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González-Alemañy E, Ostrosky F, Lozano A, Lujan A, Perez M, Castañeda D, Diaz K, Lara R, Sacristan E, Bobes MA. Brain structural change associated with Cognitive Behavioral Therapy in maltreated children. Brain Res 2024; 1825:148702. [PMID: 38070819 DOI: 10.1016/j.brainres.2023.148702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Severely maltreatment child is a harmful social factor that can disrupt normal neurodevelopment. Two commonly reported effects of maltreatment are post-traumatic stress disorder (PTSD) symptoms and brain structural and functional alteration. While Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is effectively used to reduce PTSD symptoms in maltreated children, yet, its impact on brain structural alterations has not been fully explored. This study investigated whether TF-CBT can attenuate alterations in brain structures associated with PTSD in middle childhood. METHODS The study evaluated the longitudinal effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on post-traumatic stress disorder (PTSD) symptoms and gray matter volume (GMV) in two groups of children under 12 years old: maltreated children (MC) and healthy non- maltreatmentd children (HC). Structural magnetic resonance images T1 were obtained before and after TF-CBT in the MC group, while the HC group was scanned twice within the same time interval. Voxel-based morphometry (VBM) was used to analyze GMV changes over time. RESULTS After TF-CBT, maltreated children showed significantly reduced PTSD symptoms. Furthermore, a significant group-by-time interaction effect was observed in certain areas of the Left Temporal, Left Occipital, and bilateral Frontal Cortex, the Basal Ganglia and Cerebellum. These interaction effects were driven by a GMV decrease in the MC group compared to the HC group. GMV changes can be predicted with clinical improvement in the left Middle Temporal gyrus, left Precuneus, and Cerebellum. CONCLUSIONS Our results suggest that TF-CBT intervention in very young maltreated children may have an effect on gray matter. This evidence demonstrates the importance of timely intervention when neuroplasticity mechanisms may be activated.
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Affiliation(s)
| | | | | | | | | | | | | | - Rafael Lara
- Centro Nacional de Investigación en Imagenología e instrumentación Médica (CI3M, Universidad Nacional Autónoma de México UNAM), México.
| | - Emilio Sacristan
- Centro Nacional de Investigación en Imagenología e instrumentación Médica (CI3M, Universidad Nacional Autónoma de México UNAM), México.
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2
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Smith AB, Cooley DT, Mesman GR, John SG, Wilburn EH, Vanderzee KL, Pemberton JR. Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:839-852. [PMID: 38045836 PMCID: PMC10689672 DOI: 10.1007/s40653-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 12/05/2023]
Abstract
Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.
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Affiliation(s)
- Allison B. Smith
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Daryl T. Cooley
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Glenn R. Mesman
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Sufna G. John
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Elissa H. Wilburn
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Karin L. Vanderzee
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Joy R. Pemberton
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
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3
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Khan MR, Al-Nuaimi S. Empowering resettled child and adolescent refugees through school-based mental health programs: Building a more inclusive community. Asian J Psychiatr 2023; 89:103766. [PMID: 37757539 DOI: 10.1016/j.ajp.2023.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Affiliation(s)
| | - Saleem Al-Nuaimi
- Child and Adolescent Psychiatry Department Hamad Medical Corporation, Doha, Qatar
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4
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Eslinger J, Sprang G, Jodts J. Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program. Clin Child Psychol Psychiatry 2023; 28:721-733. [PMID: 35762135 DOI: 10.1177/13591045221111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.
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Affiliation(s)
- Jessica Eslinger
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Ginny Sprang
- Department of Psychiatry, 12252University of Kentucky, Lexington, KY, USA.,Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
| | - Jenna Jodts
- Center on Trauma and Children, 4530University of Kentucky, Lexington, KY, USA
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5
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Tier 2 Mental Health Interventions in Primary and Secondary Schools: A Scoping Review. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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6
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Khosravi M, Adibi A. STAIR Plus Narrative Therapy-Adolescent Version (SNT-A) in An 11-Year-Old Girl With PTSD and Suicidal Behaviors Following Rape/Sexual Assault: A Case Report. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:943-948. [PMID: 35958704 PMCID: PMC9360251 DOI: 10.1007/s40653-021-00430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 06/15/2023]
Abstract
Rape/sexual assault can profoundly affect the physical, mental, and social well-being of victims. Post-traumatic stress disorder (PTSD) and suicide in rape/sexual assault survivors are significantly more frequent than the national prevalence of the condition, indicating that existing treatments require improvement. In this case report, we presented an 11-year-old Iranian girl with PTSD and suicidal behaviors following rape/sexual assault. We specifically focused on the process of helping the victim to develop effective coping skills and overcome the trauma through 16 weekly sessions of Skill Training in Affective and Interpersonal Regulation (STAIR) plus Narrative Therapy-Adolescent Version (SNT-A). During this therapeutic approach, the patient regained emotional control over the traumatic experience and made sense of the experience. Our findings revealed that SNT-A might be an effective intervention to reduce suicidal ideation among adolescent victims of rape/sexual assault. Nonetheless, further investigations in this field need to be carried out through randomized controlled trials.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amir Adibi
- Department of Child and Adolescent Psychiatry, Ilam University of Medical Sciences, Ilam, Iran
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7
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Spiegel JA, Graziano PA, Arcia E, Cox SK, Ayala M, Carnero NA, O’Mara NL. Addressing Mental Health and Trauma-Related Needs of Sheltered Children and Families with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:881-898. [PMID: 35867261 PMCID: PMC9393136 DOI: 10.1007/s10488-022-01207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 10/26/2022]
Abstract
Children and adolescents ("youth") experiencing homelessness are at a disproportionately high risk of exposure to potentially traumatic events (PTE). However, limited evidence exists as to what interventions are effective when implemented with this high-risk population. The purpose of this study was to (1) document the mental health and trauma-related needs of sheltered youth and their mothers, and (2) examine the feasibility/effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) administered within the context of a homeless shelter. Three hundred and twenty-one youth (Mage = 10.06 years, SD = 3.24 years, 56.4% male, 70.1% Black/African American, 34.6% Hispanic/Latinx) and their mothers were recruited from a homeless shelter and provided 10 weeks of TF-CBT, with the option for up to eight additional weeks of therapy based on clinical need. Families completed pre- and post-intervention assessments. Results demonstrated clinically elevated pre-intervention PTSD symptoms and rates of exposure to PTE in sheltered youth well above those previously reported in the general population. TF-CBT resulted in substantial reductions in both maternal and self-reported severity of youth PTSD symptomology, which were largely attributable to reductions in re-experiencing and arousal. Effectiveness of TF-CBT varied by age and the number of exposures to PTE. Overall, these findings illustrate the importance of assessing and addressing the mental health and trauma-related needs of sheltered youth and the feasibility and efficacy of embedding an evidence-based trauma-focused treatment protocol within a shelter environment. Additional implications of these findings are discussed.
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Affiliation(s)
- Jamie A. Spiegel
- Florida International University - Center for Children and Families and Department of Psychology, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Paulo A. Graziano
- Florida International University - Center for Children and Families and Department of Psychology, 11200 SW 8th Street, Miami, FL 33199 USA
| | | | - Shana K. Cox
- Sundari Foundation, Inc. dba Lotus House Women’s Shelter (Lotus House), 217 NW 15th Street, Miami, FL 33136 USA
| | - Muriel Ayala
- Sundari Foundation, Inc. dba Lotus House Women’s Shelter (Lotus House), 217 NW 15th Street, Miami, FL 33136 USA
| | - Nicole A. Carnero
- Sundari Foundation, Inc. dba Lotus House Women’s Shelter (Lotus House), 217 NW 15th Street, Miami, FL 33136 USA
| | - Noelle L. O’Mara
- Sundari Foundation, Inc. dba Lotus House Women’s Shelter (Lotus House), 217 NW 15th Street, Miami, FL 33136 USA
| | - Sundari Foundation
- Sundari Foundation, Inc. dba Lotus House Women’s Shelter (Lotus House), 217 NW 15th Street, Miami, FL 33136 USA
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Harvey AM, Brown RA. Book Review: The Family Guide to Getting Over OCD: Reclaim Your Life & Help Your Loved One, by Jonathan S. Abramowitz. New York: The Guilford Press, 2021. 241 pp. ISBN 978-1-4625-2. J Cogn Psychother 2022; 36:207-225. [DOI: 10.1891/jcp-2021-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Hoogsteder LM, Ten Thije L, Schippers EE, Stams GJJM. A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:735-757. [PMID: 33899551 DOI: 10.1177/0306624x211010290] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.
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10
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Yohannan J, Carlson JS, Volker MA. Cognitive behavioral treatments for children and adolescents exposed to traumatic events: A meta-analysis examining variables moderating treatment outcomes. J Trauma Stress 2022; 35:706-717. [PMID: 34800050 DOI: 10.1002/jts.22755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/06/2022]
Abstract
Due to the negative impact of trauma exposure, effective treatments are necessary to prevent and improve negative trauma-related outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for children and adolescents exposed to traumatic events. Despite the various meta-analyses that have examined trauma treatments, there is a paucity of research on the moderating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of treatment components on outcomes. A search identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was shown to be effective for trauma-exposed youth. CBT subtreatments did not produce significantly different results from one another. Moderators shown to significantly impact CBT treatment outcomes for posttraumatic stress symptom were trauma type, Q = 24.09, p = .004, ds = -0.22 to -1.42, and gender, Q = 10.68, p = .005, ds = -0.53 to -1.36, whereas moderators shown to impact treatment outcomes for depression were study design, Q = 10.95, p = .004, ds = -0.26 to -0.50, and treatment setting, Q = 10.98, p = .004, ds = -0.31 to -0.56. The implications of these findings for research and practice are discussed.
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Affiliation(s)
- Justina Yohannan
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, Michigan, USA
| | - John S Carlson
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, Michigan, USA
| | - Martin A Volker
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, Michigan, USA
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11
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Lydecker JA. Conceptual Application of Trauma-Focused Cognitive Behavioral Therapy to Treat Victims of Bullying. JOURNAL OF PREVENTION AND HEALTH PROMOTION 2022; 3:231-245. [PMID: 37622163 PMCID: PMC10448948 DOI: 10.1177/26320770221074008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Bullying is a critical pediatric public health problem; estimates across diverse methodologies generally indicate that roughly 36% of youth are bullied. Although policy initiatives aim to address the universal prevention of bullying, and school-level secondary prevention programs aim to reduce the occurrence of bullying, tertiary prevention and intervention programs that mitigate the negative consequences experienced by victims of bullying remain an understudied need. The nature of bullying (that it occurs as events, leaves children feeling unsafe, and engenders emotional distress) and the association of bullying with posttraumatic stress symptoms among youth suggests that trauma treatment for bullying is promising. This manuscript presents the rationale for treating victims of bullying with trauma-focused cognitive behavioral therapy (TF-CBT), describes the components of TF-CBT, and discusses how to use TF-CBT specifically for bullying. Conducting research on treatment outcomes when using TF-CBT for bullying is critical to evaluate its efficacy and effectiveness in this group. Behavioral clinical trials would provide evidence for whether TF-CBT reduces the mental health harm experienced by youth victims of bullying. This evidence is an essential step to address the public health problem of bullying because the scientific literature currently does not have a well-established individual-level treatment for victims of bullying that mental health providers in diverse settings can deliver, despite individuals' beliefs that health care providers are important sources of help for youth who have been bullied.
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12
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Wamser-Nanney R. Caregiver-Child Symptom Concordance: Links to Premature Termination From Trauma-Focused Therapy. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1614-NP1636. [PMID: 32538294 DOI: 10.1177/0886260520929654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rates of attrition from child trauma-focused treatment are high, yet few predictors of premature termination are known. Caregiver-child symptom discrepancies are common in this population and have been related to treatment outcome. However, research has not examined whether caregiver-child symptom concordance is associated with attrition. The aim of the study was to determine whether pretreatment caregiver-child symptom agreement predicted premature termination from trauma-focused treatment. Two hundred and sixty-nine treatment-seeking children ages 8 to 12 (M = 9.97, SD = 1.49; 64.7% female, 51.3% Black) and their non-offending caregivers were included in the study. Two operational definitions of attrition are as follows: (a) clinician-rated dropout, and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions), which were used to more thoroughly examine premature termination. Rates of attrition were high (68.1% clinician-rated premature termination, 37.4% received inadequate dose). Levels of symptom concordance between caregivers and children were low across symptom difficulties (intraclass correlations = .003-.16). Lower levels of discordance for posttraumatic stress symptoms (PTSS) were associated with an increased likelihood of receiving an adequate dose of treatment (odds ratio [OR] = 1.03). Nonetheless, unexpectedly, higher levels of caregiver-child discordance for anxiety symptoms at pretreatment predicted both clinician-rated treatment completion and adequate dose (ORs = .97, .96, respectively). However, caregiver's and children's perceptions of children's trauma-related difficulties may not converge, and thus, both reports are important to assess. Symptom disagreement regarding PTSS may help identify families at risk for attrition.
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Dumornay NM, Finegold KE, Chablani A, Elkins L, Krouch S, Baldwin M, Youn SJ, Marques L, Ressler KJ, Moreland-Capuia A. Improved emotion regulation following a trauma-informed CBT-based intervention associates with reduced risk for recidivism in justice-involved emerging adults. Front Psychiatry 2022; 13:951429. [PMID: 36276328 PMCID: PMC9579430 DOI: 10.3389/fpsyt.2022.951429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Male youth who have been involved in the juvenile legal system have disproportionate rates of trauma and violence exposure. Many justice-involved youth have untreated mental illness, with an estimated 66% of young men who are incarcerated meeting criteria for at least one mental health disorder, including posttraumatic stress disorder (PTSD), depression, and substance abuse. While Cognitive Behavioral Therapy (CBT) approaches are considered among effective evidence-based treatments for addressing and treating behavioral and emotional difficulties, male youth with a history of incarceration and youth who are at risk for (re)incarceration, violence, emotion dysregulation, and trauma face significant barriers in accessing these services. METHODS Roca, Inc. (Roca), an internationally recognized organization moving the needle on urban violence by working relentlessly with young people at the center of violence in Massachusetts and Maryland, employs a trauma-informed CBT-based skills curriculum and approach in their intervention model, to improve youths' educational, employment, parenting, and life skills opportunities, while decreasing risk for recidivism, addressing trauma and increasing skills for emotion regulation. The aim of this analysis was to assess the effectiveness of Roca's trauma-informed CBT skills curriculum on youths' emotional and behavioral outcomes. We analyzed data from over 300 participating emerging adult men from four sites in Massachusetts and one site in Baltimore, Maryland who had at least three series of data collection across multiple skills-based sessions. RESULTS We found improvements in outcomes in overall mean scores related to decreased distress about employment and education, as are expected with standard intervention approaches for justice-involved youth. Participants who show improvement in emotion regulation across engagement (approximately half the cohort), were found to have significant improvements in distress related to relationship and family functioning and self-care, and decreased substance use, along with other outcomes compared to those participants with less improvement in emotion regulation. Furthermore, improvement in different aspects of emotion regulation were associated with improved relationships, life distress, substance use, and improved prosocial thinking. CONCLUSIONS Together, these data suggest that adding mental health support and skills training, such as with trauma-informed CBT models, to programs for justice-involved youth may lead to significant improvements in functioning, quality of life, and mental health outcomes.
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Affiliation(s)
- Nathalie M Dumornay
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Institute of Child Development, University of Minnesota, Minneapolis, MN, United States
| | - Katherine E Finegold
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,School and Child Clinical Psychology, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Soo Jeong Youn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J Ressler
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alisha Moreland-Capuia
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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14
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Chipalo E. Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:545-558. [PMID: 34790283 PMCID: PMC8586102 DOI: 10.1007/s40653-021-00370-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED In 2019, more than 25.9 million children under 18 were displaced due to unending political conflicts. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) has a high level of empirical evidence to support its efficacy in processing trauma and behavioral problems in non-refugee children. Yet, little is known about its long-term effectiveness in refugee children. This study conducted a systematic review that assessed the evidence of the effectiveness of TF-CBT in reducing trauma symptoms among refugee children under 18 years of age. A systematic review was conducted from peer-reviewed literature databases (12 databases): PsycINFO, PubMed, Scopus, Google Scholar, ProQuest Dissertations and Theses (PQDT), Cochrane Library, MEDLINE, PROSPERO, EBSCOHost, Campbell Collaboration Library of Systematic Reviews, Social Sciences Index, and grey literature sources published from 1990 to 2019. The search yielded 1650 articles, and 4 peer reviewed studies were identified that met inclusion criteria and yielded a sample size of 64 refugee children from 21 different countries. All 4 studies provided evidence that supported TF-CBT's effectiveness in decreasing trauma symptoms and sustainment during the follow-up assessment among refugee children participants. Despite TF-CBT effectiveness for trauma symptoms treatment, there is still limited evidence to suggest that TF-CBT is effective for all refugee children due to the pilot nature of the studies, and its underutilization in traumatized refugee children from different cultural backgrounds. Future studies should conduct more TF-CBT interventions with diverse refugee children to provide more empirical support for its effectiveness with that population. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00370-0.
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Affiliation(s)
- Edson Chipalo
- School of Social Work, The University of Alabama, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL 35401 USA
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15
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Silva EP, Emond A, Ludermir AB. Depression in childhood: The role of children's exposure to intimate partner violence and maternal mental disorders. CHILD ABUSE & NEGLECT 2021; 122:105305. [PMID: 34517271 DOI: 10.1016/j.chiabu.2021.105305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is a global problem with high prevalence rates, and is linked to maternal mental disorders (MMD). Children's exposure to IPV (CEIPV) can have impacts on their physical and mental health, including depression. OBJECTIVE To analyze the associations between exposure to both CEIPV and MMD and depression in schoolchildren. PARTICIPANTS AND SETTING 630 mother-child pairs were evaluated in a poor urban district in Recife, Northeast Brazil. METHODS A cohort study investigated the effects of IPV during pregnancy, postpartum and six to nine years after delivery. Women were asked about their experience of IPV, their own mental health, and the exposure of their child to violence. The child's mood was reported by the mother, using the Short Mood and Feelings Questionnaire (SMFQ). Ten types of CEIPV, and the age of onset of exposure, were compared with the child's subsequent risk of depression. RESULTS IPV was associated with MMD in 31.9% of the women at some period of time. Depressive symptoms were reported in 15.7% of school-age children. All types of CEIPV were associated with depression at school age. Multivariable analyses of exposure to IPV and MMD at different ages showed that exposure to both IPV and MMD in the first year of life had the strongest association with childhood depression (OR = 9.1; 95% CI: 2.4-33.9). CONCLUSIONS The frequency of CEIPV and MMD, and the high prevalence of depression at school age, shows the importance of assessing MMD and identifying exposure to IPV in pregnancy and the early years.
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Affiliation(s)
- Elisabete Pereira Silva
- Universidade Federal de Pernambuco, Hospital das Clínicas, 2o andar - Av. Prof. Moraes Rêgo, s/n. Cidade Universitária, 50.670-420, Recife, PE, Brazil.
| | - Alan Emond
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road Clifton, Bristol BS8 1NU, United Kingdom
| | - Ana Bernarda Ludermir
- Universidade Federal de Pernambuco, Av. da Engenharia, s/n, Bloco "D" - 1° Andar - Cidade Universitária, 50.740-600, Recife, PE, Brazil
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Wamser-Nanney R. Child-reported posttraumatic stress symptoms and attrition from therapy. CHILD ABUSE & NEGLECT 2021; 121:105266. [PMID: 34479132 DOI: 10.1016/j.chiabu.2021.105266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/26/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND High rates of attrition from child trauma-focused treatment are a significant barrier to mitigating children's trauma-related difficulties. Nonetheless, to date, only one study has investigated child-reported posttraumatic stress symptoms (PTSS) in relation to dropout from trauma-focused therapy and the posttraumatic stress disorder (PTSD) symptom clusters remain unexamined. OBJECTIVE The present study sought to determine whether higher levels of child-reported PTSS, as well as the specific DSM-IV PTSD symptom clusters, predicted attrition from trauma-focused cognitive behavioral therapy (TF-CBT). PARTICIPANTS/SETTING/METHOD One hundred and seventy one children ages 7-18 (M = 11.76, SD = 2.71; 67.4% female; 55.8% Black) were included in the study from an archival database. Dropout was investigated by two operational definitions: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). RESULTS Sixty eight percent (68.4%) of the children prematurely terminated treatment per their clinician, yet 70.2% received an adequate treatment dose. Child's age and income were related to clinician-rated attrition, but PTSS did not correspond with either attrition definition. None of the PTSD symptom clusters were associated with clinician-rated dropout; however, higher levels of avoidance symptoms were tied to increased likelihood of the child receiving an adequate dose of treatment. CONCLUSION From a public health perspective, it is encouraging that children who are reporting higher levels of PTSS may not be at greater risk for attrition.
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Affiliation(s)
- Rachel Wamser-Nanney
- Psychological Sciences, University of Missouri, St. Louis, MO 63121, United States of America.
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17
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Intimate Partner Violence and Sexually Transmitted Infections Among Women in Sub-Saharan Africa. J Immigr Minor Health 2021; 23:191-198. [PMID: 32767184 DOI: 10.1007/s10903-020-01064-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intimate partner violence (IPV) is a serious public health issue that increases risk for sexually transmitted infections (STIs). Data was obtained from women (n = 32,409) who completed the Demographic Health Survey's (DHS) domestic violence module in 7 countries in sub-Saharan Africa between 2011 and 2015. DHS questions assessed lifetime physical, emotional and sexual IPV, cumulative exposure to IPV as well as the presence of a STI in the past 12 months. Multivariate logistic regression examined the association between IPV and STIs adjusting for potentially influential covariates. Data were weighted and analyzed using STATA Software (version 14.0). Women who had experienced physical, emotional sexual and cumulative IPV were significantly more likely to have had a STIs in the past 12 months. In order to reduce the burden of STIs, initiatives may need to address underlying mechanisms such as gender norms and power inequalities which perpetuate IPV.
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18
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Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:705-719. [PMID: 31813066 DOI: 10.1007/s10488-019-01003-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A systematic review was conducted to identify determinants (barriers and facilitators) of implementing evidence-based psychosocial interventions for children and youth who experience emotional or behavioral difficulties due to trauma exposure. Determinants were coded, abstracted, and synthesized using the Exploration, Preparation, Implementation, and Sustainment framework. Twenty-three articles were included, all of which examined implementation of Trauma-Focused Cognitive Behavioral Therapy or Cognitive-Behavioral Intervention for Trauma in Schools. This review identified multilevel and multiphase determinants that can be addressed by implementation strategies to improve implementation and clinical outcomes, and suggests how future studies might address gaps in the evidence base.
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19
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Wamser-Nanney R. Maternal Support and Attrition from Child Trauma-Focused Therapy. J Trauma Stress 2021; 34:840-850. [PMID: 34057745 DOI: 10.1002/jts.22698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/07/2022]
Abstract
Many children prematurely terminate from trauma-focused therapy (TFT), and attrition is a critical barrier in addressing the impacts of childhood sexual abuse (CSA). The field's knowledge of risk factors for dropout is growing; however, one aspect of the child's environment that remains unexamined is maternal support following the CSA disclosure/discovery. Maternal support has been theorized to play a valuable role in influencing children's outcomes after CSA and may be relevant in understanding attrition. The objective of the current study was to investigate the associations between children's symptoms, relationship to the perpetrator, and maternal support in relation to premature termination from TFT among 186 sexually abused children (Mage = 9.24 years, SD = 3.72, 67.3% female). Two operational definitions of attrition were used: (a) clinician-rated dropout (i.e., clinician's ratings of whether the child completed treatment) and (b) whether the child received an adequate treatment dose treatment (i.e., ≥12 sessions). Maternal marital status was the only factor associated with clinician-rated treatment dropout, OR = 2.35, whereas maternal support and blame/doubt were unrelated. Living farther from the clinic was tied to an increased risk of receiving an inadequate treatment dose, OR = 0.96. Replication of these findings is needed, particularly using a clinician-administered measure of caregiver support; yet, maternal emotional support and blame/doubt may not evince strong ties to dropout from TFT among sexually abused children. Additional work is needed to discern if there are key subgroups for whom support is more strongly related to the risk of premature termination following CSA.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, Missouri, USA
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20
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Jones LM, Nolte K, O'Brien AJ, Trumbell JM, Mitchell KJ. Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings. J Pediatr Nurs 2021; 59:37-44. [PMID: 33460878 DOI: 10.1016/j.pedn.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks. DESIGN AND METHODS Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview. RESULTS Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health. CONCLUSIONS Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks. PRACTICE IMPLICATIONS Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.
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Affiliation(s)
- Lisa M Jones
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
| | - Kerry Nolte
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Alyssa J O'Brien
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Jill M Trumbell
- Human Development & Family Studies, University of New Hampshire, Durham, NH, United States of America.
| | - Kimberly J Mitchell
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
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21
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Lombera A, Lee AH, Sharma-Patel K, Brown EJ. Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms. CHILD ABUSE & NEGLECT 2021; 115:105010. [PMID: 33639557 DOI: 10.1016/j.chiabu.2021.105010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/26/2021] [Accepted: 02/13/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes. OBJECTIVE The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms. PARTICIPANTS AND SETTING A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment. METHOD Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence. RESULTS The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD. CONCLUSION Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.
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Affiliation(s)
| | - Amy Hyoeun Lee
- Child HELP Partnership, St. John's University, United States
| | | | - Elissa J Brown
- Child HELP Partnership, St. John's University, United States
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Kletter H, Matlow R, Tanovic S, Carrion V. Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms. ACTA ACUST UNITED AC 2021; 8:125-140. [PMID: 33898161 PMCID: PMC8054844 DOI: 10.1007/s40501-021-00241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
Purpose Few of the existing evidence-based interventions for child trauma exposure were specifically designed to address experiences and outcomes of complex developmental trauma. Stanford's cue-centered therapy (CCT) was designed to address this gap by offering a flexible, integrative, and insight-oriented treatment approach that is grounded in principles of neuroscience, developmental trauma, client empowerment, and allostasis. This article reviews the CCT rationale, treatment components, evidence base, and training approach. Recent findings Studies demonstrate promising outcomes indicating CCT effectiveness in reducing child and caregiver posttraumatic stress, and in improving child functioning. Further research, however, is needed to identify which clients are best-suited for CCT (versus other available child trauma treatments) and to identify which components of CCT are most critical for addressing complex developmental trauma. Summary CCT advances the field of child trauma treatment by offering an intervention approach focused on addressing complex developmental trauma. Positive treatment and training outcomes indicate utility of CCT for clients and clinicians. Innovations in research and training approaches are needed to further dissemination and implementation of CCT and other related child trauma interventions for complex developmental trauma.
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Affiliation(s)
- Hilit Kletter
- Department of Child/Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 USA
| | - Ryan Matlow
- Department of Child/Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 USA
| | - Selma Tanovic
- Department of Child/Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 USA
| | - Victor Carrion
- Department of Child/Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 USA
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23
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Bunnell BE, Nemeth LS, Lenert LA, Kazantzis N, Deblinger E, Higgins KA, Ruggiero KJ. Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions. COGNITIVE THERAPY AND RESEARCH 2021; 45:272-286. [PMID: 34108776 PMCID: PMC8183976 DOI: 10.1007/s10608-020-10090-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions. METHODS Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n=21) and youth TF-CBT patients ages 8-17 (n=15) and their caregivers (n=12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers. RESULTS The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities). CONCLUSIONS This study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A. Lenert
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Esther Deblinger
- Child Abuse Research Education & Service (CARES) Institute, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Kristen A. Higgins
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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24
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McGuire A, Steele RG, Singh MN. Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children. Clin Child Fam Psychol Rev 2021; 24:20-37. [PMID: 33428071 DOI: 10.1007/s10567-020-00334-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the most widely studied and disseminated treatments for posttraumatic stress disorder (PTSD) and other comorbid conditions, and has been identified as a "level one" or "well-established" intervention for school-aged children and adolescents. The present systematic review examined the literature on the application of TF-CBT within a preschool-aged population (i.e., children ages three to six), as well as the developmental literature that could increase the efficacy of TF-CBT for preschool-aged children. Information on the use of TF-CBT with preschool-aged children was extracted from randomized controlled trials, case studies, meta-analyses, and other forms of empirical evidence, as part of the evidence-based practice in psychology framework. In comparison to research with school-aged children and adolescents, fewer studies have directly assessed the efficacy of TF-CBT for preschool-aged children who have been exposed to trauma. Given the few studies published to date and difference in treatment protocols for TF-CBT used with preschool-age children, TF-CBT appears to meet criteria as a "level two" or "probably efficacious" intervention for preschool-aged children specifically. According to the available literature, language and cognitive abilities, family context, culture, and clinician expertise are considered as potential variables to address when contemplating the use of TF-CBT for preschool-aged children with symptoms of post-traumatic stress.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA.
| | - Ric G Steele
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA
| | - Mehar N Singh
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA
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25
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Craig SL, Leung VWY, Pascoe R, Pang N, Iacono G, Austin A, Dillon F. AFFIRM Online: Utilising an Affirmative Cognitive-Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1541. [PMID: 33562876 PMCID: PMC7915123 DOI: 10.3390/ijerph18041541] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023]
Abstract
Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = -5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.
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Affiliation(s)
- Shelley L. Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Vivian W. Y. Leung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Rachael Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada; (V.W.Y.L.); (R.P.); (N.P.)
| | - Gio Iacono
- School of Social Work, University of Connecticut, Storrs, CT 06269, USA;
| | - Ashley Austin
- Ellen Whiteside-McDonnell School of Social Work, Barry University, Tallahassee, FL 32304, USA;
| | - Frank Dillon
- College of Integrative Sciences and Arts, Arizona State University, Tempe, AZ 85281, USA;
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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27
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D'Inverno AS, Idaikkadar N, Houry D. Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program-United States, January 2017-December 2019. Am J Public Health 2021; 111:485-493. [PMID: 33476240 DOI: 10.2105/ajph.2020.306034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States.Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention's National Syndromic Surveillance Program data. We stratified the data by sex and age groups.Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years.Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.
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Affiliation(s)
- Ashley Schappell D'Inverno
- Ashley Schappell D'Inverno is with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Nimi Idaikkadar is with the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC. Debra Houry is with the National Center for Injury Prevention and Control, CDC
| | - Nimi Idaikkadar
- Ashley Schappell D'Inverno is with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Nimi Idaikkadar is with the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC. Debra Houry is with the National Center for Injury Prevention and Control, CDC
| | - Debra Houry
- Ashley Schappell D'Inverno is with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Nimi Idaikkadar is with the Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, CDC. Debra Houry is with the National Center for Injury Prevention and Control, CDC
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Haleemunnissa S, Didel S, Swami MK, Singh K, Vyas V. Children and COVID19: Understanding impact on the growth trajectory of an evolving generation. CHILDREN AND YOUTH SERVICES REVIEW 2021; 120:105754. [PMID: 33281255 PMCID: PMC7695548 DOI: 10.1016/j.childyouth.2020.105754] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 05/05/2023]
Abstract
The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5-7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0-18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.
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Affiliation(s)
- S Haleemunnissa
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Siyaram Didel
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
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Ross SL, Sharma-Patel K, Brown EJ, Huntt JS, Chaplin WF. Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome? CHILD ABUSE & NEGLECT 2021; 111:104734. [PMID: 33162104 DOI: 10.1016/j.chiabu.2020.104734] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. OBJECTIVE The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). PARTICIPANTS AND SETTING Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. METHODS Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. RESULTS There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. CONCLUSIONS This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.
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Affiliation(s)
| | - Komal Sharma-Patel
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - Elissa J Brown
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - Jessica S Huntt
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - William F Chaplin
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
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30
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Wamser-Nanney R. Sexual Behavior Problems and Premature Termination From Pediatric Trauma-Focused Treatment Among Sexually Abused Children. J Trauma Stress 2020; 33:835-842. [PMID: 32479696 DOI: 10.1002/jts.22518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/02/2019] [Accepted: 11/13/2019] [Indexed: 11/07/2022]
Abstract
Premature termination from child trauma-focused treatment is common; however, the role of children's level of symptoms as a risk factor for attrition remains uncertain. In particular, children's sexual behavior problems (SBPs) have received scant attention in the prior attrition literature, and no known studies to date have thoroughly examined SBPs in relation to premature treatment termination. The current study investigated whether higher levels of children's SBPs were associated with increased risk for attrition from trauma-focused treatment in a sample of 242 sexually abused children aged 2-12 years (M = 7.48 years, SD = 2.68; 64.5% female, 54.1% White). To assess the potential associations between SBPs and treatment dropout more thoroughly, two definitions of attrition were utilized: (a) clinician-rated dropout and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Whereas only 34.3% of the children completed treatment per their clinician, 69.4% received an adequate dose of treatment. In contrast to the study hypotheses, neither development-related nor sexual abuse-specific SBPs were associated with either clinician-rated dropout or adequate dose status, ORs = 0.99-1.00. Sexual acting-out behaviors in sexually abused children may not correspond with attrition from trauma-focused treatment at multiple points of treatment. Given the heterogeneity of SBPs, further assessment of whether attrition patterns differ across subgroups of children who exhibit SBPs is needed.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, Missouri, USA
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31
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Márquez YI, Deblinger E, Dovi AT. The Value of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in Addressing the Therapeutic Needs of Trafficked Youth: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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32
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Wamser-Nanney R. Predictors of Attrition Among Young Children Receiving Trauma-Focused Therapy. J Trauma Stress 2020; 33:564-574. [PMID: 32479708 DOI: 10.1002/jts.22513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
Findings from studies of predominately school-aged children indicate that few children complete trauma-focused treatment; however, researchers have not specifically examined risk factors for dropout among young trauma-exposed children. The purpose of the present study was to investigate risk factors for attrition among young children receiving trauma-focused therapy. Study participants were 189 treatment-seeking children aged 3-5 years (M = 4.86 years, SD = 0.71; 54.1% female, 47.7% White) and their nonoffending legal guardian(s). Child and family characteristics, number of traumatic events, and pretreatment posttraumatic stress symptoms (PTSS) were examined in relation to two attrition definitions: (a) clinician-rated dropout and (b) whether the child received an adequate treatment dose (i.e., 12 or more sessions). Although 70.3% of children prematurely terminated therapy per their clinician, a nearly equivalent portion (67.4%) received an adequate treatment dose. Family characteristics were largely not associated with attrition, although residing farther from the clinic was related to clinician-rated treatment dropout, OR = 0.96. As expected, higher levels of externalizing symptoms were associated with clinician-rated dropout and inadequate dose status, ORs = .95 and .96, respectively, whereas lower levels of trauma-related anger were related to clinician-rated treatment completion, OR = 1.03, and lower levels of PTSS and sexual concerns corresponded with an increased likelihood the child received an inadequate treatment dose, ORs = 1.03 and 1.02, respectively. Thus, child and family factors appear to play a small role in predicting attrition; however, higher levels of externalizing problems and lower levels of PTSS may increase the risk for dropout.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, Louis, Missouri, USA
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33
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Martin CG, Everett Y, Skowron EA, Zalewski M. The Role of Caregiver Psychopathology in the Treatment of Childhood Trauma with Trauma-Focused Cognitive Behavioral Therapy: A Systematic Review. Clin Child Fam Psychol Rev 2020; 22:273-289. [PMID: 30796672 DOI: 10.1007/s10567-019-00290-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Trauma-focused cognitive behavioral therapy (TF-CBT) is regarded as one of the most effective treatments for children who have experienced trauma and is rapidly being disseminated. To best ensure efficacy, even among treatment refractory symptoms, a better understanding of the factors that lead TF-CBT to be more or less effective for some children is warranted. One major factor that has not been systematically considered is the role of caregiver psychopathology. Therefore, this systematic review of 18 empirical studies examined how TF-CBT has incorporated caregiver psychopathology into the treatment of childhood trauma and how it is related to treatment outcomes. The results of this review provide preliminary support for TF-CBT decreasing caregiver psychopathology, in terms of symptoms of depression, PTSD, and emotional distress related to the child's experience of trauma, as well as partial support for caregiver depression, rather than caregiver PTSD or distress, influencing child treatment outcomes. It also illuminates the strong need for future TF-CBT studies to routinely measure caregiver psychopathology. Several recommendations are provided to ensure that the emerging research base can inform clinical practice guidelines on how to incorporate caregivers who exhibit psychopathology and potentially develop modifications to the existing treatment to address trauma and symptoms in both members of the caregiver-child dyad, when needed.
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Affiliation(s)
| | - Yoel Everett
- Department of Psychology, 1227 University of Oregon, Eugene, OR, 97403, USA
| | - Elizabeth A Skowron
- Department of Counseling Psychology & Human Services, 5251 University of Oregon, Eugene, OR, 97403, USA
| | - Maureen Zalewski
- Department of Psychology, 1227 University of Oregon, Eugene, OR, 97403, USA
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34
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Wang Y, Chung MC. Linking Rejection Sensitivity, Shyness and Unsociability with Posttraumatic Stress Disorder and Psychiatric Co-Morbidity among Chinese Adolescents. Psychiatr Q 2020; 91:309-319. [PMID: 31898211 DOI: 10.1007/s11126-019-09701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated whether rejection sensitivity (RS), shyness and unsociability would positively correlate with Posttraumatic Stress Disorder (PTSD) and psychiatric co-morbidity and whether shyness and unsociability would mediate the impact of RS on distress outcomes. Four hundred and one adolescents from three middle schools in China completed a demographic questionnaire, Children's Rejection Sensitivity Questionnaire, Children's Shyness Questionnaire, Child Social Preference Scale, Posttraumatic Stress Disorder Checklist for DSM-5, and the General Health Questionnaire-28. The results showed that RS and shyness were mostly correlated with PTSD and psychiatric co-morbidity whereas unsociability was not and therefore not a mediator. Shyness, on the other hand, mediated the impact of angry RS and anxious RS on PTSD, as well as anxious RS on psychiatric co-morbidity. To conclude, the severity of PTSD along with other psychological difficulties tends to increase for those who are shy and sensitive to rejection.
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Affiliation(s)
- Yabing Wang
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong.
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35
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Wamser-Nanney R. Risk Factors for Attrition From Pediatric Trauma-Focused Treatment. CHILD MALTREATMENT 2020; 25:172-181. [PMID: 31510772 DOI: 10.1177/1077559519874406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rates of attrition from pediatric trauma-focused treatments are high, yet few studies have examined predictors of dropout. The aim of the study was to investigate whether higher levels of caregiver- and child-reported pretreatment difficulties predicted attrition from trauma-focused therapy. One hundred seventy-two children aged 6-18 (M = 10.53, SD = 3.36; 64% female, 64% Black) and their caregivers were included in the study. Two operational definitions of attrition were utilized: (1) clinician-rated dropout and (2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Rates of clinician-rated attrition were high (76.2%); however, 73.8% received an adequate dose. Despite expectations, higher levels of rule-breaking and aggressive behavior were related to clinician-rated dropout (d = 0.59, .63, respectively) but were not significant predictors in a logistic regression model. Child-reported symptoms were unrelated to clinician-rated attrition. Higher levels of caregiver-reported anxiety/depression, somatic complaints, and trauma-related difficulties corresponded with adequate dose (ds = 0.52-1.06). Yet only caregiver-reported sexual concerns predicted adequate dose in a regression model (OR = 1.09). Caregiver- and child-reported symptoms may be unrelated to clinician-rated treatment completion and appear to play a small role in understanding whether the child received an adequate dose of treatment.
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36
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Murphy NA, Yuan M, Elias MJ. Youth leadership programming in high-poverty minority students. EVALUATION AND PROGRAM PLANNING 2020; 79:101728. [PMID: 31765907 DOI: 10.1016/j.evalprogplan.2019.101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Nina A Murphy
- Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway Township, NJ 08854, United States.
| | - May Yuan
- Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway Township, NJ 08854, United States.
| | - Maurice J Elias
- Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway Township, NJ 08854, United States.
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Abdulah DM, Abdulla BMO. Suicidal ideation and attempts following a short-term period of art-based intervention: An experimental investigation. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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38
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Gameon JA, Skewes MC. A Systematic Review of Trauma Interventions in Native Communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:223-241. [PMID: 31518009 PMCID: PMC7243818 DOI: 10.1002/ajcp.12396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.
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Affiliation(s)
- Julie A Gameon
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | - Monica C Skewes
- Department of Psychology, Montana State University, Bozeman, MT, USA
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39
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Kirlic N, Cohen ZP, Singh MK. Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth. ADVERSITY AND RESILIENCE SCIENCE 2020; 1:5-28. [PMID: 34278327 PMCID: PMC8281391 DOI: 10.1007/s42844-020-00001-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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40
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Powell BJ, Haley AD, Patel SV, Amaya-Jackson L, Glienke B, Blythe M, Lengnick-Hall R, McCrary S, Beidas RS, Lewis CC, Aarons GA, Wells KB, Saldana L, McKay MM, Weinberger M. Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS). Implement Sci Commun 2020; 1. [PMID: 32391524 PMCID: PMC7207049 DOI: 10.1186/s43058-020-00009-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Implementing and sustaining evidence-based programs with fidelity may require multiple implementation strategies tailored to address multi-level, context-specific barriers and facilitators. Ideally, selecting and tailoring implementation strategies should be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. There is a need for more rigorous methods for assessing and prioritizing implementation determinants (barriers and facilitators) and linking implementation strategies to determinants. The Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS) is an intervention designed to increase the effectiveness of evidence-based practice implementation and sustainment. COAST-IS will enable organizational leaders and clinicians to use Intervention Mapping to select and tailor implementation strategies to address their site-specific needs. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. Methods COAST-IS will be piloted with community mental health organizations that are working to address the needs of children and youth who experience trauma-related emotional or behavioral difficulties by engaging in a learning collaborative to implement an evidence-based psychosocial intervention (trauma-focused cognitive behavioral therapy). Organizations will be matched and then randomized to participate in the learning collaborative only (control) or to receive additional support through COAST-IS. The primary aims of this study are to (1) assess the acceptability, appropriateness, feasibility, and perceived utility of COAST-IS; (2) evaluate the organizational stakeholders' fidelity to the core elements of COAST-IS; and (3) demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial. Discussion COAST-IS is a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. If effective, COAST-IS has the potential to improve the implementation and sustainment of a wide range of evidence-based practices in mental health and other sectors. Trial registration This study was registered in ClinicalTrials.gov (NCT03799432) on January 10, 2019 (last updated August 5, 2019).
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheila V Patel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,National Center for Child Traumatic Stress, Durham, NC, USA.,North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Beverly Glienke
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Mellicent Blythe
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Lengnick-Hall
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Stacey McCrary
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Cara C Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Kenneth B Wells
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,The Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dorsey S, Gray CL, Wasonga AI, Amanya C, Weiner BJ, Belden CM, Martin P, Meza RD, Weinhold AK, Soi C, Murray LK, Lucid L, Turner EL, Mildon R, Whetten K. Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial. BMC Psychiatry 2020; 20:10. [PMID: 31914959 PMCID: PMC6947833 DOI: 10.1186/s12888-019-2364-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. METHODS BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. DISCUSSION The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. TRIAL REGISTRATION Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington Guthrie Hall 119A, Box 351525, Seattle, WA, 98195, USA.
| | - Christine L Gray
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Campus Box 90392, Durham, NC, 27710, USA
| | | | - Cyrilla Amanya
- Research Department, Ace Africa Kenya, P.O. Box 1185, Bungoma, 50200, Kenya
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA
- Department of Health Services, School of Public Health, University of Washington, Box 357965, Seattle, WA, 98195, USA
| | - C Micha Belden
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Campus Box 90392, Durham, NC, 27710, USA
| | - Prerna Martin
- Department of Psychology, University of Washington Guthrie Hall 119A, Box 351525, Seattle, WA, 98195, USA
| | - Rosemary D Meza
- Department of Psychology, University of Washington Guthrie Hall 119A, Box 351525, Seattle, WA, 98195, USA
| | - Andrew K Weinhold
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Campus Box 90392, Durham, NC, 27710, USA
| | - Caroline Soi
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th floor, Baltimore, MD, 21205, USA
| | - Leah Lucid
- Department of Psychology, University of Washington Guthrie Hall 119A, Box 351525, Seattle, WA, 98195, USA
| | - Elizabeth L Turner
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Campus Box 90519, Durham, NC, 27708, USA
| | - Robyn Mildon
- Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, Victoria, 3053, Australia
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Campus Box 90392, Durham, NC, 27710, USA
- Terry Sanford Institute of Public Policy, Duke University, Box 90239, Durham, NC, 27708, USA
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Mavranezouli I, Megnin-Viggars O, Daly C, Dias S, Stockton S, Meiser-Stedman R, Trickey D, Pilling S. Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis. J Child Psychol Psychiatry 2020; 61:18-29. [PMID: 31313834 DOI: 10.1111/jcpp.13094] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. METHODS We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. CONCLUSIONS Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence.
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Affiliation(s)
- Ifigeneia Mavranezouli
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Odette Megnin-Viggars
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Caitlin Daly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sofia Dias
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Stockton
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Trickey
- The Anna Freud Centre, The Kantor Centre of Excellence, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
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Vanderzee KL, Sigel BA, Pemberton JR, John SG. Treatments for Early Childhood Trauma: Decision Considerations for Clinicians. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:515-528. [PMID: 32318220 PMCID: PMC7163896 DOI: 10.1007/s40653-018-0244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The period from birth to age six represents a time of significant risk for exposure to trauma. Following trauma exposure, children may experience significant negative and lasting psychological, cognitive, and physical effects. Over the last two decades, the demand for and availability of evidence-based treatments (EBTs) for children under the age of six who have experienced trauma has dramatically increased. Three of the most well-supported and widely disseminated EBTs for early childhood trauma are Trauma-Focused Cognitive Behavioral Therapy, Parent-Child Interaction Therapy, and Child-Parent Psychotherapy. Increasingly, clinicians are receiving training in more than one EBT. This paper provides an overview of each intervention; presents clinicians with various child, caregiver, and environmental factors to consider when deciding amongst these three EBTs; and applies these considerations to three composite cases.
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Affiliation(s)
- Karin L. Vanderzee
- Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Child Study Center, 1210 Wolfe Street, Slot 654, Little Rock, AR 72202 USA
| | - Benjamin A. Sigel
- Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 554, Little Rock, AR 72205 USA
| | - Joy R. Pemberton
- Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Child Study Center, 1210 Wolfe Street, Slot 654, Little Rock, AR 72202 USA
| | - Sufna G. John
- Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Child Study Center, 1210 Wolfe Street, Slot 654, Little Rock, AR 72202 USA
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Neelakantan L, Hetrick S, Michelson D. Users' experiences of trauma-focused cognitive behavioural therapy for children and adolescents: a systematic review and metasynthesis of qualitative research. Eur Child Adolesc Psychiatry 2019; 28:877-897. [PMID: 29802515 DOI: 10.1007/s00787-018-1150-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
Trauma-focused cognitive behavioural therapy (TF-CBT) is an effective intervention for post-traumatic stress disorder, yet implementation may be hindered by practitioners' concerns about how treatment is experienced by users. This metasynthesis systematically reviews qualitative evidence on youth and caregivers' experiences of TF-CBT to better understand user perspectives on process and outcomes of treatment. A systematic review and metasynthesis were undertaken for qualitative studies of treatment experience related to TF-CBT. Data were extracted according to Evidence for Policy and Practice Information and Coordinating Centre guidelines, and studies were critically appraised using Critical Appraisal Skills Programme checklists. Findings from included studies were coded and synthesized using thematic synthesis methodology. Eight studies were selected after a full-text review of 39 papers. Findings were organised around nine sub-themes, under three broad thematic categories: 'engagement in TF-CBT'; 'experience of treatment components'; and 'therapeutic outcomes'. Youth were often unclear about what to expect from treatment and concerned about (in)compatibility with their therapist. Youth reports indicated how such misgivings can be addressed through early psychoeducation and efforts to strengthen the therapeutic alliance. Once underway, treatment was viewed as a place of refuge and validation, aided by therapist competence and confidentiality. Youth and caregivers felt that constructing a trauma narrative was instrumental for recovery. Cognitive-behavioural coping techniques were useful during treatment and in the long-term. While participants in TF-CBT may begin treatment with unclear expectancies, careful attention to early engagement and other process issues can optimise process and outcomes. Implications for clinical practice and further research are discussed.
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Affiliation(s)
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Daniel Michelson
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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45
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Pernebo K, Fridell M, Almqvist K. Reduced psychiatric symptoms at 6 and 12 months' follow-up of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence. CHILD ABUSE & NEGLECT 2019; 93:228-238. [PMID: 31125853 DOI: 10.1016/j.chiabu.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/26/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Long-term follow-up studies of interventions for children exposed to intimate partner violence are few, and the sustainability of their outcomes often remains unexplored and uncertain. Current research including follow-up assessment suggests that treatment gains may be maintained or continue post termination. In addition some children may show increased levels of symptoms. OBJECTIVE The present effectiveness study investigated the long-term outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. PARTICIPANTS AND SETTING The study included 50 children, 24 girls and 26 boys, aged 4 to 13 years attending a psychotherapeutic child and adolescent mental health service intervention and a psychoeducative community-based intervention. METHODS Background information, child and parental mental health problems, trauma symptoms, and exposure to violence were assessed pre- and post treatment and at 6 and 12 months' follow-up. RESULTS Sustained treatment gains and late improvements in children's internalizing and externalizing symptoms and in symptoms of traumatic stress were recorded from post treatment to the follow-up assessments (p = .004- .044; d = 0.29-0.67). No significant increase in symptoms was reported. Additionally, very little continued or renewed child exposure to violence was reported. CONCLUSIONS The results of the study indicate that the children did benefit from the two interventions studied and that the outcomes of reduced child symptoms and protection from exposure to violence were sustainable. Children with severe trauma symptoms benefited the most, though maternal psychological problems may for some have hindered recovery. Clinical implications are discussed.
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Affiliation(s)
- Karin Pernebo
- Department of Psychology, Linnaeus University, Växjö, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Mats Fridell
- Department of Psychology, Lund University, S-221 00, Lund, Sweden
| | - Kjerstin Almqvist
- Department of Social and Psychological Sciences, Karlstad University, S-651 88, Karlstad, Sweden
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Smith P, Dalgleish T, Meiser‐Stedman R. Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. J Child Psychol Psychiatry 2019; 60:500-515. [PMID: 30350312 PMCID: PMC6711754 DOI: 10.1111/jcpp.12983] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/19/2023]
Abstract
Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.
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Affiliation(s)
- Patrick Smith
- Department of PsychologyInstitute of Psychiatry Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology, Norwich Medical SchoolUniversity of East AngliaNorwichUK
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Greig A, MacKay T, Ginter L. Supporting the mental health of children and young people: a survey of Scottish educational psychology services. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2019. [DOI: 10.1080/02667363.2019.1573720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anne Greig
- Argyll & Bute Psychological Service, Helensburgh, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Tommy MacKay
- Argyll & Bute Psychological Service, Helensburgh, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Linden Ginter
- Argyll & Bute Psychological Service, Helensburgh, UK
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48
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van Westrhenen N, Fritz E, Vermeer A, Boelen P, Kleber R. Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study. PLoS One 2019; 14:e0210857. [PMID: 30759101 PMCID: PMC6374007 DOI: 10.1371/journal.pone.0210857] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
Aim To evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event. Design A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites). Methods 125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping. Results Results showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth. Conclusion In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.
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Affiliation(s)
- Nadine van Westrhenen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Elzette Fritz
- Department of Educational Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Adri Vermeer
- Department of Education and Pedagogics, Utrecht University, Utrecht, The Netherlands
| | - Paul Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Rolf Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Abstract
While research has demonstrated an association between trauma and mental health, this study examined the association between trauma experienced premigration, during migration, and postmigration, and current mental health status among Latino youth aged 12-17 years old living in the US for < 3 years. Participants reported traumatic events experienced in their home country, during migration, and after settling in the US. Regression models examined trauma experienced at each stage of the migration process predicting current levels of depression, anxiety, and post-traumatic stress disorder. Two-thirds of youth experienced at least one traumatic event, 44% experienced an event once, and 23% experienced two or more traumatic events during migration. Trauma experienced at different migration stages was associated with distinctive mental health outcomes. It is essential that access to culturally sensitive assessment and treatment services be available to ensure transition to a healthy adulthood.
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50
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Lewey JH, Smith CL, Burcham B, Saunders NL, Elfallal D, O’Toole SK. Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:457-472. [PMID: 32318168 PMCID: PMC7163897 DOI: 10.1007/s40653-018-0212-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen's d was small (-0.359) and statistically significant (p < 0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings.
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Affiliation(s)
- Jennifer H. Lewey
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
- Direct Care and Treatment - Forensic Services (DCT-FS), Minnesota Department of Human Services (DHS), St. Peter, MN USA
| | - Christopher L. Smith
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, San Francisco, CA USA
- Youth Opportunities Upheld, Inc. (YOU, Inc.), Worchester, MA USA
| | - Brandi Burcham
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Nia L. Saunders
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Dina Elfallal
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
| | - Siobhan K. O’Toole
- Clinical Psychology Department, California School of Professional Psychology at Alliant International University, 5130 E. Clinton Way, Fresno, CA 93727 USA
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