The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth

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Abstract

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one of the most widely disseminated mental health interventions for children and youth. The purpose of this study is to systematically review the evidence of TF-CBT's ability to reduce symptoms of post-traumatic stress, depression and behavior problems in children and youth who have survived trauma. A search was conducted to locate studies that evaluated TF-CBT or interventions highly similar to TF-CBT. Ten studies (twelve articles) were selected for inclusion in three sets of meta-analyses. Findings were consistent amongst meta-analyses; pooled estimates were similar whether we were analyzing the effects of interventions that were highly similar to TF-CBT, or if we were exclusively analyzing the effects of the branded intervention. Results show that there is a significant difference between the TFCBT condition and comparison conditions in its ability to reduce symptoms of PTSD (g = .671), depression (g = .378) and behavior problems (g = .247) immediately after treatment completion. This difference held for PTSD at twelve months after treatment completion (.389) but did not hold for depression or behavior problems. There was not a significant difference between the TF-CBT condition and alternative active control conditions immediately after treatment completion. Therefore, TF-CBT is an effective intervention for the treatment of PTSD in youth.

Highlights

► A search for TF-CBT trials located 1621 references; 12 were included. ► Findings were consistent across 3 sets of meta analyses. ► Pooled estimates show a medium effect size for symptoms of PTSD at immediate post. ► Effects for depression and behavior problems become insignificant after 12 months. ► Differences between TF-CBT and active control conditions were not significant.

Introduction

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one of the most widely disseminated mental health interventions for children and youth (Cohen and Mannarino, 2008, Cohen et al., 2006, Saunders, 2011, Saunders et al., 2010). Despite its popularity, a systematic review of its effects has not yet been published. Systematic reviews are unique in their ability to reveal the overall effects of interventions, pooling and analyzing the results of every trial in which an intervention has been evaluated while considering the quality of each of those trials. The purpose of this study is to systematically review the evidence of TF-CBT's ability to reduce symptoms of post-traumatic stress, depression and behavior problems in children and youth who have survived at least one traumatic event.

Section snippets

What is TF-CBT?

While there are a number of trauma-focused interventions for children that employ cognitive treatment components, clinicians who work with traumatized children tend to be most familiar with the trauma-focused cognitive behavioral intervention developed by Cohen et al. (2006). We refer to this as the branded version of TF-CBT because it has been manualized and widely disseminated in this form. It is a highly structured, conjoint parent/child intervention, consisting of sequential 90-minute

Study inclusion

Our first and most vexing task was to determine which versions of TF-CBT and which TF-CBT studies should be included in the systematic review. A cursory examination of the studies cited by the treatment developers and on the TF-CBT website at the Medical University of South Carolina revealed that many of the studies often cited as evidence of TF-CBT's effects did not use the branded version of TF-CBT. Several used interventions similar to TF-CBT, but those interventions did not use all of the

Studies selected for inclusion

Table 3 provides descriptions of the ten studies included in this review, and the analyses in which each study was included. Of the ten studies, three evaluated the branded version of TF-CBT. The other seven interventions, (1) Overshadowing the Threat of Terrorism (OTT) (Berger et al., 2007); (2) Recovering From Abuse Program (RAPP) (Celano et al., 1996), (3) Mother and Child Cognitive Behavioral Therapy (Deblinger et al., 1996), (4) Family Cognitive Behavioral Therapy (King et al., 2000), (5)

Discussion

This is the first systematic review of TF-CBT for children and youth to provide pooled estimates of the intervention's ability to reduce symptoms of PTSD, depression and behavior problems. The pooled estimates strongly suggest that TF-CBT is more effective than attention control, standard community care and waitlist control conditions at reducing symptoms of PTSD in youth, both immediately and 12 months after the termination of treatment. Therefore, enthusiasm for this intervention appears to be

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      However, we only know of one review that set out to evaluate the TF-CBT according to Cohen et al. and calculated pooled ES for PTSS but it was published 10 years ago (Cary & McMillen, 2012). The systematic review by Cary and McMillen (2012) is commonly referred to when describing the evidence base of TF-CBT. The authors distinguished between TF-CBT according to Cohen et al. and studies that did not comprise all but at least 4–5 of the most relevant treatment components.

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