Ifigeneia Mavranezouli1,2, Odette Megnin-Viggars1,2, Caitlin Daly3, Sofia Dias3, Sarah Stockton2, Richard Meiser-Stedman4, David Trickey5, Stephen Pilling1,2. 1. Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. 2. National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK. 3. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 4. Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK. 5. The Anna Freud Centre, The Kantor Centre of Excellence, London, UK.
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.
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.
Authors: Ifigeneia Mavranezouli; Odette Megnin-Viggars; Nick Grey; Gita Bhutani; Jonathan Leach; Caitlin Daly; Sofia Dias; Nicky J Welton; Cornelius Katona; Sharif El-Leithy; Neil Greenberg; Sarah Stockton; Stephen Pilling Journal: PLoS One Date: 2020-04-30 Impact factor: 3.240
Authors: Alison Salloum; Yuanyuan Lu; Henian Chen; Troy Quast; Judith A Cohen; Michael S Scheeringa; Kristen Salomon; Eric A Storch Journal: J Am Acad Child Adolesc Psychiatry Date: 2022-01-12 Impact factor: 13.113
Authors: Briana S Last; Simone H Schriger; Carter E Timon; Hannah E Frank; Alison M Buttenheim; Brittany N Rudd; Sara Fernandez-Marcote; Carrie Comeau; Sosunmolu Shoyinka; Rinad S Beidas Journal: Implement Sci Commun Date: 2021-01-11
Authors: Anke de Haan; Caitlin Hitchcock; Richard Meiser-Stedman; Markus A Landolt; Isla Kuhn; Melissa J Black; Kristel Klaus; Shivam D Patel; David J Fisher; Tim Dalgleish Journal: BMJ Open Date: 2021-02-24 Impact factor: 2.692