Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis

Mavranezouli, Ifigeneia, Megnin-Viggars, Odette, Daly, Caitlin, Dias, Sofia, Stockton, Sarah, Meiser-Stedman, Richard, Trickey, David and Pilling, Stephen (2020) Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis. Journal of Child Psychology and Psychiatry, 61 (1). pp. 18-29. ISSN 0021-9630

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Abstract

Background : Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. Methods : We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. Results : We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling, and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. Conclusions : TF-CBT, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence.

Item Type: Article
Uncontrolled Keywords: post-traumatic stress disorder,network meta-analysis,intervention
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 19 Jun 2019 11:30
Last Modified: 28 Jul 2020 00:09
URI: https://ueaeprints.uea.ac.uk/id/eprint/71490
DOI: 10.1111/jcpp.13094

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