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Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis.
Journal of Child Psychology and Psychiatry ( IF 7.6 ) Pub Date : 2019-07-17 , DOI: 10.1111/jcpp.13094
Ifigeneia Mavranezouli 1, 2 , Odette Megnin-Viggars 1, 2 , Caitlin Daly 3 , Sofia Dias 3 , Sarah Stockton 2 , Richard Meiser-Stedman 4 , David Trickey 5 , Stephen Pilling 1, 2
Affiliation  

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 as follows: 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 Trauma-focused cognitive behavioural therapy, 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.

中文翻译:

研究评论:创伤后应激障碍的儿童和青少年的心理和社会心理治疗:网络荟萃分析。

背景技术创伤后应激障碍(PTSD)是潜在的慢性致残性疾病,其影响暴露于创伤的显着少数年轻人。先前的研究得出的结论是,针对创伤的认知行为疗法(TF-CBT)是青少年PTSD的有效疗法,但是人们对不同心理疗法的相对优势了解甚少。方法我们对PTSD儿童和青少年的心理和社会心理干预进行了系统的回顾和网络荟萃分析。结果包括治疗后和1-4个月随访时的PTSD症状改变评分,以及治疗后缓解。结果我们纳入了32项针对17种干预措施的试验,共有2260名参与者。总体而言,证据是中等到低质量的。在直接证据和间接证据之间均未发现不一致之处。与等待名单相比,个别形式的TF-CBT在治疗后显示出持续的减轻PTSD症状的巨大效果。效果等级随等待清单降序的干预顺序如下:创伤后应激障碍的认知疗法(SMD -2.94,95%CrI -3.94至-1.95),躯体/认知疗法联合,儿童-父母心理疗法,联合TF-CBT /父母培训,冥想,叙述性接触,接触/长时间接触,游戏疗法,科恩TF-CBT /认知加工疗法(CPT),眼球脱敏和再加工(EMDR),父母培训,TF-CBT组,支持咨询和家庭疗法(SMD -0.37,95%CrI -1.60至0.84)。家长培训,支持咨询和家庭治疗的结果尚无定论。科恩TF-CBT / CPT,TF-CBT组和支持咨询的证据基础最大。由于证据有限,在随访和治疗后缓解方面有关PTSD症状变化的结果尚不确定。结论以创伤为重点的认知行为疗法,特别是个体形式,似乎在青年人PTSD的治疗中最有效。EMDR是有效的,但程度较小。支持性咨询似乎无效。结果表明,对于情绪自由技术,儿童父母心理治疗,联合TF-CBT /父母培训和冥想具有很大的积极作用,但是由于这些证据是基于非常有限的证据,因此需要进一步的研究来证实这些发现。似乎在管理青年PTSD方面最有效。EMDR是有效的,但程度较小。支持性咨询似乎无效。结果表明,对于情绪自由技术,儿童父母心理治疗,联合TF-CBT /父母培训和冥想具有很大的积极作用,但是由于这些证据是基于非常有限的证据,因此需要进一步的研究来证实这些发现。似乎在管理青年PTSD方面最有效。EMDR是有效的,但程度较小。支持性咨询似乎无效。结果表明,对于情绪自由技术,儿童父母心理治疗,联合TF-CBT /父母培训和冥想具有很大的积极作用,但是由于这些证据是基于非常有限的证据,因此需要进一步的研究来证实这些发现。
更新日期:2019-07-17
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