Nearly a year ago I blogged about a promising but small RCT, which showed that Trauma-focused cognitive behavioural therapy may help young children with post traumatic stress disorder (PTSD). The blog generated a fair bit of feedback from readers and so I’ve been on the look out ever since for a systematic review that brings together all of the trials in this area.

The Cochrane Depression, Anxiety and Neurosis Group have today published the review I’ve been waiting for and it concludes that there is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment.

The review team searched for randomised controlled trials that compared psychological treatments with other treatments (controls, drug therapies or other treatments) in children or adolescents who had suffered a traumatic event or had been diagnosed with PTSD. They scoured all of the databases, registers, references lists and reviews that you would expect and found 14 RCTs (including a total of 758 patients) to include in their meta-analysis.

The talking treatments included in the studies were:

• Cognitive behavioural therapy (CBT)
• Exposure-based therapy
• Psychodynamic psychotherapy
• Narrative therapy
• Supportive counselling
• Eye movement desensitisation and reprocessing (EMDR)

Data was analysed using the usual Cochrane approach of calculating the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found, they used a random-effects model.

The participants in the study had experienced different types of trauma, including:

• Sexual abuse
• Civil violence
• Natural disasters
• Domestic violence
• Motor vehicle accidents

Here’s what they found:

• Within 1 month of completing psychotherapy, across all treatments, compared to control:
  • Improvement was significantly better (3 studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85)
  • Symptoms of PTSD improved (7 studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42)
  • Anxiety improved (3 studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13)
  • Depression improved (5 studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36)
• CBT was the most effective treatment studied in the review
• Compared to control, CBT was significantly better:
  • Up to 1 month (2 studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14)
  • Up to 1 year (1 study, n = 25, OR 8.00, 95% CI 1.21 to 52.69)
• CBT had a positive impact on PTSD symptom scores, which were significantly lower for up to one year:
  • Up to 1 month (3 studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89)
  • Up to 1 year (1 study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01)
• CBT also had a positive impact on depression scores, which were lower for up to 1 month (3 studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13)
• No side effects were identified.

Donna Gillies, the researcher leading the systematic review team said:

There is fair evidence for the effectiveness of psychological therapies, particularly cognitive behavioural therapy, in treating post-traumatic stress disorder in children. However, more effort needs to be devoted to increasing follow-up in children so we can understand whether these therapies are making a difference in the long-term.

More trials comparing the various psychological therapies are required to find out whether specific psychological therapies are more effective for the treatment of PTSD in children and adolescents.

Link

Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (PDF). Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006726. DOI: 10.1002/14651858.CD006726.pub2.