Treatment of post-traumatic stress disorder in children using cognitive behavioural writing therapy

Vil Du?! incorporation of a serious game in therapy for sexually abused children and adolescents

BACKGROUND

Talking about experiences of sexual abuse in therapy is difficult for children and adolescents, amongst others due to a lack of vocabulary to describe the situation, avoidance, or feelings of shame, fear, and self-blame. The serious game Vil Du?! was developed to help children open up about sexual experiences. Vil Du?! is a non-verbal communication game, which resembles a dress-up game, in which children can show the therapist what happened to them. The current study examined how and for which therapy components Vil Du?! was used by therapists.

METHODS

We used a mixed-methods triangulation design. Therapists filled out online surveys about the use of Vil Du?! with 23 clients (M_age = 11.38 years, SD = 3.96; 61 % female). We also conducted semi-structured interviews with 10 therapists. The data were analyzed in SPSS (quantitative) and Nvivo (qualitative) following the stepwise guidelines of Zhang and Wildemuth.

RESULTS

Merged qualitative and quantitative data revealed that therapists acknowledged the usefulness of Vil Du?! mostly for the therapy components trauma narration and processing, and psycho-education about sexuality. In addition, Vil Du?! might be most useful for clients who have difficulty with disclosing sexual abuse experiences, due to limited verbal abilities or feelings of guilt, shame, avoidance, and tension.

CONCLUSIONS

Recommendations from this study were incorporated in a user manual as a first step toward more systematic and broad implementation of Vil Du?! in the treatment of young sexual abuse victims. A next step is to test whether implementing Vil Du?! in therapy is effective in reducing the negative mental health consequences of sexual abuse for children and adolescents.

Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial

BACKGROUND

With few RCTs having compared active treatments for paediatric PTSD, little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments.

OBJECTIVE

To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Cognitive Behavioural Writing Therapy (CBWT).

METHOD

Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8-18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child's baseline sociodemographic and clinical characteristics, and parent's psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups.

RESULTS

At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile.

CONCLUSIONS

The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (<4 hours) of both treatments, the present findings suggest a focus on implementation and dissemination, rather than tailoring, of evidence-based trauma-focused treatments for paediatric PTSD tied to a single event.

Efficacy of EMDR Therapy for Children With PTSD: A Review of the Literature

The rationale is synthesized for the urgency of empirical studies demonstrating the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with posttraumatic stress disorder (PTSD), symptoms of PTSD, or other trauma-related symptoms. This literature review examined 15 studies (including nine randomized clinical trials) that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured. A methodological analysis identified limitations in most studies, reducing the value of these findings. Despite these shortcomings, the methodological strength of the identified studies has increased over time. The review also summarized three meta-analyses. The need for additional rigorous research is apparent, and in order to profit from experiences of the past, the article provides some guidelines for clinicians seeking to conduct future research in their agencies.

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.

Meta-analytic review of psychological interventions for children survivors of natural and man-made disasters

Although many post-disaster interventions for children and adolescent survivors of disaster and terrorism have been created, little is known about the effectiveness of such interventions. Therefore, this meta-analysis assessed PTSD outcomes among children and adolescent survivors of natural and man-made disasters receiving psychological interventions. Aggregating results from 24 studies (total N=2630) indicates that children and adolescents receiving psychological intervention fared significantly better than those in control or waitlist groups with respect to PTSD symptoms. Moderator effects were also observed for intervention package, treatment modality (group vs. individual), providers' level of training, intervention setting, parental involvement, participant age, length of treatment, intervention delivery timing, and methodological rigor. Findings are discussed in detail with suggestions for practice and future research.

Evidence-based treatments for traumatized children and adolescents

This article reviews recent advances in empirically supported psychotherapeutic treatments for children and adolescents experiencing trauma and provides a brief summary of available interventions, as well as a context for their use. We highlight the American Academy of Child and Adolescent Psychiatry's recent practice guidelines for trauma treatment and discuss their implications for clinicians, including the benefits of involving caregivers in treatment and the rationale for using practices that are specifically trauma-focused as first-line intervention. Finally, we discuss the status of research on the real-world implementation of these therapies and the need for further research, particularly regarding clinician knowledge and use of empirically supported practices, potential stepped-care approaches to trauma treatment, and the need to reduce attrition in child trauma research and practice.