Trauma Focused Cognitive Behavioral Therapy Reduces Pediatric PTSD

Pediatric patients with posttraumatic stress disorder (PTSD) may benefit most from trauma-focused cognitive behavior therapies (TF-CBTs) in the short-, mid-, and long-term, according to systematic review and network meta-analysis findings published in JAMA Psychiatry.

In recent years, the number of randomized clinical trials (RCTs) examining psychological interventions for pediatric PTSD has increased significantly, creating a new need for a comprehensive systematic review of the available research.

To that aim, researchers conducted conducted a systematic review and network meta-analysis searching the Web of Science, MEDLINE, PsycINFO, and PTSD-pubs from inception until January 2024. They examined psychological interventions for pediatric PTSD (full or subthreshold) and including at least 10 participants per arm.

Overall, 70 RCTs were included in analyses (N=5528 patients) among which interventions were delivered individually in 59% and involved parents or primary caregivers in 41% (mean [SD] number of total sessions, 10 [5]; mean [SD] treatment duration, 11 [6.5] hours [total sessions x length]). Follow-up data was assessed in 40 RCTs. At baseline, 3979 participants met diagnostic criteria for full PTSD (reported in 52/70 trials); 57 trials involved mixed sex samples; 4 trials boys only; 9 trials girls only. Across all trials, girls self-identified as 60% of participants; mean (SD) age, 12.21 (3.08) years.

Almost three-quarters of the RCTs (74%) explored TF-CBTs. Compared with passive control conditions, significantly larger reductions in pediatric PTSD at treatment end point were associated with TF-CBTs (Hedges g, 1.06; 95% CI, 0.86-1.26); multidisciplinary treatments (MDTs; g, 0.88; 95% CI, 0.53-1.23); eye movement desensitization and reprocessing (EMDR; g, 0.86; 95% CI, 0.54-1.18); and non-trauma-focused interventions (g, 0.95; 95% CI, 0.62-1.28); (all P<.001).

Across all sensitivity analyses and relative to both active and passive control conditions, TF-CBTs were associated with short-term reductions in pediatric PTSD. Sensitivity analyses including only trials with parental involvement showed TF-CBTs vs non-trauma-focused interventions were associated with significantly greater reductions in pediatric PTSD (g, 0.35; 95% CI, 0.04-0.66; P=.03).

Results for long-term data (6-24 months posttreatment) and mid-term data (up to 5 months posttreatment) were similar, although the researchers noted MDTs and EMDR studies lacked sufficient long-term data, and passive control conditions were also lacking at long-term.

“This study presents robust evidence indicating that psychological treatments, and in particular TF-CBTs, are associated with significant reductions in pediatric PTSD,” study authors concluded.

Systematic review and meta-analysis study limitations include inconsistencies regarding mid-term outcomes, no differentiation in analysis between children and adolescents, and significant heterogeneity within and between comparison dyads. Additionally, relatively low rates of reported intention-to-treat data.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor