Compared with other psychological treatments, trauma-focused cognitive behavioral therapies (TF-CBTs) are associated with the greatest reduction in pediatric posttraumatic stress disorder (PTSD) symptoms, according to a study issued yesterday in JAMA Psychiatry.
Thole Hoppen, Ph.D., of the University of Munster, Germany, and colleagues conducted a systematic review and meta-analysis of how psychological interventions for pediatric PTSD performed compared with either a passive (e.g., wait-list) or active (e.g., psychoeducation) control. They looked at four interventions: TF-CBTs (any CBT-based intervention with a trauma focus, such as prolonged exposure or cognitive process therapy), eye-movement desensitization and reprocessing (EMDR, which uses eye movements or other external stimuli to speed up the trauma healing process), non-trauma-focused interventions, and multidisciplinary treatments (treatments that combine techniques).
The researchers identified 70 randomized clinical trials that had at least 10 participants in both the intervention and control groups. The trials’ 5,528 participants were 19 years old or younger (average age of 12) with full or subthreshold PTSD. Most (74%) of the trials examined TF-CBTs.
All the psychological interventions were associated with significantly larger reductions in pediatric PTSD than passive controls, but TF-CBTs had the highest reductions both immediately posttreatment and long term (six or more months after treatment). After TF-CBTs, the order of most effective interventions was EMDR, multidisciplinary treatments, and non-trauma-focused interventions. EMDR was associated with significant reductions in PTSD immediately posttreatment and up to five months later, but the authors noted that data on long-term improvements was lacking. TF-CBTs were also the most effective treatment when compared with active controls, when restricting analyses to high-quality trials, and when only including trials that involved parents.
“The findings suggest TF-CBTs should be the first-line treatment recommendation for pediatric PTSD,” the authors wrote. They added that “disseminating these results may help reduce common treatment barriers by counteracting common misconceptions, such as the notion that TF-CBTs are harmful rather than helpful.”
The authors continued: “[W]hile data for other treatment approaches are emerging with some promising findings, more data (including long-term data) are needed to draw firmer conclusions.”
For related information, see the Psychiatric News article “Trauma-Focused CBT, Racial Socialization Build Resilience in Black Youth.”
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