Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-25T10:27:32.666Z Has data issue: false hasContentIssue false
  • English
  • Français

The effectiveness of psychological interventions for post-traumatic stress disorder in children, adolescents and young adults: a systematic review and meta-analysis

Published online by Cambridge University Press:  22 June 2020

Rayanne John-Baptiste Bastien Open the ORCID record for Rayanne John-Baptiste Bastien [Opens in a new window] ,
Hannah E. Jongsma ,
Melissa Kabadayi  and
Jo Billings
Rayanne John-Baptiste Bastien*
Affiliation:
Division of Psychiatry, UCL, London, England
Hannah E. Jongsma
Affiliation:
Division of Psychiatry, UCL, London, England
Melissa Kabadayi
Affiliation:
Division of Psychiatry, UCL, London, England
Jo Billings
Affiliation:
Division of Psychiatry, UCL, London, England
*
Author for correspondence: Rayanne John-Baptiste Bastien, E-mail: uctvrjo@ucl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Children and adolescents display different symptoms of post-traumatic stress disorder (PTSD) than adults. Whilst evidence for the effectiveness of psychological interventions has been synthesised for adults, this is not directly applicable to younger people. Therefore, this systematic review and meta-analysis synthesised studies investigating the effectiveness of psychological interventions for PTSD in children, adolescents and young adults. It provides an update to previous reviews investigating interventions in children and adolescents, whilst investigating young adults for the first time.

Methods

We searched published and grey literature to obtain randomised control trials assessing psychological interventions for PTSD in young people published between 2011 and 2019. Quality of studies was assessed using the Cochrane Risk of Bias tool. Data were analysed using univariate random-effects meta-analysis.

Results

From 15 373 records, 27 met criteria for inclusion, and 16 were eligible for meta-analysis. There was a medium pooled effect size for all psychological interventions (d = −0.44, 95% CI −0.68 to −0.20), as well as for Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) (d = −0.30, 95% CI −0.58 to −0.02); d = −0.46, 95% CI −0.81 to −0.12).

Conclusions

Some, but not all, psychological interventions commonly used to treat PTSD in adults were effective in children, adolescents and young adults. Interventions specifically adapted for younger people were also effective. Our results support the National Institute for Health and Care Excellence guidelines which suggest children and adolescents be offered TF-CBT as a first-line treatment because of a larger evidence base, despite EMDR being more effective.

Keywords

AdolescentsCBTchildrencognitive behavioural therapyEMDRinterventionspost-traumatic stress disorderPTSDtherapyyouth
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 10 , July 2020 , pp. 1598 - 1612
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Baggerly, J., & Exum, H. A. (2008). Counseling children after natural disasters: Guidance for family therapists. The American Journal of Family Therapy, 36(1), 79–83.CrossRefGoogle Scholar
Barron, I., Abdallah, G., & Heltne, U. (2016). Randomized control trial of teaching recovery techniques in rural occupied Palestine: Effect on adolescent dissociation. Journal of Aggression, Maltreatment and Trauma, 25(9), 955–973.CrossRefGoogle Scholar
Barron, I. G., Abdallah, G., & Smith, P. (2013). Randomized control trial of a CBT trauma recovery program in Palestian schools. Journal of Loss and Trauma, 18(4), 306–321.CrossRefGoogle Scholar
Boedhoe, P. S. W., Heymans, M. W., Schmaal, L., Abe, Y., Alonso, P., Ameis, S. H., … Twisk, J. W. R. (2018). An empirical comparison of meta- and mega- analysis with data from the ENIGMA obsessive-compulsive disorder working group. Frontiers in Neuroinformatics, 12, 102. doi: 10.3389/fninf.2018.00102CrossRefGoogle ScholarPubMed
Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused behavioural therapy for use with children and youth. Children and Youth Services Review, 34, 748–757.CrossRefGoogle Scholar
Chen, Y., Wu Shen, W., Gao, K., Lam, C. S., Chang, W. C., & Deng, H. (2014). Effectiveness RCT of a CBT intervention for youths who lost parents in the Sichuan, China, earthquake. Psychiatric Services, 65(2), 259–262.CrossRefGoogle Scholar
Church, D., Piña, O., Reategui, C., & Brooks, A. (2012). Single-Session reduction of the intensity of traumatic memories in abused adolescents after EET: A randomized controlled pilot study. Traumatology, 18(3), 73–79.CrossRefGoogle Scholar
Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence. Archives of Pediatrics and Adolescent Medicine, 165(1), 16–21.CrossRefGoogle ScholarPubMed
Copeland, W. E., Keeler, G., & Angold, A. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584.CrossRefGoogle ScholarPubMed
Curtis, A. C. (2015). Defining adolescence. Journal of Adolescent and Family Health, 7(2), Article 2. Available at: https://scholar.utc.edu/jafh/vol7/iss2/2Google Scholar
Dawson, K., Joscelyne, A., Meijer, C., Steel, Z., Silove, D., & Bryant, R. A. (2018). A controlled trial of trauma-focused therapy versus problem-solving in Islamic Children affected by civil conflict and disaster in Aceh, Indonesia. Australian and New Zealand Journal of Psychiatry, 52(3), 253–261.CrossRefGoogle ScholarPubMed
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioural therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28(1), 67–75.CrossRefGoogle ScholarPubMed
Deeks, J.J., Higgins, J.P.T., & Altman, D.G. (Eds.). (2019). Chapter 10: Analysing data and undertaking meta-analyses. In Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.), Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Retrieved from www.training.cochrane.org/handbookGoogle Scholar
De Roos, C., Greenwald, R., Den Hollander-Gijsman, M., Noorthoorn, E., Van Burren, S., & De Jongh, A. (2011). A randomized comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disaster-exposed children. European Journal of Psychotraumatology, 2, 5694. doi: 10.3402/ejpt.v2i0.5694CrossRefGoogle Scholar
De Roos, C., Van der Oord, S., Zijlstra, B., Lucassen, S., Perrin, S., Emmelkamp, P., & DE Jongh, A. (2017). Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral therapy, and wait-list in pediatric posttraumatic disorder following single-incident trauma: A multicenter randomized clinical trial. The Journal of Child Psychology and Psychiatry, 58(11), 1219–1228.CrossRefGoogle ScholarPubMed
Diehle, J., Opmeer, B. C., Boer, F., Mannarino, A. P., & Lindauer, R. J. L. (2015). Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. European Child and Adolescent Psychiatry, 24, 227–236.CrossRefGoogle ScholarPubMed
Donner, A. (1984). Approaches to sample size estimation in the design of clinical trials- a review. Statistics in Medicine, 3, 199–214.CrossRefGoogle ScholarPubMed
Dorsey, S., Pullman, M. D., Berliner, L., Koschmann, E., McKay, M., & Deblinger, E. (2014). Engaging foster parents in treatment: A randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies. Child Abuse and Neglect, 38(9), 1508–1230.CrossRefGoogle ScholarPubMed
Ehlers, A., Bisson, J., Clark, D. M., Creamer, M., Pilling, S., Richards, D., … Yule, W. (2010). Do all psychological treatments really work the same in posttraumatic stress disorder? Clinical Psychology Review, 30(2), 269–276.CrossRefGoogle ScholarPubMed
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Ehlert, U. (2013). Enduring psychobiological effects of childhood adversity. Psychoneuroendocrinology, 38(9), 1850–1857.CrossRefGoogle ScholarPubMed
Eiland, L., & Romeo, R. D. (2013). Stress and the developing adolescent brain. Neuroscience, 249, 162–171.CrossRefGoogle ScholarPubMed
Ertl, V., Pfeiffer, A., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in northern Uganda. Journal of the American Medical Association, 306, 5.Google ScholarPubMed
Foa, E. B., Chestman, K., & Gilboa-Schechtman, E. (2008). Prolonged exposure manual for children and adolescents suffering from PTSD. New York, NY: Oxford University Press.Google Scholar
Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013). Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls a randomized clinical trial. Journal of the American Medical Association, 310(24), 2650–2657.CrossRefGoogle ScholarPubMed
Foa, E. B., Riggs, D. S., & Gershuny, B. S. (1995). Arousal, numbing and intrusion. American Journal of Psychiatry, 152, 116–210.Google ScholarPubMed
Ford, J. D., Steinberg, K. L., Hawke, J., Levine, J., & Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child and Adolescent Psychology, 41(1), 27–37.CrossRefGoogle ScholarPubMed
Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression and Anxiety, 28, 750–769.CrossRefGoogle ScholarPubMed
Gauthier, L., Dalziel, S., & Gauthier, S. (1987). The benefits of group occupational therapy for patients with Parkinson's disease. The American Journal of Occupational Therapy, 41(6), 360–365.CrossRefGoogle ScholarPubMed
Gillies, D., Taylor, F., Gray, C., O'Brien, L., & D'Abrew, N. (2012). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database of Systematic Reviews, 12. Art. No.: CD006726. doi: 10.1002/14651858.CD006726.pub2Google ScholarPubMed
Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of trauma-focused cognitive behavioural therapy for children and adolescents: A randomized controlled trial in eight German mental health clinics. Psychotherapy and Psychosomatics, 85, 159–170.CrossRefGoogle ScholarPubMed
Grégoire, G., Derderian, F., & Le Lorier, J. (1995). Selecting the language of the publications included in a meta-analysis: Is there a Tower of Babel bias? Journal of Clinical Epidemiology, 48, 159–163.CrossRefGoogle Scholar
Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, L., Deppe, J., & Steil, R. (2016). Psychological treatments for symptoms of posttraumatic stress disorder in children, adolescents, and young adults: A meta-analysis. Clinical Child and Family Psychology Review, 19, 77–93.CrossRefGoogle Scholar
Harbord, R., Harris, R., & Sterne, J. (2009). Updated tests for small-study effects in meta-analyses. In Sterne, J. A. (Ed.), Meta-Analysis in stata: An updated collection from the stata journal (pp. 138–150). College Station, TX: Stata Press.Google Scholar
Heim, C., & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49, 1023–1039.CrossRefGoogle ScholarPubMed
Higgins, J. P. T., Sterne, J. A. C., Savovic, J., Page, M. J., Hróbjartsson, A., Boutron, I., … Eldrige, S. (2016). A revised tool for assessing risk of bias in randomised trials. Cochrane Database of Systematic Reviews, 10 (Suppl 1), 29–31.Google Scholar
Jawroska, N., & MacQueen, G. (2015). Adolescence as a unique developmental period. Journal of Psychiatry Neuroscience, 40(5), 291–293.Google Scholar
Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. C., … Wentzel-Larsen, T. (2014). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child and Adolescent Psychology, 43(3), 356–369.CrossRefGoogle ScholarPubMed
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., … Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100. doi: 10.1371/journal.pmed.1000100CrossRefGoogle ScholarPubMed
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012). Trauma-Focused cognitive behavioral therapy for children sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17(3), 231–241.CrossRefGoogle ScholarPubMed
Mavranezouli, I., Megnin- Viggars, O., Daly, C., Dias, S., Stockton, S., Meiser-Stedman, R., … Pilling, S. (2020). Research review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: A network meta-analysis. The Journal of Child Psychology and Psychiatry, 61(1), 18–29.CrossRefGoogle Scholar
McLaughlin, K. A., Koenen, K. C., Friedman, M. J., Ruscio, A. M., Karam, E. G., Shahly, V., … Kessler, R. C. (2015). Sub-threshold post traumatic stress disorder in the WHO World Mental Health Surveys. Biological Psychiatry, 77(4), 375–384.CrossRefGoogle Scholar
Mendes, D. D., Mello, M. F., Ventura, P., Passarela, C. M., & Mari, J. J. (2008). A systematic review on the effectiveness of cognitive behavioural therapy for posttraumatic stress disorder. International Journal of Psychiatry in Medicine, 38(3), 241–259.CrossRefGoogle ScholarPubMed
Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., … Bolton, P. A. (2015). Effectiveness of trauma-focused cognitive behavioural therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial. Journal of American Medical Asssociation Pediatrics, 169(8), 761–769.Google ScholarPubMed
National Institute for Care and Excellence. (2018). Psychological interventions for prevention and treatment of children and young people. National Institute for Care and ExcellenceRetrieved from https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adultsGoogle Scholar
Nevo, G. A., & Manassis, K. (2011). An adaptation of prolonged exposure therapy for pediatric single incident trauma: A case series. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20(2), 127–133.Google Scholar
Nixon, R. D. V., Sterk, J., & Pearce, A. (2012). A randomized trial of cognitive behavioural therapy and cognitive therapy for children with posttraumatic stress disorder following single-incident trauma. Journal of Abnormal Child Psychology, 40, 327–337.CrossRefGoogle ScholarPubMed
Nixon, R. D. V., Sterk, J., Pearce, A., & Weber, N. (2017). A randomized trial of cognitive behavior therapy for children with posttraumatic stress following single-incident trauma: Predictors and outcome at 1-year follow-Up. Psychological Trauma: Theory, Research, Practice and Policy, 9(4), 471–478.CrossRefGoogle ScholarPubMed
O'Dougherty Wright, M., Crawford, E., & Del Castillo, D. (2009). Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas. Child Abuse and Neglect, 33(1), 59–68.CrossRefGoogle Scholar
Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal Clinical Nursing, 17(5), 677–687.CrossRefGoogle ScholarPubMed
Pfefferbaum, A., Mathalon, D. H., Sullivan, E. V., Rawles, J. M., Zipursky, R. B., & Lim, K. O. (1994). A quantitative magnetic resonance imaging study of changes in brain morphology from infancy to late adulthood. Journal of the American Medical Association Neurology, 51(9), 874–887.Google ScholarPubMed
Pfeiffer, E., Sachser, C., Rohlmann, F., & Goldbeck, L. (2018). Effectiveness of a trauma-focused group intervention for young refugees: A randomized controlled trial. The Journal of Child Psychology and Psychiatry, 59(11), 1171–1179.CrossRefGoogle ScholarPubMed
Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., & Pariwatcharakul, P. (2015). Randomized controlled trial of group cognitive behavioural therapy for post-traumatic stress disorder in children and adolescents exposed to tsunami in Thailand. Behavioural and Cognitive Psychotherapy, 43, 549–561.CrossRefGoogle ScholarPubMed
Rodenburg, R., Benjamin, A., De Roos, C., Meijer, A. M., & Stams, G. J. (2009). Efficacy of EMDR in children: A meta-analysis. Clinical Psychology Review, 29, 599–606.CrossRefGoogle ScholarPubMed
Rosner, R., Rimane, E., Frick, U., Gutermann, J., Hagl, M., Renneberg, B., … Steil, R. (2019). Effect of developmentally adapted cognitive processing therapy for youth with symptoms of posttraumatic stress disorder after childhood sexual and physical abuse: A randomized clinical trial. Journal of the American Medical Association Psychiatry, 76(5), 484–491.Google ScholarPubMed
Rossouw, J., Yadin, E., Alexander, D., Mbanga, I., Jacobs, T., & Seedat, S. (2016). A pilot and feasibility randomized controlled study of prolonged exposure treatment and supportive counselling for post-traumatic stress disorder in adolescents: A third world, task-shifting, community-based sample. Trials, 17, 548. doi: 10.1186/s13063-016-1677-6CrossRefGoogle ScholarPubMed
Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018). Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: Task-shifting randomized controlled trial. BMC Psychiatry, 213, 587–594.Google Scholar
Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860.CrossRefGoogle ScholarPubMed
Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012). Treatment for childhood refugee trauma: A randomized, controlled trial. International Journal of Play Therapy, 21(2), 57–73.CrossRefGoogle Scholar
Steinberg, L. (2014). Age of opportunity: Lessons from the new science of adolescence. Boston, MA: Houghton Mifflin Harcourt.Google Scholar
Styron, T., & Janoff-Bulman, R. (1997). Childhood attachment and abuse: Long-term effects on adult attachment, depression and conflict resolution. Child Abuse and Neglect, 21(10), 1015–1023.CrossRefGoogle ScholarPubMed
Valentine, J. C., Pigott, T. D., & Rothstein, H. R. (2010). How many studies do you need? A primer on statistical power for meta-analysis. Journal of Educational and Behavioural Statistics, 35(2), 215–247.CrossRefGoogle Scholar
Supplementary material: File

John-Baptiste Bastien et al. Supplementary Materials

John-Baptiste Bastien et al. Supplementary Materials

Download John-Baptiste Bastien et al. Supplementary Materials(File)
File 532.7 KB