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Hoeboer CM, Kullberg MLJ, Oprel DA, Schoorl M, van Minnen A, Antypa N, Mouthaan J, de Kleine RA, van der Does W. Impact of three variants of prolonged exposure therapy on comorbid diagnoses in patients with childhood abuse-related PTSD. Cogn Behav Ther 2024; 53:377-393. [PMID: 38411129 PMCID: PMC11090154 DOI: 10.1080/16506073.2024.2318729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
Recent studies indicated that Prolonged Exposure (PE) is safe and effective for posttraumatic stress disorder (PTSD). It is unclear whether PE also leads to a reduction in comorbid diagnoses. Data from a large randomized controlled trial (N = 149) on the effects of three variants of PE for PTSD were used. We examined the treatment effects on co-morbid diagnoses of depressive, anxiety, obsessive compulsive, substance abuse, psychotic, eating and personality disorders in a sample of patients with PTSD related to childhood abuse. Outcomes were assessed with clinical interviews at baseline, post-treatment and at 6- and 12-month follow-up. All variants of PE led to a decrease from baseline to post-treatment in diagnoses of depressive, anxiety, substance use and personality disorders. Improvements were sustained during follow-up. We found an additional decrease in the number of patients that fulfilled the diagnostic criteria of a depressive disorder between 6- and 12-month follow-up. No significant changes were observed for the presence of OCD, psychotic and eating disorders. Findings suggest that it is effective to treat PTSD related to childhood abuse with trauma-focused treatments since our 14-to-16 weeks PE for PTSD resulted in reductions in comorbid diagnoses of depressive, anxiety, substance use and personality disorders.
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Affiliation(s)
- Chris M. Hoeboer
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Danielle A.C. Oprel
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
| | - Maartje Schoorl
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Agnes van Minnen
- PSYTREC, Bilthoven, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Joanne Mouthaan
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Rianne A. de Kleine
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
| | - Willem van der Does
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- PsyQ, Parnassia Groep, The Hague, The Netherlands
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Alpert E, Shotwell Tabke C, Cole TA, Lee DJ, Sloan DM. A systematic review of literature examining mediators and mechanisms of change in empirically supported treatments for posttraumatic stress disorder. Clin Psychol Rev 2023; 103:102300. [PMID: 37320986 DOI: 10.1016/j.cpr.2023.102300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
Despite the availability of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), relatively little is known regarding these treatments' mechanisms of change. This systematic review moves beyond previous reviews by summarizing the findings and reviewing the methodological quality of literature that specifically examined mediators/mechanisms of change in ESTs for PTSD. Studies were included if they were written in English, empirical, peer-reviewed, claimed to study mediators/mechanisms of a recommended PTSD treatment, measured the mediator/mechanism during or before and after treatment, and included a posttreatment PTSD or global outcome (e.g., functioning). PsycINFO and PubMed were searched on October 7, 2022. Two coders screened and coded studies. Sixty-two eligible studies were identified. The most consistent mediator/mechanism was reduction in negative posttraumatic cognitions, followed by between-session extinction and decreased depression. Only 47% of studies measured the mediator/mechanism before the outcome and measured the mediator/mechanism and outcome at least three times, and 32% also used growth curve modeling to establish temporal precedence of change in the mediator/mechanism and outcome. Many of the mediators/mechanisms examined had weak or no empirical support. Results highlight the need for improved methodological rigor in treatment mediator and mechanism research. Implications for clinical care and research are discussed. PROSPERO ID: 248088.
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Affiliation(s)
- Elizabeth Alpert
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America.
| | - Chelsea Shotwell Tabke
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Travis A Cole
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America
| | - Daniel J Lee
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Denise M Sloan
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
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Caro P, Turner W, Caldwell DM, Macdonald G. Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev 2023; 6:CD013361. [PMID: 37279309 PMCID: PMC10243720 DOI: 10.1002/14651858.cd013361.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Following sexual abuse, children and young people may develop a range of psychological problems, including anxiety, depression, post-traumatic stress disorder (PTSD), and a range of behaviour problems. Those working with children and young people experiencing these problems may use one or more of a range of psychological approaches. OBJECTIVES To assess the relative effectiveness of psychological interventions compared to other treatments or no treatment controls, to overcome psychological consequences of sexual abuse in children and young people up to 18 years of age. Secondary objectives To rank psychotherapies according to their effectiveness. To compare different 'doses' of the same intervention. SEARCH METHODS In November 2022 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and two trials registers. We reviewed the reference lists of included studies, alongside other work in the field, and communicated with the authors of included studies. SELECTION CRITERIA We included randomised controlled trials comparing psychological interventions for sexually abused children and young people up to 18 years old with other treatments or no treatments. Interventions included: cognitive behavioural therapy (CBT), psychodynamic therapy, family therapy, child centred therapy (CCT), and eye movement desensitisation and reprocessing (EMDR). We included both individual and group formats. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias for our primary outcomes (psychological distress/mental health, behaviour, social functioning, relationships with family and others) and secondary outcomes (substance misuse, delinquency, resilience, carer distress and efficacy). We considered the effects of the interventions on all outcomes at post-treatment, six months follow-up and 12 months follow-up. For each outcome and time point with sufficient data, we performed random-effects network and pairwise meta-analyses to determine an overall effect estimate for each possible pair of therapies. Where meta-analysis was not possible, we report the summaries from single studies. Due to the low number of studies in each network, we did not attempt to determine the probabilities of each treatment being the most effective relative to the others for each outcome at each time point. We rated the certainty of evidence with GRADE for each outcome. MAIN RESULTS We included 22 studies (1478 participants) in this review. Most of the participants were female (range: 52% to 100%), and were mainly white. Limited information was provided on socioeconomic status of participants. Seventeen studies were conducted in North America, with the remaining studies conducted in the UK (N = 2), Iran (N = 1), Australia (N = 1) and Democratic Republic of Congo (N = 1). CBT was explored in 14 studies and CCT in eight studies; psychodynamic therapy, family therapy and EMDR were each explored in two studies. Management as usual (MAU) was the comparator in three studies and a waiting list was the comparator in five studies. For all outcomes, comparisons were informed by low numbers of studies (one to three per comparison), sample sizes were small (median = 52, range 11 to 229) and networks were poorly connected. Our estimates were all imprecise and uncertain. Primary outcomes At post-treatment, network meta-analysis (NMA) was possible for measures of psychological distress and behaviour, but not for social functioning. Relative to MAU, there was very low certainty evidence that CCT involving parent and child reduced PTSD (standardised mean difference (SMD) -0.87, 95% confidence intervals (CI) -1.64 to -0.10), and CBT with only the child reduced PTSD symptoms (SMD -0.96, 95% CI -1.72 to -0.20). There was no clear evidence of an effect of any therapy relative to MAU for other primary outcomes or at any other time point. Secondary outcomes Compared to MAU, there was very low certainty evidence that, at post-treatment, CBT delivered to the child and the carer might reduce parents' emotional reactions (SMD -6.95, 95% CI -10.11 to -3.80), and that CCT might reduce parents' stress. However, there is high uncertainty in these effect estimates and both comparisons were informed only by one study. There was no evidence that the other therapies improved any other secondary outcome. We attributed very low levels of confidence for all NMA and pairwise estimates for the following reasons. Reporting limitations resulted in judgements of 'unclear' to 'high' risk of bias in relation to selection, detection, performance, attrition and reporting bias; the effect estimates we derived were imprecise, and small or close to no change; our networks were underpowered due to the low number of studies informing them; and whilst studies were broadly comparable with regard to settings, the use of a manual, the training of the therapists, the duration of treatment and number of sessions offered, there was considerable variability in the age of participants and the format in which the interventions were delivered (individual or group). AUTHORS' CONCLUSIONS There was weak evidence that both CCT (delivered to child and carer) and CBT (delivered to the child) might reduce PTSD symptoms at post-treatment. However, the effect estimates are uncertain and imprecise. For the remaining outcomes examined, none of the estimates suggested that any of the interventions reduced symptoms compared to management as usual. Weaknesses in the evidence base include the dearth of evidence from low- and middle-income countries. Further, not all interventions have been evaluated to the same extent, and there is little evidence regarding the effectiveness of interventions for male participants or those from different ethnicities. In 18 studies, the age ranges of participants ranged from 4 to 16 years old or 5 to 17 years old. This may have influenced the way in which the interventions were delivered, received, and consequently influenced outcomes. Many of the included studies evaluated interventions that were developed by members of the research team. In others, developers were involved in monitoring the delivery of the treatment. It remains the case that evaluations conducted by independent research teams are needed to reduce the potential for investigator bias. Studies addressing these gaps would help to establish the relative effectiveness of interventions currently used with this vulnerable population.
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Affiliation(s)
- Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - William Turner
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Su YJ. PTSD and depression in adult burn patients three months postburn: The contribution of psychosocial factors. Gen Hosp Psychiatry 2023; 82:33-40. [PMID: 36933318 DOI: 10.1016/j.genhosppsych.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Burn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn. METHODS Participants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn. RESULTS Three months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM-5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes. CONCLUSION A sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology.
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Affiliation(s)
- Yi-Jen Su
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
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Lange BCL, Nelson A, Lang JM, Stirman SW. Adaptations of evidence-based trauma-focused interventions for children and adolescents: a systematic review. Implement Sci Commun 2022; 3:108. [PMID: 36209138 PMCID: PMC9548160 DOI: 10.1186/s43058-022-00348-5] [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] [Received: 03/29/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based interventions (EBIs) to address the adverse outcomes stemming from these experiences. Though EBIs are intended to be delivered according to set parameters, these EBIs are frequently adapted. However, little is known about existing adaptations of EBIs for children who experienced PTEs or other adversities. As such, this review aimed to determine: (1) why existing EBIs designed to address PTEs and other adversities experienced by children are adapted, (2) what processes are used to determine what elements should be adapted, and (3) what components of the intervention are adapted. METHODS Nine academic databases and publicly available search engines were used to identify academic and grey literature. Initial screening, full-text review, data extraction, and quality determinations were completed by two members of the research team. Data were synthesized narratively for each adapted EBI by research question. RESULTS Forty-two studies examining the adaptations of nine different EBIs were located, with Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools being the most commonly adapted EBIs. Most frequently, EBIs were adapted to improve fit with a new population and to address cultural factors. Most commonly, researchers in combination with others made decisions about adapting interventions, though frequently who was involved in these decisions was not described. Common content adaptations included the addition of intervention elements and the tailoring/tweaking/refining of intervention materials. Common contextual adaptations included changes to the intended population, changes to the channel of treatment delivery, and changes to who administered the intervention. CONCLUSIONS Most published studies of EBI adaptions have been developed to improve fit and address cultural factors, but little research is available about adaptations made by clinicians in day-to-day practice. Efforts should be made to evaluate the various types of adaptations and especially whether adaptations improve access to services or improve child outcomes in order to ensure that all children exposed to trauma can access effective treatment. TRIAL REGISTRATION The protocol for this systematic review was published with PROSPERO (CRD42020149536).
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Affiliation(s)
- Brittany C. L. Lange
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Ashley Nelson
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Jason M. Lang
- grid.475976.eChild Health and Development Institute of Connecticut, Inc., Farmington, USA ,grid.208078.50000000419370394Department of Psychiatry, UCONN Health, Farmington, USA ,grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
| | - Shannon Wiltsey Stirman
- grid.429666.90000 0004 0374 5948National Center for PTSD, Washington, D.C., USA ,grid.168010.e0000000419368956Stanford University, Stanford, USA
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Wiener SJ, Fitzgerald S, Einhorn H. A trauma-informed guide to caring for adolescents following sexual assault. Curr Opin Pediatr 2021; 33:354-360. [PMID: 34039900 DOI: 10.1097/mop.0000000000001030] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings. RECENT FINDINGS All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality). SUMMARY A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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7
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Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kangaslampi S, Peltonen K. Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00478-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractPsychological interventions can alleviate posttraumatic stress symptoms (PTSS). However, further development of treatment approaches calls for understanding the mechanisms of change through which diverse interventions affect PTSS. We systematically searched the literature for controlled studies of mechanisms of change in psychological interventions for PTSS. We aimed to detect all empirically studied mechanisms and evaluate the level of evidence for their role in the alleviation of PTSS. We identified 34 studies, of which nine were among children. We found evidence for improvements in maladaptive posttraumatic cognitions as a general mechanism of change involved in diverse interventions, among both adults and children. We also found some preliminary evidence for increases in mindfulness as a mechanism of change in mindfulness- and spiritually-oriented interventions among adults. We found scant, mixed empirical evidence for other mechanisms of change. Notably, studies on changes in traumatic memories as a mechanism of change were lacking, despite clinical emphasis on their importance. A major limitation across reviewed studies was that most could not establish temporal order of changes in mechanisms and PTSS. Including thorough analyses of mechanisms of change beyond cognitions in all future trials and improving the reporting of findings would aid the development and implementation of even more effective interventions.
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9
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Khan A, Khan S, Shah ST. Efficacy of eye movement desensitization & reprocessing versus cognitive behavioral therapy in Post-Traumatic Stress and Depressive Symptoms: Study protocol for a Randomized Controlled Trial. Contemp Clin Trials Commun 2019; 16:100439. [PMID: 31517134 PMCID: PMC6737300 DOI: 10.1016/j.conctc.2019.100439] [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] [Received: 04/08/2019] [Revised: 07/23/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022] Open
Abstract
Post-Traumatic Stress Disorder(PTSD) develops after exposure to or witnessing traumatic events. PTSD is highly comorbid and individuals with PTSD usually report Depressive Symptoms(DS). Common treatment choices for PTSD and DS are either EMDR or CBT, however, little is known about their comparative efficacy, especially in Pakistan. Therefore, this Randomized Controlled Trial(RCT) aims at determining the comparative efficacy of EMDR vs CBT in Pakistan. This study will also examine the association between reduction in symptoms of PTSD and DS over course of treatment. In this regard, two arms Crossover Randomized Controlled Trial(RCT) with Repeated Measures Design will be selected. This study will be conducted at two rehabilitation centers and patients will be screened at Time:01, baseline; Time:02, during treatment; Time:03, post treatment and Time:04, 06 months follow-up. All analyses will be performed according to intention-to-treat principle. Variations in symptoms will be analysed by using descriptive statistics, χ 2 tests, t-tests, and one way ANOVA. To examine changes in PTSD and DS across time and to check efficacy of each treatment, a series of Linear Mixed Models will be run. Furthermore, a series of multi-level lagged mediation analysis will be performed to check bi-directional mediation between changes PTSD and DS over time. This protocol has outlined the rationale for determining efficacy of EMDR and CBT in Pakistan. It will help in answering a broad range of questions concerning efficacy of newly developed evidence-based treatments. Moreover, it may also guide future research on the treatment of PTSD and DS in the developing countries.
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Affiliation(s)
- Anwar Khan
- Department of Social Sciences, Khushal Khan Khattak University, Karak, Pakistan
| | - Salim Khan
- Department of Psychiatry, Ayub Medical College, Abbotabad, Pakistan
| | - Syed Tahir Shah
- Department of Psychiatry, Ayub Medical College, Abbotabad, Pakistan
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10
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Moring JC, Nason E, Hale WJ, Wachen JS, Dondanville KA, Straud C, Moore BA, Mintz J, Litz BT, Yarvis JS, Young-McCaughan S, Peterson AL, Resick PA. Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members. J Affect Disord 2019; 256:541-549. [PMID: 31280079 PMCID: PMC6750963 DOI: 10.1016/j.jad.2019.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/07/2019] [Accepted: 06/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among active duty service members and veterans with PTSD, depression is the most commonly diagnosed comorbid psychiatric condition. More research is warranted to investigate the relationship between PTSD and depression to improve treatment approaches. Byllesby et al. (2017) used confirmatory factor analyses in a sample of trauma-exposed combat veterans with PTSD and found that only the general distress factor, and not any specific symptom cluster of PTSD, predicted depression. This study seeks to replicate Byllesby et al. (2017) in a sample of treatment-seeking active duty soldiers. METHODS Confirmatory factor analyses, bifactor modeling, and structural equation modeling (SEM) were used with data gathered at pretreatment and posttreatment as part of a large randomized clinical trial. RESULTS Confirmatory factor analyses and bifactor modeling demonstrated that PTSD symptom clusters, Negative Alterations in Cognition and Mood (NACM) and Alterations in Arousal and Reactivity (AAR), as well as the general distress factor significantly predicted depression at pretreatment and posttreatment. LIMITATIONS The current study was predominantly male, limiting the generalizability to female service members with PTSD. Also, self-report measures were used, which may introduce response-bias. CONCLUSIONS The current study did not replicate Byllesby et al. (2017). Results demonstrated that the relationship between PTSD and depression among active duty service members can be explained by both transdiagnostic factors and disorder-specific symptoms.
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Affiliation(s)
- John C. Moring
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Corresponding author: John C. Moring, Department
of Psychiatry, University of Texas Health Science Center at San Antonio, 7550
IH-10 West, Suite 1325, San Antonio, TX 78229, USA. Tel.: +1 210-562-6700. Fax:
+1 210-562-6710. (J.C. Moring)
| | - Erica Nason
- School of Social Work, Texas State University, San Marcos,
TX, USA
| | - Willie J. Hale
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jennifer Schuster Wachen
- National Center for PTSD, VA Boston Healthcare System,
Boston, MA, USA,Deparment of Psychiatry, Boston University School of
Medicine, Boston, MA, USA
| | - Katherine A. Dondanville
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Casey Straud
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Brian A. Moore
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Epidemiology and Biostatistics, University of
Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brett T. Litz
- Deparment of Psychiatry, Boston University School of
Medicine, Boston, MA, USA,Massachusetts Veterans Epidemiological Research and
Information Center, VA Boston Healthcare System, Boston, MA, USA,Department of Psychological and Brain Sciences, Boston
University, Boston, MA, USA
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army
Medical Center, Fort Hood, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health
Science Center at San Antonio, San Antonio, TX, USA,Department of Psychology, University of Texas at San
Antonio, San Antonio, TX, USA,Research and Development Service, South Texas Veterans
Health Care System, San Antonio, TX, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, NC, USA
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Peltonen K, Kangaslampi S. Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy. Eur J Psychotraumatol 2019; 10:1558708. [PMID: 30693077 PMCID: PMC6338259 DOI: 10.1080/20008198.2018.1558708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/26/2018] [Accepted: 12/01/2018] [Indexed: 11/02/2022] Open
Abstract
Background and Objective: Millions of children and adolescents worldwide suffer from post-traumatic stress disorder (PTSD) and other problems due to prolonged exposure to traumatizing events. Forms of cognitive-behavioural therapy are the most commonly used treatment for PTSD, but evidence from sophisticated studies in clinical settings among children is limited. Method: This multicentre, parallel, non-blinded, pragmatic randomized controlled trial assessed the effectiveness of narrative exposure therapy (NET) in traumatized children and adolescents. Fifty 9-17-year-old participants, who had experienced prolonged traumatic conditions in the form of refugeedom or family violence and suffered from PTSD symptoms, were randomized into NET (n = 29) and treatment as usual (TAU; n = 21) active control groups. The objective was to determine whether NET can be feasibly implemented within the existing healthcare system of a high-income country and whether it would reduce mental health problems, especially PTSD, and increase resilience, in children and adolescents with multiple traumas more effectively than TAU. We hypothesized that NET would be more effective than TAU in reducing symptoms and increasing resilience. Results: Analysis of variance revealed that PTSD and psychological distress, but not depression symptoms, decreased regardless of treatment group. Resilience increased in both groups. Within-group analyses showed that the decrease in PTSD symptoms was significant in the NET group only. The effect sizes were large in NET but small in TAU. Concerning PTSD symptom cut-off scores, the reduction in the share of participants with clinical-level PTSD was significant in the NET group only. Intention-to-treat analyses using linear mixed models confirmed these results. Conclusions: Despite its shortcomings, this study gives preliminary support for the safety, effectiveness, and usefulness of NET among multiply traumatized children and adolescents in clinical settings. Close attention must be paid to the implementation of the new intervention as an everyday tool in healthcare.
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Affiliation(s)
- Kirsi Peltonen
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Samuli Kangaslampi
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
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Kangaslampi S, Garoff F, Peltonen K. Narrative exposure therapy for immigrant children traumatized by war: study protocol for a randomized controlled trial of effectiveness and mechanisms of change. BMC Psychiatry 2015; 15:127. [PMID: 26081580 PMCID: PMC4469253 DOI: 10.1186/s12888-015-0520-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Millions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war. METHODS/DESIGN We are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9-17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions. DISCUSSION The results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children. TRIAL REGISTRATION ClinicalTrials.gov NCT02425280 . Registered 15 April 2015.
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Affiliation(s)
- Samuli Kangaslampi
- School of Social Sciences and Humanities/Psychology, FI-33014, University of Tampere, Tampere, Finland.
| | - Ferdinand Garoff
- Institute of Behavioural Sciences/Psychology, FI-00014, University of Helsinki, Helsinki, Finland.
| | - Kirsi Peltonen
- School of Social Sciences and Humanities/Psychology, FI-33014, University of Tampere, Tampere, Finland.
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