A Randomized Trial of Cognitive Behaviour Therapy and Cognitive Therapy for Children with Posttraumatic Stress Disorder Following Single-Incident Trauma

School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Journal of Abnormal Child Psychology (Impact Factor: 3.09). 09/2011; 40(3):327-37. DOI: 10.1007/s10802-011-9566-7
Source: PubMed


The present study compared the efficacy of trauma-focused cognitive behavior therapy (CBT) with trauma-focused cognitive therapy (without exposure; CT) for children and youth with posttraumatic stress disorder (PTSD). Children and youth who had experienced single-incident trauma (N = 33; 7-17 years old) were randomly assigned to receive 9 weeks of either CBT or CT which was administered individually to children and their parents. Intent-to-treat analyses demonstrated that both interventions significantly reduced severity of PTSD, depression, and general anxiety. At posttreatment 65% of CBT and 56% of the CT group no longer met criteria for PTSD. Treatment completers showed a better response (CBT: 91%; CT: 90%), and gains were maintained at 6-month follow-up. Maternal depressive symptoms and unhelpful trauma beliefs moderated children's outcome. It is concluded that PTSD secondary to single-incident trauma can be successfully treated with trauma-focused cognitive behavioural methods and the use of exposure is not a prerequisite for good outcome.

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Available from: Reginald D.V. Nixon, Apr 16, 2015
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    • "Approximately half this sample came from Australia and the other half the United Kingdom, with data from the present report representing their 6-month posttrauma assessment (Meiser- Stedman, Smith, Glucksman, Yule, & Dalgleish, 2008; Meiser- Stedman, Yule, Smith, Glucksman, & Dalgleish, 2005; Nixon, Ellis, Nehmy, & Ball, 2010). Children and adolescents who presented for treatment at the researchers' traumatic stress clinics and were diagnosed with PTSD (N ϭ 68, age 6 –17 years) made up Sample 2, and these data were also derived evenly from Australia and the United Kingdom (Nixon et al., 2012; Smith et al., 2007). "
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    ABSTRACT: The psychometric properties of the Child PTSD Symptom Scale (CPSS) were examined in 2 samples. Sample 1 (N = 185, ages 6-17 years) consisted of children recruited from hospitals after accidental injury, assault, and road traffic trauma, and assessed 6 months posttrauma. Sample 2 (N = 68, ages 6-17 years) comprised treatment-seeking children who had experienced diverse traumas. In both samples psychometric properties were generally good to very good (internal reliability for total CPSS scores = .83 and .90, respectively). The point-biserial correlation of the CPSS with posttraumatic stress disorder (PTSD) diagnosis derived from structured clinical interview was .51, and children diagnosed with PTSD reported significantly higher symptoms than non-PTSD children. The CPSS demonstrated applicability to be used as a diagnostic measure, demonstrating sensitivity of 84% and specificity of 72%. The performance of the CPSS Symptom Severity Scale to accurately identify PTSD at varying cutoffs is reported in both samples, with a score of 16 or above suggested as a revised cutoff. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Full-text · Article · Jul 2013 · Psychological Assessment
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    • "To date, very few treatment studies in this area have included a parental treatment component, with those that have, concluding that a combined parent and child trauma-focused CBT condition results in the best outcomes for children. Although the recent pilot studies conducted by Smith et al. (2007) and Nixon et al., (2012) did include some degree of parental involvement, this was not quantified and did not appear to be administered in a standardized fashion. Based on the literature from the related field of child anxiety disorders, it may be concluded that parental involvement appears to confer some additional benefit, though the effect may be small in size. "
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    ABSTRACT: Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome research in this area. This review focuses on two key issues within the child PTSD literature-namely the role of parents in treatment and the timing of intervention. The issue of parental involvement in the treatment of child PTSD is a question that is increasingly being recognized as important. In addition, the need to find a balance between providing early intervention to at risk youth while avoiding providing treatment to those youth who will recover spontaneously has yet to be addressed. This paper outlines the rationale for and the development of a trauma-focused CBT protocol with separate parent and child programs, for use with children and adolescents experiencing PTSD following an accidental injury. The protocol is embedded within an indicated intervention framework, allowing for the early identification of youth at risk within a medical setting. Two case studies are presented in order to illustrate key issues raised in the review, implementation of the interventions, and the challenges involved.
    Full-text · Article · Sep 2012 · Clinical Child and Family Psychology Review
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    ABSTRACT: OBJECTIVE To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later. DESIGN Prospective, randomized, longitudinal study. SETTING Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey. PARTICIPANTS Two hundred children with persistent functional abdominal pain and their parents. INTERVENTIONS A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention. MAIN OUTCOME MEASURES Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data. RESULTS Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13). CONCLUSIONS Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain. TRIAL REGISTRATION Identifier: NCT00494260.
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