test aşamasında 4 kadın katılımcı değerlendirmeye katılmadığı için, son-test çalışması 21 kadın, 5 erkek olmak üzere 26 vaka ile yapılmıştır. Araştırma verileri özgül fobi değerlendirmesi için DSM-5 Özgül Fobi Ölçeği, Durumluk ve Sürekli Kaygı Ölçeği ve Demografik Bilgi Formu ile toplanmış, bu aşamadan sonra tüm katılımcılara 8 seans EMDR terapisi uygulanmıştır. Bulgular: Araştırma sonucunda katılımcıların nesne veya durum karşısında duyulan kaygı ve korku duygusu (z=4,46; p<0,05) ile nesne veya durumdan kaçınma davranışı (z=3,74; p<0,05), durumluk kaygı (z=3,158; p<0,05) ve sürekli kaygı (z=3,158; p<0,05) sıralama ortalamaları arasındaki farklılık anlamlı bulunmuştur. Ayrıca katılımcıların algıladıkları nesne veya durum karşısında duyulan kaygı ve korku duygusu düzeylerinin kadın katılımcılar için anlamlı derecede yüksek olduğu saptanırken (z=6,64; p>0,05); medeni durum, çalışma durumu, daha önce psikolojik yardım alma durumu arasında bir fark bulunmamıştır. Sonuç: EMDR uygulamasının katılımcıların özgül fobi algısı ile durumluk ve sürekli kaygı düzeyini düşürdüğü ve EMDR'nin bireylerin gerek özgül fobi algısı ve gerekse durumluk ve sürekli kaygı algısı üzerinde olumlu bir etkiye sahip olduğu belirlenmiştir.
The author was fortunate to experience and help shape the development of the trauma approach with children and adolescents from the very beginning. This brought a great joy for and in the therapeutic work, an intense impulse for one's own inner work, an intellectual pleasure in working out new concepts andmany wonderful encounters in all the workshops with people who had the welfare of children so much at heart. He is deeply convinced that the future belongs to this approach because it is effective and counteracts the "privatization of stress" (Fisher, 2013).
İzlediği filmden sonra gerçeklikten kopuş hali yaşadığını bildiren danışana EMDR terapisi uygulanmıştır. Danışanın yaşadığı gerçeklikten kopuş hali depersonalizasyon ve derealizasyon olarak adlandırılmaktadır. Depersonalizasyon, bireyin kendisine yabancılaşması olarak tanımlanmaktadır. Derealizasyon ise rüyadaymış gibi bir deneyimi içeren ruhsal dağılma durumudur. EMDR; bilişsel ve psikodinamik terapide kullanılan unsurları bir araya getiren bir terapi yöntemidir. EMDR terapisi depersonalizasyon ve derealizasyon için kullanılabilen bir terapi modelidir. Bu araştırmada EMDR terapisinin derealizasyon ve depersonalizasyon üzerindeki etkinliği gözlemlenmesi amaçlanmıştır. Bu amaç doğrultusunda hazırlanan çalışma 12 seanslık EMDR terapi seanslarını içermektedir. Vaka EMDR’nin standart protokolüne göre ele alınmıştır. Danışan depersonalizasyon ve derealizasyon yaşamaya başladığından 3 ay sonra terapi başlangıcı olmuştur. Danışanın geçmişine bakıldığında aile kaynaklı olumsuz yaşam deneyimleri mevcuttur. Semptomların örseleyici bir deneyim ile başlaması, danışanın EMDR terapisine uygun olabileceğini düşündürmüştür. EMDR terapisine hazırlık seansı yapılmıştır. Danışanın içinde bulunduğu durumu anlatan psiko-eğitim verilmiştir. Standart protokol gereğince, olayı en son yaşadığı anıdaki kendi ile ilgili olumsuz inancı belirlenip geriye akış tekniği uygulanmıştır. Terapi hedefi ve danışanın iç-dış kaynakları belirlenmiştir. EMDR standart protokolü gereğince danışanın önce, çekirdek anı olarak adlandırılan ilk anısı EMDR yöntemi ile çalışılmıştır. İlk anı EMDR yöntemi ile çalışılıp öznel rahatsızlık derecesi ortadan kalktıktan sonra danışanın yaşadığı en kötü anı EMDR yöntemi ile çalışılmıştır. EMDR terapisi öncesi ve sonrası karşılaştırılmıştır. Semptomlar tamamıyla ortadan kalkmamış fakat belirgin azalmalar olmuştur.
Formålet med rapporten var at kortlægge den eksisterende evidens for en
række behandlingsmetoder til traumatiserede børn. Dette ud fra et identificeret behov i
forskningsmæssige- og praktiske sammenhænge, hvor der er en mangel på viden om og belysning af tilgængelige evidensbaserede behandlingsmetoder, særligt blandt førskolebørn og yngre skolebørn.
I kølvandet af en national konference om Traumefokuserede indsatser og behandling til børn, som Videnscenter for Psykotraumatologi afholdt i 2020, nedsattes derfor en arbejdsgruppe for at imødekomme behovet for mere viden om traumefokuseret behandling til yngre børn i en dansk kontekst. Denne arbejdsgruppe bestod af behandlere, praktikere og forskere fra Videnscenteret. I arbejdsgruppen har vi kortlagt en række anvendte traumefokuserede behandlingsmetoder med henblik på at undersøge deres evidens og med henblik på at kvalificere disse behandlingsmetoder i en dansk kontekst. De kortlagte behandlingsmetoder inkluderer: Compassion Focused Therapy, Eye Movement Desensitization and Reprocessing, legeterapi, narrativ eksponeringsterapi til
traumatiserede børn og unge, sandplay, Somatic Experience®, Theraplay ® og traumefokuseret kognitiv adfærdsterapi.
Med henblik på at kortlægge evidensen af hver enkelt behandlingsmetode udførte vi, på tværs af seks databaser, otte systematiske litteratursøgninger. Vi søgte i de elektroniske databaser EMBASE, Eric, Medline, PILOTS, PsycINFO og PubMed. Søgningerne havde til formål at identificere empiriske studier foretaget blandt børn under 12 år med traumerelateret symptomatologi og vanskeligheder, som er publiceret på engelsk eller skandinaviske sprog i peer-reviewede tidsskrifter. Det var et kriterie, at studierne undersøgte behandlingernes effekt, at barnets traumehistorik er beskrevet, og at de i deres assessment anvendte standardiserede mål for traumesymptomer og traumerelaterede vanskeligheder.
På tværs af litteratursøgningerne og databaserne blev 7849 studier identificeret, hvoraf 46
opfyldte kriterierne for inklusion. Vi identificerede ni empiriske studier om Eye Movement
Desensitization and Reprocessing, to om legeterapi, tre om narrativ eksponeringsterapi til
traumatiserede børn og unge og 32 om traumefokuseret kognitiv adfærdsterapi. Søgningen identificerede ingen studier, der har undersøgt de resterende behandlingsmetoder. Dette betyder, at der for disse behandlingsmetoder på nuværende tidspunkt hverken foreligger evidens for eller imod deres effekt.
Karakteriserende for de behandlingsmetoder, hvor det var muligt at identificere empiriske studier, var varierende studiedesigns, relativt kulturelt homogene samples og få længerevarende opfølgningsmålinger (maksimalt 12 mdr.). Sammenfattende indikerer studierne, at hver af de fire behandlingsmetoder har en gavnlig effekt på deltagernes symptomer og vanskeligheder. På nuværende tidspunkt er traumefokuseret kognitiv adfærdsterapi mest undersøgt, hvorfor evidensen for denne er mest solid. Hernæst følger evidensen for Eye Movement Desensitization and Reprocessing og sluttelig narrativ eksponeringsterapi til traumatiserede børn og unge, og legeterapi, hvor der foreligger præliminær evidens.
Som led på vejen mod at sikre, at traumatiserede børn og deres familier tilbydes den
evidensbaserede behandling, der egner sig bedst til netop deres udfordringer, er der derfor fortsat et stort behov for flere undersøgelser af hver enkelt behandlingsmetodes effekt. Der er behov for studier med randomiserede kontrollerede designs, multiple opfølgningsmålinger og validerede,
standardiserede mål for traumerelaterede symptomer og vanskeligheder. Dette gør sig gældende generelt for alle behandlingsmetoder, men særlig for de behandlingsmetoder, som anvendes i praksis, men som endnu ikke har forskningsmæssigt belæg for eller imod deres virkning til denne målgruppe (Compassion Focused Therapy, Sandplay, Somatic Experience®, Theraplay®) eller som har begrænset evidens for en gavnlig effekt (narrativ eksponeringsterapi til traumatiserede børn og unge samt legeterapi).
While eye movement desensitization and reprocessing (EMDR) is considered an evidence-based treatment for posttraumatic stress disorder (PTSD) in adults, there are differences as to how various international treatment guidelines judge the strength of this evidence base. Furthermore, in areas other than adult PTSD, major guidelines differ even more as to the strength of the evidence base and when to use EMDR. In 2019, the Council of Scholars: The Future of EMDR Therapy Project was initiated. Several working groups were established, with one assigned to the focus area of research. This article is a product of that working group. Firstly the group concluded that there were five areas where there was some base that EMDR was effective, but more data were needed to increase the likelihood that it would be considered in future international treatment guidelines. These areas were PTSD in children and adolescents, early EMDR interventions, combat PTSD, unipolar depression, and chronic pain. In addition, research into cost-effectiveness of EMDR therapy was identified as one of the priorities. A hierarchical system was used for classifying and rating evidence in the focus areas. After assessing the 120 outcome studies pertaining to the focus areas, we conclude that for two of the areas (i.e., PTSD in children and adolescents and EMDR early interventions research) the strength of the evidence is rated at the highest level, whereas the other areas obtain the second highest level. Some general recommendations for improving the quality of future research on the effectiveness of EMDR therapy are formulated.
Sexual abuse is a serious social issue with adverse psychosocial consequences in the person who is victimized. High prevalence rate of abuse in both children and adults, no matter female or male, indicate that anyone can be a victim of this hazard. The manifestation of mental-health outcomes is diverse in nature and different across individuals and is determined by complex array of factors. This calls for the application of intervention techniques that are well-established by empirical research to be effective among victims of sexual abuse. This chapter is an attempt to discuss treatment methods established as effective and also other methods that are in use, though with limited research literature on its effectiveness or efficacy, for Posttraumatic Stress Disorder (PTSD) and other prominent and debilitating psychological and interpersonal effects of sexual abuse. Further, special issues concerning research and practice as well as future directions are outlined.
This special issue aims to highlight the importance of exploring the empirical base for eye movement desensitization and reprocessing (EMDR) therapy with children and adolescents. Such an endeavor is set within a context where the American Psychological Association recommends trauma-focused cognitive behavioral therapy (TF-CBT) as the treatment of choice and the National Institute of Health and Care Excellence (NICE) recommends EMDR for children when TF-CBT fails to be effective. Studies in this special issue suggest otherwise and represent EMDR’s global reach over seven different countries. The studies address a range of conceptual gaps and evaluate differing EMDR protocols for individual and group delivery. Participants from preschool to adolescence experienced single event, cumulative violence, and trajectories of trauma and present with a range of trauma symptoms. Although studies with differing methodologies highlight the efficacy of EMDR with differing populations, recommendations are made for rigorous research designs in order to influence professional guidance organizations.
The rationale is synthesized for the urgency of empirical studies demonstrating the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with posttraumatic stress disorder (PTSD), symptoms of PTSD, or other trauma-related symptoms. This literature review examined 15 studies (including nine randomized clinical trials) that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured. A methodological analysis identified limitations in most studies, reducing the value of these findings. Despite these shortcomings, the methodological strength of the identified studies has increased over time. The review also summarized three meta-analyses. The need for additional rigorous research is apparent, and in order to profit from experiences of the past, the article provides some guidelines for clinicians seeking to conduct future research in their agencies.
Résumé
Introduction
Cet article traite des troubles du comportement de l’enfant, motifs fréquents de consultation dans les centres médico psychologiques de pédopsychiatrie. Ces troubles peuvent avoir des étiologies multiples.
Objectif
Nous allons décrire les différentes phases de la prise en charge d’un enfant de 5 ans, Brian, présentant un état de stress post traumatique suite au décès de son père.
Méthode
Nous utiliserons la technique EMDR afin de traiter l’état de stress post traumatique (ESPT) de Brian.
Résultats
Le travail EMDR permettra de diminuer les symptômes d’ESPT chez Brian mais nous verrons dans cet article que la prise en charge de l’enfant restera indissociable de celle de sa mère
Conclusion
Ainsi, le travail intrafamilial associé à la prise en charge individuelle est indispensable dans le suivi psychologique d’un enfant présentant un traumatisme. 2
Eye movement desensitization and reprocessing (EMDR) is an empirically validated psychotherapy approach used to treat mental health disorders stemming from trauma and other adverse life experiences in children, adolescents, and adults (Shapiro 1995/2001, Shapiro 2014a, b). EMDR therapy involves eight standardized phases to comprehensively address the clinical picture. Treatment includes targeting and implementing the standardized information processing procedures to address (1) the memories of disturbing events that are etiological to emotional, cognitive, and behavioral problems, (2) current situations that trigger dysfunction, and (3) the incorporation of needed skills for future challenges. The case conceptualization, procedures, and protocols are based on the adaptive information processing (AIP) model, which posits that memories of disturbing events may be physiologically stored in unprocessed form, leading to problems in day-to-day functioning.
z Bu makalede 1980'li yılların sonunda ortaya çıkan " Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşleme (Eye Movement Desensitization and Processing-EMDR) " yaklaşımını tanıtmak amaçlanmış, yaklaşımın kuramsal temeline ve etkililiğine ilişkin bilgiler verilmiştir. EMDR, psikolojik danışmanın parmak hareketleri kılavuzluğunda, danışanın gözlerini sistematik bir şekilde (sağa-sola) hareket ettirmesi (ya da göz hareketlerini yapmak yerine danışana el çırpma, sesli uyaranlar verme gibi ikili uyaranlar verilmesi) ve eş zamanlı olarak danışanın geçmiş yaşantılarının ya da travmatik deneyiminin imgesel olarak ortaya çıkarılmasını içerir. Böylece EMDR danışanların olumsuz yaşantılarını duygusal sağlıklarına katkıda bulunacak şekilde yeniden işlemelerine yardımcı olur. EMDR özellikle travma sonrası stres bozukluğunun tedavisinde etkililiğini kanıtlamıştır ve ülkemizde travma sonrası psikolojik danışma uygulamalarında kullanımı için araştırmalara ihtiyaç vardır.
Background:
In the past 15 years, there have been a substantial number of rigorous studies examining the effectiveness of various treatments for child trauma and posttraumatic stress disorder (PTSD). Although a number of review articles exist, many have focused on randomized controlled trials or specific treatment methodologies, both of which limit the ability to draw conclusions across studies and the statistical power to test the effect of particular treatment characteristics on treatment outcomes. The current study is a review and meta-analysis of 74 studies examining treatments for children exposed to violence.
Methods:
After reviewing the literature, we examined the relationship of a variety of treatment characteristics (e.g., group or individual treatments) and sample characteristics (e.g., average age) on treatment effect sizes.
Results:
Results indicated that individual therapies and those with exposure paradigms within a cognitive-behavioral therapy or skills-building framework show the most promise, but treatment is somewhat less effective for those with more severe symptomology and for younger children.
Conclusions:
Future treatments should consider the developmental and social contexts that may impede treatment progress for young children and consider how best to develop the effectiveness of group interventions that can be readily delivered in settings of mass trauma.
Children react to severe and acute stress in ways that are very similar to adults. Until people started to interview children directly, this was not obvious and initially it had been thought that children rarely developed post traumatic stress disorder. Now it is recognised that even pre-school children manifest symptoms of PTSD and slightly different criteria have been developed to make valid diagnoses. The point prevalence of PTSD in young persons is in the region of 1-5%, but the incidence after particularly frightening experiences can be around 15% after single trauma and over 50% in war exposed children. By age 18, a majority of children will haver experienced at least one very stressful event and so it is clear that only a minority go on to develop PTSD. Cognitive appraisals by the child predominate in determining which of them develop PTSD. Disruption of the HPA axis is involved as are genetic and family factors. Trauma Focused Cognitive Behavioural Therapies have proven to be the most effective interventions at present for both single event and multiple trauma as involved in sexual abuse and domestic violence. The latter may have longer lasting sequelae. Medication is not generally recommended for use with children with PTSD. There is limited evidence as to the best form of early intervention that will both comfort the child and lead to an early resolution of the reactions. There is general agreement that single, one-off interventions are not recommended.
Twenty children and adolescents were treated for a single traumatic memory with a single session of eye movement desensitization and reprocessing (EMDR). Treatment was delayed 1 m for half the group. Over half of the 20 participants moved from Clinical to Normal levels on the Impact of Events Scale, and all but 3 showed at least partial symptom relief on several measures at 1-3 m following a single EMDR session.
Results should be interpreted with caution, but were positive, and essentially consistent with analogous findings of EMDR with adults.
Fourteen randomly assigned Iranian girls ages 12–13 years who had been sexually abused received up to 12 sessions of CBT or EMDR treatment. Assessment of post-traumatic stress symptoms and problem behaviours was completed at pre-treatment and 2 weeks post-treatment. Both treatments showed large effect sizes on the post-traumatic symptom outcomes, and a medium effect size on the behaviour outcome, all statistically significant. A non-significant trend on self-reported post-traumatic stress symptoms favoured EMDR over CBT. Treatment efficiency was calculated by dividing change scores by number of sessions; EMDR was significantly more efficient, with large effect sizes on each outcome. Limitations include small N, single therapist for each treatment condition, no independent verification of treatment fidelity, and no long-term follow-up. These findings suggest that both CBT and EMDR can help girls to recover from the effects of sexual abuse, and that structured trauma treatments can be applied to children in Iran. Copyright © 2004 John Wiley & Sons, Ltd
The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reup-take inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up.
Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.
The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission.
This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma.
We suggest that trauma contributes to the development and persistence of conduct problems, and should be addressed. Eye movement desensitization and reprocessing (EMDR) was selected as a promising trauma treatment. Twenty-nine boys with conduct problems in residential or day treatment were randomized into standard care or standard care plus 3 trauma-focused EMDR sessions. The EMDR group showed large and significant reduction of memory-related distress, as well as trends towards reduction of post-traumatic symptoms. The EMDR group also showed large and significant reduction ofproblem behaviors by 2-month follow-up, whereas the control group showed only slight improvement. These findings provide support for EMDR's use as a trauma treatment for boys ages 10-16, as well as support for the hypothesis that effective trauma treatment can lead to reduced conduct problems in this population.
Zusammenfassung. EMDR (Eye Movement Desensitization and Reprocessing) ist ein eigenstandiges, effektives und empirisch gut belegtes Verfahren zur Behandlung chronischer posttraumatischer Belastungsstorung (PTBS) im Erwachsenenalter. Die vorliegende Arbeit gibt einen Uberblick uber den Forschungsstand des Einsatzes von EMDR bei traumatisierten Kindern und Jugendlichen. Die existierenden kontrolliert-randomisierten Studien werden zusammengefasst und in ihrer methodologischen Gute eingeschatzt. Die empirische Bewahrtheit und Effektivitat des Verfahrens wird dargestellt. Die Ergebnisse weisen - wenn auch auf schmaler empirischer Basis - darauf hin, dass EMDR bei Kindern und Jugendlichen hinsichtlich der Symptomreduktion und Effizienz (geringe Behandlungsdauer) vergleichbar wirksam ist wie bei Erwachsenen. Fragen der Integration des Verfahrens in die bestehende Versorgungsstruktur werden diskutiert.
Citation: Greenwald, R. (1994). Applying eye movement desensitization and reprocessing (EMDR) to the treatment of traumatized children: Fi ve case studies. Anxiety Disorders Practice Journal, 1, 83-97. Abstract Eye movement desensitization and reprocessing (EMDR) is a recently developed psychotherapy method which appears to increase efficiency in treating trauma-based psychological disturbance. Applications to child tr eatment were explored in five case studies of children suffering from post-traumatic symptoms several months after Hurricane Andrew. Subjects were treated with one or two EMDR sessions, until Subjective Units of Disturbance (SUDS) went to 0. Follow-up parent interviews at on e and four weeks post-treatment found all subjects returning to pre-trauma levels of func tioning, with additional improvement in some cases. Further study is recommended.
The authors report on the development and initial validation of two brief measures of children’s posttraumatic symptoms: a child self-report and a parent report. Intended applications include postdisaster screening, tracking children’s recovery in research and clinical settings, and screening for posttraumatic stress among children with various presenting problems. A sample of 206 urban and rural schoolchildren, Grades 3 through 8, and their parents, completed these measures as well as a checklist of the child’s trauma-loss history. Findings provide preliminary support for the internal consistency, test-retest reliability, content validity, and criterion validity of each measure. We recommend cautious use of the measures, and suggest additional avenues of study.
Previous studies have shown that children and adolescents exposed to traumatic experience in a disaster can suffer from high levels of post-traumatic stress. The present paper is the first a series reporting on the long-term follow-up of a group of young adults who as teenagers had survived a shipping disaster—the sinking of the “Jupiter” in Greek waters—between 5 and 8 years previously. The general methodology of the follow-up study as a whole is described, and the incidence and long-term course of Post-Traumatic Stress Disorder (PTSD). It is the first study of its kind on a relatively large, representative sample of survivors, using a standardised diagnostic interview, and comparing survivors with a community control group. Survivors of the Jupiter disaster (N= 217), and 87 young people as controls, were interviewed using the Clinician Administered PTSD Scale (CAPS). Of the 217 survivors, 111 (51.7%) had developed PTSD at some time during the follow-up period, compared with an incidence in the control group of 3.4% (N= 87). In the large majority of cases of PTSD in the survivors for whom time of onset was recorded, 90%(N= 110), onset was not delayed, being within 6 months of the disaster. About a third of those survivors who developed PTSD (30%,N= 111) recovered within a year of onset, through another third (34%,N= 111) were still suffering from the disorder at the time of follow-up, between 5 and 8 years after the disaster. Issues relating to the generalisability of these findings are discussed.
Despite the prevalence of childhood trauma, studies regarding psychotherapy for children suffering from posttraumatic stress disorder (PTSD) are scarce, especially regarding the treatment for pediatric PTSD following single-incident trauma. Treatment practices for this population rely mainly on the paradigms of therapy for adult PTSD and pediatric PTSD following sexual abuse. This review outlines the studies published in the last 10 years pertaining to the treatment of pediatric PTSD following single-incident trauma. This is done in the context of available literature on the paradigms mentioned above. Of 742 articles dealing with treatment of pediatric trauma, 10 were found relevant to the treatment of pediatric PTSD following single-incident trauma. The modalities of treatment most frequently reported in this context were cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and play therapy. As a whole, CBT studies were methodologically more rigorous, used manualized, reproducible treatment, and were group, school-based therapies. EMDR treatments were usually short and individual. Most studies showed statistically significant improvement but were still methodologically lacking. We conclude that research on the subject of treatment for pediatric PTSD following single-incident trauma constitutes a neglected part of the study of pediatric PTSD. This stands in contrast to the obvious prevalence of this type of trauma. We encourage future research that will address issues such as clarifying the role of pharmacotherapy, comparing different modes of treatment, dismantling treatment “packages,” researching developmentally sensitive treatments, conducting long-term follow-up, and comparing different PTSD populations. Depression and Anxiety 22:177–189, 2005. © 2005 Wiley-Liss, Inc.
To study the efficacy of eye movement desensitization and reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions of either EMDR or an active listening (AL) control. Factorial ANOVA interaction effects and simple main effects for outcome measure (Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale) indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the posttreatment outcome variable means of EMDR-treated participants compared favorably with nonpatient or successfully treated norm groups on all measures.
The purpose of this study was to compare the prevalence of Post Traumatic Stress Disorder and other diagnoses in three groups of abused children, sexual only (N = 127), physical only (N = 43), and BOTH (N = 34).
The children, aged 7 to 13 years, were referred to the project from several sources at Arkansas Children's Hospital and from associated local agencies. The victims and caregivers were separately administered the Diagnostic Interview for Children and Adolescents, Revised Version (DICA). Additionally, caregivers and classroom teachers completed the Child Behavior Checklist (CBCL). Characteristics of the abuse were obtained from an investigative questionnaire.
Both victims and caregivers endorsed high rates of disorders, with caregivers generally giving higher rates than children and boys having more externalizing diagnoses than girls. Children in the BOTH group had more diagnoses overall. Concordance between victims and caregivers was modest. PTSD was significantly comorbid with most affective disorders. On the CBCL, caregivers rated girls less disturbed than boys and the sexually abused only group less disturbed than the other groups. Teachers rated the boys more adversely than girls but did not see differences by abuse group. A younger age of onset of sexual abuse and coercion to maintain secrecy predicted a higher number of total diagnoses. Also, children who were physically abused by males had more diagnoses than those physically abused by females.
Children who have been both physically/sexually abused appear to be at highest risk of psychiatric disturbance. PTSD, though common (circa one-third of victims), is generally comorbid with other affective disorders.
Previous studies have shown that children and adolescents exposed to traumatic experience in a disaster can suffer from high levels of post-traumatic stress. The present paper is the first a series reporting on the long-term follow-up of a group of young adults who as teenagers had survived a shipping disaster-the sinking of the "Jupiter" in Greek waters-between 5 and 8 years previously. The general methodology of the follow-up study as a whole is described, and the incidence and long-term course of Post-Traumatic Stress Disorder (PTSD). It is the first study of its kind on a relatively large, representative sample of survivors, using a standardised diagnostic interview, and comparing survivors with a community control group. Survivors of the Jupiter disaster (N = 217), and 87 young people as controls, were interviewed using the Clinician Administered PTSD Scale (CAPS). Of the 217 survivors, 111 (51.7%) had developed PTSD at some time during the follow-up period, compared with an incidence in the control group of 3.4 % (N = 87). In the large majority of cases of PTSD in the survivors for whom time of onset was recorded, 90 % (N = 110), onset was not delayed, being within 6 months of the disaster. About a third of those survivors who developed PTSD (30%, N = 111) recovered within a year of onset, through another third (34 %, N = 111) were still suffering from the disorder at the time of follow-up, between 5 and 8 years after the disaster. Issues relating to the generalisability of these findings are discussed.
To explore several key aspects of the diagnosis and assessment for posttraumatic stress disorder (PTSD) in infants and young children.
Fifteen traumatized, clinic-referred children, and a comparison sample of 12 at-risk children, all younger than 48 months of age, were assessed with a standardized procedure and a semistructured diagnostic interview. The assessments were videotaped and reviewed by two blind raters for scoring DSM-IV PTSD criteria and an alternative set of PTSD criteria for young children. Raters were debriefed and consensus ratings were used to make best-estimate diagnoses.
The investigation of procedural validity showed that 12% of the diagnostic criteria present in these children could be detected by a clinician through direct observation or interaction with the children. The remainder of criteria were apparent only through caregiver report. Problematic aspects of parental reporting were most evident for the avoidance/numbing of responsiveness criteria. The traumatized subjects showed significantly more alternative criteria of PTSD than DSM-IV criteria of PTSD. The main sources of rater disagreement are described.
Additional sources of information would complement the multidimensional assessment of PTSD in young children. The set of alternative criteria appears to show greater criterion validity than the DSM-IV criteria.
Effective psychological intervention is needed to help children recover from disaster-related posttraumatic stress disorder (PTSD). This controlled study evaluated the effectiveness of a brief intervention for disaster-related PTSD. At one-year follow-up of a prior intervention for disaster-related symptoms, some previously treated children were still suffering significant trauma symptoms. Using a randomized lagged-groups design, we provided three sessions of Eye Movement Desensitization and Reprocessing (EMDR) treatment to 32 of these children who met clinical criteria for PTSD. The Children's Reaction Inventory (CRI) was the primary measure of the treatment's effect on PTSD symptoms. Associated symptoms were measured using the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Treatment resulted in substantial reductions in both groups' CRI scores and in significant, though more modest, reductions in RCMAS and CDI scores. Gains were maintained at six-month follow-up. Health visits to the school nurse were significantly reduced following treatment. Psychosocial intervention appears useful for children suffering disaster-related PTSD. Conducting controlled studies of children's treatment in the postdisaster environment appears feasible.
The controlled treatment outcome studies that examined the efficacy of EMDR in the treatment of posttraumatic stress disorder have yielded a range of results, with the efficacy of EMDR varying across studies. The current study sought to determine if differences in outcome were related to methodological differences. The research was reviewed to identify methodological strengths, weaknesses, and empirical findings. The relationships between effect size and methodology ratings were examined, using the Gold Standard (GS) Scale (adapted from Foa & Meadows, 1997). Results indicated a significant relationship between scores on the GS Scale and effect size, with more rigorous studies according to the GS Scale reporting larger effect sizes. There was also a significant correlation between effect size and treatment fidelity. Additional methodological components not detected by the GS Scale were identified, and suggestions were made for a Revised GS Scale. We conclude by noting that methodological rigor removes noise and thereby decreases error measurement, allowing for the more accurate detection of true treatment effects in EMDR studies.
To examine the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms and their relation to clinical impairment, to examine the requirement of meeting all DSM-IV symptom cluster criteria (i.e., criteria B, C, D), and to examine the aggregation of PTSD symptom clusters across developmental stages.
Fifty-nine children between the ages of 7 and 14 years with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents.
Data support the utility of distinguishing between the frequency and the intensity of symptoms in the investigation of the phenomenology of pediatric PTSD. Children fulfilling requirements for two symptom clusters did not differ significantly from children meeting all three cluster criteria with regard to impairment and distress. Reexperience (cluster B) showed increased aggregation with avoidance and numbing (cluster C) and hyperarousal (cluster D) in the later stages of puberty.
Frequency and intensity of symptoms may both contribute to the phenomenology of pediatric PTSD. Children with subthreshold criteria for PTSD demonstrate substantial functional impairment and distress.
Psychological treatments can reduce symptoms of post traumatic stress disorder (PTSD). Trauma focused treatments are more effective than non-trauma focused treatments. This review concerns the efficacy of psychological treatment (excluding eye movement desensitisation and reprocessing) in the treatment of PTSD. There is evidence that individual trauma focused cognitive-behavioural therapy (TFCBT), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There is some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There is insufficient evidence to show whether or not psychological treatment is harmful. Trauma focused cognitive behavioural therapy should be considered in individuals with PTSD.
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