Sammanställning av randomiserade studier på TF-KBT, nov 2015

RCTArticleList, nov 2015

Sammanställning av pre, post och quasi experimentella studier

Pre Post and Quasi, nov 2015

1. Artikel om jämförelse mellan mindre intensiv TF-KBT och mer traditionell TF-KBT för yngre barn.

Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. Journal of Child Psychology and Psychiatry doi:10.1111/jcpp.12471

http://www.ncbi.nlm.nih.gov/pubmed/?term=Stepped+care+versus+standard+trauma-focused

2. Norsk TF-KBT studie med randomiserad design.

Författare Jensen, et al.

Trauma-focused cognitive behavioral therapy, therapy as usual, treatment effectiveness, traumatized youth

Journal of Clinical Child and Adolescent Psychology, Vol 43(3), May, 2014. pp. 356-369

ABSTRACT: The efficacy of trauma–focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = −1.05, d = −0.55), 95% CI [−1.67, −0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [−1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, χ²(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract)

3. Norsk studie som undersöker den  terapeutiska  alliansen vid TF-KBT.

Ormhaug et al.

Journal of Consulting and Clinical Psychology, Vol 82(1), Feb, 2014. pp. 52-64

 The therapeutic alliance in treatment of traumatized youths: Relation to outcome in a randomized clinical trial.

ABSTRACT:

Objective: We examined the contribution of alliance to the outcome of therapy with traumatized youths across two different treatment conditions (trauma-focused cognitive behavioral therapy [TF-CBT] and therapy as usual [TAU]). Method: Participants were 156 youths (M age = 15.1 years, range = 10–18; 79.5% girls), randomly assigned to TF-CBT or TAU. Symptoms were assessed pretreatment, midtreatment (Session 6), and posttreatment (Session 15). Alliance was assessed after Sessions 1 and 6, using the Therapeutic Alliance Scale for Children—Revised (TASC-R). Results: Alliance scores were comparable across treatment conditions, but TF-CBT participants had significantly lower posttraumatic stress symptoms (PTSS) posttreatment (d = 0.51). Hierarchical regression analyses showed that there were no significant alliance effects in models without an Alliance × Treatment Group interaction: Alliance ratings were significant predictors of reduction in PTSS (Est. = −0.53, p = .003, 95% confidence interval [CI] = −0.87 to −0.18) and additional outcomes measured in TF-CBT but not in TAU (PTSS posttreatment: Est. = 0.01, p = .647, 95% CI = −0.29 to 0.47). Conclusion: This study was the first to investigate the contribution of alliance to outcome among adolescents with posttraumatic symptoms, treated with TF-CBT or TAU. Our findings indicated that there was an important interaction between alliance and therapeutic approach, as alliance predicted outcome in TF-CBT, but not in the nonspecific treatment condition. A positive working relationship appeared to be especially important in the context of this evidence-based treatment, which requires youth involvement in specific therapy tasks. Further, findings showed that use of a manual did not compromise alliance formation. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract)

4. Artikel om TF-KBT behandling vid komplex traumatisering.

Cohen et al.

Child Abuse & Neglect, Vol 36(6), Jun, 2012. pp. 528-541T

Trauma-focused CBT for youth with complex trauma

ABSTRACT: Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF–CBT) for youth with complex trauma. Methods: TF–CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include (a) dedicating proportionally more of the model to the TF–CBT coping skills phase; (b) implementing the TF–CBT Safety component early and often as needed throughout treatment; (c) titrating gradual exposure more slowly as needed by individual youth; (d) incorporating unifying trauma themes throughout treatment; and (e) when indicated, extending the TF–CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results: Recent data from youth with complex trauma support the use of the above TF–CBT strategies to successfully treat these youth. Conclusion: The above practical strategies can be incorporated into TF–CBT to effectively treat youth with complextrauma. Practice implications: Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF–CBT for youth with complex trauma. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)

5. Artikel som jämför TF-KBT och EMDR. Resultatet visar att båda metoderna är ungefär lika effektiva för barnen, för föräldrarna verkar TF-KBT vara mer effektivt.

Diehle et al.

European Child & Adolescent Psychiatry, Vol 24(2), Feb, 2015. pp. 227-236.

Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial.

ABSTRACT: To prevent adverse long-term effects, children who suffer from posttraumatic stress symptoms (PTSS) need treatment. Trauma–focused cognitive behavioral therapy (TF-CBT) is an established treatment for children with PTSS. However, alternatives are important for non-responders or if TF-CBT trained therapists are unavailable. Eye movementdesensitization and reprocessing (EMDR) is a promising treatment for which sound comparative evidence is lacking. The current randomized controlled trial investigates the effectiveness and efficiency of both treatments. Forty-eight children (8–18 years) were randomly assigned to eight sessions of TF-CBT or EMDR. The primary outcome was PTSS as measured with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Secondary outcomes included parental report of child PTSD diagnosis status and questionnaires on comorbid problems. The Children’s Revised Impact of Event Scale was administered during the course of treatment. TF-CBT and EMDR showed large reductions from pre- to post-treatment on the CAPS-CA (−20.2; 95 % CI −12.2 to −28.1 and −20.9; 95 % CI −32.7 to −9.1). The difference in reduction was small and not statistically significant (mean difference of 0.69, 95 % CI −13.4 to 14.8). Treatment duration was not significantly shorter for EMDR (p = 0.09). Mixed model analysis of monitored PTSS during treatment showed a significant effect for time (p< 0.001) but not for treatment (p = 0.44) or the interaction of time by treatment (p = 0.74). Parents of children treated with TF-CBT reported a significant reduction of comorbid depressive and hyperactive symptoms. TF-CBT and EMDR are effective and efficient in reducing PTSS in children. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract)

6. En randomiserad studie där man jämför fyra olika uppsättningar av TF-KBT komponenter. Kortare och längre samt med och utan traumanarrativ. Här finns också en Powerpoint sammanställning på Svenska om man vill använda. OBS på eget ansvar.

6a: PPP: TF-KBT impact of the trauma narrative and treatment length (2011) Deblinger et al.

Deblinger et al.

Depression and Anxiety, Vol 28(1), Jan, 2011. pp. 67-75

Trauma-focused cognitive behavioral therapy for children: Impact of the traumanarrative and treatment length.

ABSTRACT: Background: Child sexual abuse (CSA) is associated with the development of a variety of mental health disorders, and Trauma–Focused Cognitive Behavioral Therapy (TF-CBT) is an established treatment for children who have experienced CSA. However, there are questions about how many TF-CBT sessions should be delivered to achieve clinical efficacy and whether a trauma narrative (TN) component is essential. This study examined the differential effects of TF-CBT with or without the TN component in 8 versus 16 sessions. Methods: Two hundred and ten children (aged 4-11 years) referred for CSA and posttraumatic stress disorder symptoms were randomly assigned to one of the four treatment conditions: 8 sessions with no TN, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Results: Mixed-model ANCOVAs demonstrated that significant posttreatment improvements had occurred with respect to 14 outcome measures across all conditions. Significant main and interactive effect differences were found across conditions with respect to specific outcomes. Conclusions: TF-CBT, regardless of the number of sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the children’s personal safety skills. The eight session condition that included the TN component seemed to be the most effective and efficient means of ameliorating parents’ abuse-specific distress as well as children’s abuse-related fear and general anxiety. On the other hand, parents assigned to the 16 session, no narrative condition reported greater increases in effective parenting practices and fewer externalizing child behavioralproblems at posttreatment. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract)

7. Att arbeta med förstärkande metoder för att engagera familjehemsplacerade barn och föräldrar. Det verkar finnas en kvalitativ positiv skillnad om man jobbar med de evidensbaserade engageringsmetoderna.

Dorsey et al.

Child Abuse & Neglect, Vol 38(9), Sep, 2014. pp. 1508-1520.

Engaging foster parents in treatment: A randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies.

8: Overgeneralized Beliefs, Accommodation, and treatment outcome in Youth receiving TF-CBT for childhood trauma. En studie som visar att behandlingsresultatet för 81 barn (7-17 år) och det kvarvarande behandlingsresultatet 1 år efter avslutad behandling påverkades i hög grad av de övergeneraliserade föreställningar som barnet hade under traumabearbetningsfasen. Studien visar på hur viktigt det är att bedöma barnets föreställningar i början av behandlingen och anpassa behandlingen/arbeta mer aktivt med kognitiva förvrängningar.

Ready et al.

Behavior Therapy, Vol 46(5), Sep, 2015. pp. 671-688.

Overgeneralized beliefs, accommodation, and treatment outcome in youth receivingtrauma–focused cognitive behavioral therapy for childhood trauma.

ABSTRACT: Inhibition of fear generalization with new learning is an important process in treatments for anxiety disorders. Generalization of maladaptive cognitions related to traumatic experiences (overgeneralized beliefs) have been demonstrated to be associated with posttraumatic stress disorder (PTSD) in adult populations, whereas more balanced, accommodated beliefsare associated with symptom improvement. It is not yet clear whether (a) overgeneralization and accommodation are associated with PTSD treatment outcome in youth, or (b whether accommodated beliefs can interact with or inhibit cognitive overgeneralization, as has been demonstrated in research on behavior-based fear generalization. The current study examined the relationships between overgeneralized and accommodated beliefs, child age, and symptom reduction in a sample of 81 youth (age 7–17 years), who received Trauma–Focused Cognitive Behavioral Therapy. Overgeneralizedand accommodated beliefs expressed during the exposure phase of treatment were coded in audio-recorded therapysessions. Overgeneralization predicted (a) higher internalizing symptom scores at posttreatment, particularly for younger children, and less improvement over treatment, and (b) higher externalizing scores at 1-year follow-up and steeper symptom increases over this period. In contrast, accommodation was associated with (a) lower posttreatment internalizing symptoms and greater improvement over treatment, and (b) lower externalizing scores at 1-year follow-up, particularly for younger children. High levels of accommodation moderated the relationship between overgeneralization and worse symptom outcomes, except when predicting the slope of internalizing scores over treatment, and age did not moderate these effects. There were no significant predictors of child-reported PTSD-specific symptoms, although PTSD symptoms did decrease significantly over the course of treatment and maintain 1year after treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract)

9. Amygdala response predicts trajectory of symptom reduction during Trauma-FocusedCognitive-Behavioral Therapy among adolescent girls with PTSD.

Cisler et al.

Journal of Psychiatric Research, Vol 71, Dec, 2015. pp. 33-40.

ABSTRACT:  Trauma–Focused Cognitive-Behavioral Therapy (TF-CBT) is the gold standard treatment for pediatric PTSD. Nonetheless, clinical outcomes in TF-CBT are highly variable, indicating a need to identify reliable predictors that allow forecasting treatment response. Here, we test the hypothesis that functional neuroimaging correlates of emotion processing predict PTSD symptom reduction during Trauma–Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with PTSD. Thirty-four adolescent girls with PTSD related to physical or sexual assault were enrolled in TF-CBT, delivered in an approximately 12 session format, in an open trial. Prior to treatment, they were engaged in an implicit threat processing task during 3T fMRI, during which they viewed faces depicting fearful or neutral expressions. Among adolescent girls completing TF-CBT (n = 23), slopes of PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment degree of bilateral amygdala activation while viewing fearful vs neutral images. Adolescents with less symptom reduction were characterized by greater amygdala activation to both threat and neutral images (i.e., less threat-safety discrimination), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images. These clinical outcome relationships with pre-treatment bilateral amygdala activation remained when controlling for possible confounding demographic or clinical variables (e.g., concurrent psychotropic medication, comorbid diagnoses). While limited by a lack of a control group, these preliminary results suggest that pre-treatment amygdala reactivity to fear stimuli, a component of neurocircuitry models of PTSD, positively predicts symptom reduction during TF-CBT among assaulted adolescent girls, providing support for an objective measure for forecasting treatment response in this vulnerable population. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract)

10.  Trauma focused CBT for children with co-occurring trauma and behavior problems

En artikel med mycket matnyttigt för kliniker. Extra bra för att få tips om hur man jobbar med utagerande problematik parallellt med Traumabearbetning. Rekommenderas.

Cohen et al.