LITERATURE REVIEW 2
Literature Review: PTSD
Tania Gonzalez Diaz
Miller and Campion (2016) conducted a meta-analysis of 74 studies to evaluate the effectiveness of PTSD interventions for children exposed to violence. Using a social ecological framework, the investigators examined the relationships between treatment characteristics such as group or individual treatments and sample traits in terms of child trauma history. Study results indicated that single therapy interventions or skills building or cognitive behavior therapy are more effective treatments although the treatment does not work well for children with severe forms of trauma. These aspects led the researchers to conclude that treatmentsshould take into consideration children’s social contexts that may hamper treatment progress in very young children and examine how to develop effective group interventions that can be delivered in mass trauma settings.
In a randomized controlled trial, Eslinger, Sprang, and Otis (2015) conducted a research in a foster care setting to examine the association between different types of traumas children are exposed to child gender placement status and treatment received and the outcome of end of treatment scores. 134 children aged between 2 and 12 years were administered Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternateversion at baseline and end of treatment. The participants received empirically based interventions of either TF-CBT or parent child interaction therapy. Results of the ANCOVA analyses revealed that substantial differences in externalizing and overall problem behavior scores were shown at the end of treatment, mainly by child age. Older children revealed higher levels of externalization and overall behavior scores at the end of treatment in comparison with the younger children in the sample. In a different study that involved pre-experimental single group pretest–posttest design, Dauber, Lotsos, and Pulido (2015) described a one group pre-test and posttest evaluation of children who experienced complex trauma of various types. The researchers examined changes in traumatic stress and co-occurring emotional behavioral symptoms. Study results indicated significant changes in anxiety symptoms related to depression, anger, dissociation, and sexual issues following exposure to treatment. Post-traumatic stress symptoms were relived and declined in children after treatment although this did not reach any statistical significance.
Children exposed to trauma and post-traumatic stress need treatment to prevent prolonged effects. To investigate and compare theeffectiveness of EMDR with TF-CBT, Diehle, Opmeer, Boer, Mannarino, and Lindauer (2015) enrolled 48 children aged between 8 and 18 ears into a randomized controlled trial. The children were randomly assigned to either TF-CBT or EMDR therapies and PTSS as the primary outcomes was measured using the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA). The secondary outcomes were parental reports PTSD diagnosis status and questionnaires on comorbid issues. The children’s revised Impact of Event Scale was administered during treatment and indicated significant reductions form pre to post treatment on the CAPS-CA, although the difference was not statistically significant. Parents of children treated with TF-CBT indicated and reported a significant reduction of comorbid depressive and hyperactive issues. TF-CBT and EMDR were seen as effective in reducing PTSS symptoms in children.
Children experiencing mental health problems require effective and safe treatment interventions to support their current and future social and emotional development to prevent emotional dysfunctions and social deficits. Although psychotropic drugs are the initial treatment choice and preference, psychosocial and psychotherapy interventions are essential to support traumatized children’s mental health. In their current study that used German wide data, Abbas, Ihle, Adler, Engel, Günster, Holtmann, … and Schubert (2017) carried out a systematic review to investigate utilization of psychotherapy and psychosocial interventions and identification of predisposing need and enabling factors for non-drug interventions for children with mental health issues as a result of trauma. The most prominent predictors of non-drug interventions and enablers identified were residential region,
specific psychiatric diagnosis, psychiatric co-morbidity, and psychotropic drug use, and area deprivation.
This literature review reveals a generalconsensus among mental health researchers that there is need to treat children exposed to trauma and post-traumatic stress symptoms using psycho therapies such as trauma focused CBT, parental interactions and EMDR. The researchers recognize that pharmacological treatments are normally the first line of treatment preferred by several mental health specialists. Research evidence reveals that there is a need to combine these pharmacological treatments with psychothepries in order to support healthy social and emotional development in children with PTSD. This is becausepsychotherapies provide children with social, emotional and behavioralskills required to live a normal life while medication treatment may help in alleviating several mental health issues such as depression, anxiety, and extreme anger. However, several inconsistencies were identified in the studies. In addition, some of the study results did not yield statistically significant results and were marked by several limitations. For instance, the Abbas et al. (2017) study had data base limitations in which the documented diagnoses could not be externally validated and the data base did not include information on severity of mental health issues. This causes the study to become weak and un-generalizable and makes it difficult to make reasonable inferences form the study. The main strength of tis study was the large data sued in the study which covered over 30% of German children with PSTD. Additionally, some studies fail take into consideration children’s family and social conditions which are integral to determining success of several psychotherapies. This literature review indicates strong support for the need for change of practice in which mental health nurses and practitioners should focus on utilization of combination therapies and interventions inorder to support children’s emotional and social development and effectively reduce the effects of PTSD as children become older and begin to exhibit severe behavioral problems.
Abbas, S., Ihle, P., Adler, J.-B., Engel, S., Günster, C., Holtmann, M., … Schubert, I. (2017). Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders. European Child & Adolescent Psychiatry, 26(4), 433–444. https://doi.org/10.1007/s00787-016-0900-z
Dauber, S., Lotsos, K., & Pulido, M. (2015). Treatment of complex trauma on the front lines: A preliminary look at child outcomes in an agency sample. Child & Adolescent Social Work Journal, 32(6), 529–543. https://doi.org/10.1007/s10560-015-0393-5
Diehle, J., Opmeer, B., Boer, F., Mannarino, A., & Lindauer, R. (2015). Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. European Child & Adolescent Psychiatry, 24(2), 227–236. https://doi.org/10.1007/s00787-014-0572-5
Eslinger, J., Sprang, G., & Otis, M. (2015). Children with multi-trauma histories: Special considerations for care and implications for treatment selection. Journal of Child & Family Studies, 24(9), 2757–2768.https://doi.org/10.1007/s10826-014-0079-1
Miller, G. L. E., & Campion, K. (2016). Interventions for posttraumatic stress with children exposed to violence: Factors associated with treatment success. Journal of Clinical Psychology, 72(3), 226–248. https://doi.org/10.1002/jclp.22238