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Psychological and psychosocial treatments for children and young people with post‐traumatic stress disorder: a network meta‐analysis

Citation: 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. of Child Psychology and Psychiatry, 17 July 2019

Study Source Journal: https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.13094

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.

 

Craig’s Notes: I have not yet been able to obtain and review the original paper for details at this writing. In the meanwhile I believe here are some of the key elements:

This is a PTSD meta-analysis focuses specifically and children and young people, not adults, not veterans etc.

They included 32 trials of 17 different interventions with a total of 2,260 participants. The authors included “combined somatic/cognitive therapies” but only included EFT/Emotional Freedom Techniques in this category. This is a nice testament to the phraseology that we have been working on with regards to working with US National Certification standards describing Energy Psychology interventions as a whole as Cognitive Somatic Energy Practices.

This meta analyses evaluated previously published studies. As I read this abstract the authors appeared to rate the interventions’ respective effectiveness based on the significance of their effect size with the largest being CT for PTSD and second being the category that includes EFT which is huge when considered this was published in the Journal of Child Psychology and Psychiatry.

  1. Cognitive Therapy for PTSD
  2. Combined somatic/cognitive therapies (THIS CATEGORY INCLUDES EFT)
  3. Child–parent psychotherapy
  4. Combined TF‐CBT/parent training
  5. Meditation
  6. Narrative exposure
  7. Exposure/prolonged exposure
  8. Play therapy
  9. Cohen TF‐CBT/cognitive processing therapy (CPT)
  10. Eye movement desensitisation and reprocessing (EMDR)
  11. Parent training
  12. Group TF‐CBT
  13. Supportive counselling and family therapy