Abstract
Trauma-focused cognitive behavioral therapy (TF-CBT) is the treatment of choice for traumatized youth, however, follow-up studies are scarce, and treatment effects for co-occurring depression show mixed findings. The aims of this study were to examine whether treatment effects of TF-CBT are maintained at 18 month follow-up and whether degree of co-occurring depression influences treatment effects. As rapid improvement in psychological functioning is warranted for youth, we also investigated whether the symptom trajectory was different for TF-CBT compared to therapy as usual (TAU). The sample consisted of 156 youth (M age = 15.05, 79.50% girls) randomly assigned to TF-CBT or TAU. The youth were assessed for posttraumatic stress symptoms (PTSS), depression, anxiety and general mental health symptoms. Mixed effects analyses followed the symptom courses over 5 time points. Youth receiving TF-CBT maintained their symptom improvement at 18 months follow-up with scores below clinical cut-of on all symptom measures. The most depressed youth had also a significant decline in symptoms that were maintained at follow-up. Symptom trajectories differed as the TF-CBT group reported a more rapid symptom reduction compared to the TAU condition. In the TAU condition, participants received 1.5 times the number of treatment sessions compared to the TF-CBT participants. After 18 months the groups were significantly different on general mental health symptoms only. In conclusion, youth receiving TF-CBT experienced more efficient improvement in trauma related symptoms than youth receiving TAU and these improvements were maintained after 18 months. Also youth experiencing serious co-occurring depression benefitted from TF-CBT.
Similar content being viewed by others
Notes
Details of these results are not shown here, but will be given upon request from the first author.
References
Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1230–1236.
Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: a systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34, 748–757. doi:10.1016/j.childyouth.2012.01.003.
Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: outcome during one year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228–1235.
Cohen, J. A., & Mannarino, A. P. (2006). Treating childhood traumatic grief. New York: Routledge/Taylor & Francis Group.
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2005a). Trauma-focused cognitive-behavioral therapy for sexually abused children. Washington, DC: American Psychological Association.
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005b). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135–145.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Publications.
Cohen, J. A., Jaycox, L. H., Walker, D. W., Mannarino, A. P., Langley, A. K., & DuClos, J. L. (2009). Treating traumatized children after hurricane Katrina: project Fleur-de lisTM. Clinical Child and Family Psychology Review, 12, 55–64.
Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 165, 16–21.
Cohen, J. A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36, 528–541. doi:10.1016/j.chiabu.2012.03.007.
De Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., et al. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric Services, 65, 591–602. doi:10.1176/appi.ps.201300255.
Deblinger, E., Steer, R. A., & Lippmann, J. (1999). Two year follow-up study of CBT for sexually abused children suffering posttraumatic stress symptoms. Child Abuse & Neglect, 23, 1371–1378.
Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474–1484. doi:10.1097/01.chi.0000240839.56114.bb.
Deblinger, E., Cohen, J. A., Mannarino, A. P., Murray, L. A., & Epstein, C. (2008). TF-CBT fidelity checklist. Unpublished instrument. Stratford: UMDNJ-SOM CARES Institute.
Dorsey, S., McLaughlin, K. A., Kerns, S. E. U., Harrison, J. P., Lambert, H. K., Briggs, E. C., et al. (2016). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 1–28. doi:10.1080/15374416.2016.1220309.
Farrell, A. D., Sullivan, T. N., Kliewer, W., Allison, K. W., Erwin, E. H., Meyer, A. L., & Esposito, L. (2006). Peer and school problems in the lives of urban adolescents: frequency, difficulty, and relation to adjustment. Journal of School Psychology, 44, 169–190. doi:10.1016/j.jsp.2006.02.001.
Fisher, L. D., Dixon, D. O., Herson, J., Frankowski, R. K., Hearron, M. S., & Peace, K. E. (1990). Intention to treat in clinical trials. In K. E. Peace (Ed.), Statistical issues in drug research and development (pp. 331–350). New York: Marcel Dekker.
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. (2001). The child PTSD symptom scale: a preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30, 376–384. doi:10.1207/S15374424JCCP3003_9.
Gillies, D., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2012). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database of Systematic Reviews, 12. doi:10.1002/14651858.CD006726.pub2.
Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of trauma-focused cognitive behavioral therapy (Tf-CBT) for children and adolescents: a randomized controlled trial in eight German mental health clinics. Psychotherapy and Psychosomatics, 85, 159–170. doi:10.1159/000442824.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345.
Gupta, S. K. (2011). Intention-to-treat concept: a review. Perspective Clinical Resource, 2, 109–112. doi:10.4103/2229-3485.83221.
Hornik, K. (2012). The R FAC. Retrieved from http://CRAN.R-project.org/doc/FAQ/R-FAQ.html (ISBN 3-9000051-08-9).
Hukkelberg, S. S., & Jensen, T. K. (2011). The dimensionality of posttraumatic stress symptoms and their relationship to depression in children and adolescents. Journal of Traumatic Stress, 24, 326–333. doi:10.1002/jts.20637.
Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. C., Hukkelberg, S. S., Indregard, T., Stormyren, S. D., & Wentzel-Larsen, T. (2013). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child & Adolescent Psychology, 43, 356–369. doi:10.1080/15374416.2013.822307.
Kassam-Adams, N., Marsac, M. L., & Cirilli, C. (2010). Posttraumatic stress disorder symptom structure in injured children: functional impairment and depression symptoms in a confirmatory factor analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 616–625. doi:10.1097/00004583-201006000-00010.
Lang, J. M., Franks, R. P., Epstein, C., Stover, C., & Oliver, J. A. (2015). Statewide dissemination of an evidence-based practice using breakthrough series Collaboratives. Children and Youth Services Review, 55, 201–209. doi:10.1016/j.childyouth.2015.06.005.
Lenz, A. S., & Hollenbaugh, K. M. (2015). Meta-analysis of trauma-focused cognitive behavioral therapy for treating PTSD and co-occurring depression among children and adolescents. Counseling Outcome Research and Evaluation, 6, 18–32.
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012). Trauma-focused cognitive-behavioral therapy for children: sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17, 231–241. doi:10.1177/1077559512451787.
McLeod, B. D., & Weisz, J. R. (2010). The therapy process observational coding system for child psychotherapy strategies scale. Journal of Clinical Child & Adolescent Psychology, 39, 436–443. doi:10.1080/15374411003691750.
Murray, L. K., Cohen, J. A., Ellis, B. H., & Mannarino, A. (2008). Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth. Child and Adolescent Psychiatric Clinics of North America, 17, 585–604.
Murray, L. K., Dorsey, S., Skavenski, S., Kasoma, M., Imasiku, M., Bolton, P., et al. (2013a). Identification, modification, and implementation of an evidence-based psychotherapy for children in a low-income country: the use of TF-CBT in Zambia. International Journal of Mental Health Systems, 7, 1–12. doi:10.1186/1752-4458-7-24.
Murray, L. K., Familiar, I., Skavenski, S., Jere, E., Cohen, J., Imasiku, M., et al. (2013b). An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. Child Abuse & Neglect, 37, 1175–1185. doi:10.1016/j.chiabu.2013.04.017.
Nanni, V., Uher, R., & Danese, A. (2012). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. The American Journal of Psychiatry, 169, 141–151.
NICE. (2005). NICE clinical guideline on post-traumatic stress disorder. Retrieved from http://www.nice.org.uk/Guidance/CG26.
Nixon, R. D. V., Meiser-Stedman, R., Dalgleish, T., Yule, W., Clark, D. M., Perrin, S., & Smith, P. (2013). The child PTSD symptom scale: an update and replication of its psychometric properties. Psychological Assessment, 25, 1025–1031. doi:10.1037/a0033324.
Pinheiro, J., & Bates, D. (2000). Mixed effects models in S and S-plus. New York: Springer-Verlag.
Resnick, M. D., Bearman, P. S., Blum, R., & et al. (1997). Protecting adolescents from harm: findings from the national longitudinal study on adolescent health. JAMA, 278, 823–832. doi: 10.1001/jama.1997.03550100049038.
Rønning, J., Handegaard, B., Sourander, A., & Mørch, W.-T. (2004). The strengths and difficulties self-report questionnaire as a screening instrument in Norwegian community samples. European Child & Adolescent Psychiatry, 13, 73–82. doi:10.1007/s00787-004-0356-4.
Sigel, B. A., Kramer, T. L., Conners-Burrow, N. A., Church, J. K., Worley, K. B., & Mitrani, N. A. (2013). Statewide dissemination of trauma-focused cognitive-behavioral therapy (TF-CBT). Children and Youth Services Review, 35, 1023–1029. doi:10.1016/j.childyouth.2013.03.012.
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37, 156–183. doi:10.1080/15374410701818293.
Smith, P., Perrin, S., Dalgleish, T., Meiser-Stedman, R., Clark, D. M., & Yule, W. (2013). Treatment of posttraumatic stress disorder in children and adolescents. Current Opinion in Psychiatry, 26, 66–72. doi:10.1097/YCO.0b013e32835b2c01.
Wonderlich, S. A., Simonich, H. K., Myers, T. C., LaMontagne, W., Hoesel, J., Erickson, A. L., et al. (2011). Evidence-based mental health interventions for traumatized youth: a statewide dissemination project. Behaviour Research and Therapy, 49, 579–587. doi:10.1016/j.brat.2011.07.003.
Acknowledgements
We would like to thank Tore Wentzel-Larsen for his supervision and advice regarding the statistical analyses.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was founded by The Research Council of Norway (grant.no 190756), the Directorate for Health and Social Affairs, Norwegian Extra Foundation for Health and Rehabiliation. Trial registration: ClinicalTrials.gov Identifier: NCT00635752
Conflict of Interest
The authors declare that they have no conflict of interests.
Ethical Approval
All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Jensen, T.K., Holt, T. & Ormhaug, S.M. A Follow-Up Study from a Multisite, Randomized Controlled Trial for Traumatized Children Receiving TF-CBT. J Abnorm Child Psychol 45, 1587–1597 (2017). https://doi.org/10.1007/s10802-017-0270-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-017-0270-0