Effectiveness of Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: A Randomized Controlled Trial in Eight German Mental Health Clinics

Abstract

Background: Trauma-focused cognitive behavioral therapy (Tf-CBT) is efficacious for children and adolescents with posttraumatic stress symptoms (PTSS). Its effectiveness in clinical practice has still to be investigated. Aims: To determine whether Tf-CBT is superior to waiting list (WL), and to investigate the predictors of treatment response. Method: We conducted a single-blind parallel-group randomized controlled trial in eight German outpatient clinics with the main inclusion criteria of age 7-17 years, symptom score ≥35 on the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), and caregiver participation. Patients were randomly assigned to 12 sessions of Tf-CBT (n = 76) or a WL (n = 83). The primary outcome was the CAPS-CA symptom score assessed at 4 months by blinded evaluators. The secondary measures were diagnostic status, the Children's Global Assessment Scale (CGAS), self-reported and caregiver-reported PTSS (UCLA-PTSD Reaction Index), the Child Posttraumatic Cognitions Inventory (CPTCI), the Children's Depression Inventory (CDI), the Screen for Child Anxiety- Related Emotional Disorders (SCARED), the Child Behavior Checklist (CBCL/4-18), and the Quality of Life Inventory for Children. Results: Intention-to-treat analyses showed that Tf-CBT was significantly superior to WL on the CAPS-CA (Tf-CBT: baseline = 58.51 ± 17.41; 4 months = 32.16 ± 26.02; WL: baseline = 57.39 ± 16.05; 4 months = 43.29 ± 25.2; F_{1, 157} = 12.3; p = 0.001; d = 0.50), in terms of secondary measures of the CGAS, UCLA-PTSD-RI, CPTCI, CDI, SCARED, and CBCL/4-18, but not in terms of quality of life. Age and comorbidity significantly predicted treatment response. Conclusions: Tf-CBT is effective for children and adolescents with heterogeneous trauma types in German service settings. Younger patients with fewer comorbid disorders show most improvement.

Cognitive therapy as an early treatment for post‐traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action

“…Youth in the WL arm experienced some nontrivial recovery (33% experienced clinically significant change), at a level broadly comparable with other WL‐controlled RCTs (Goldbeck, Muche, Sachser, Tutus, & Rosner, ; King et al., ; Smith et al., ). Nevertheless, this RCT suggests that youth identified as having PTSD in the 2‐ to 6‐months window post‐trauma are more likely than not to require treatment.…”

Sustainability of Treatment Effects of Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Findings from 6- and 12-Month Follow-Ups

“…TF-CBT is not only associated with a significant reduction of posttraumatic stress symptoms (PTSS), depressive and anxiety symptoms, behavioral problems, and dysfunctional trauma-related cognitions, but also with improvement of psychosocial functioning [2,3]. …”

“…So far, only one study has demonstrated the long-term effectiveness of TF-CBT in real-world clinical settings, with youth who had been exposed to different traumatic events [5]. As this study used only self-report questionnaires, we aimed to further evaluate the long-term effectiveness of TF-CBT within our recent multicenter randomized controlled trial (RCT) [2], using multiple informants. Our hypothesis was that all improvements regarding PTSS, remission of PTSD diagnoses, psychosocial functioning, trauma-related cognitions, depression, anxiety, other internalizing and externalizing symptoms, and quality of life (QoL) at posttreatment would be maintained at 6- and 12-month follow-ups (6MFU, 12MFU).…”

“…Patients randomized to the control group were not reassessed for follow-up, as this group received quite heterogeneous interventions after the waiting period. More details of the study have been reported previously [2]. The study received ethics approval from the IRB at the Ulm University in Ulm, Germany, and was registered under ClinicalTrials.gov (NCT01516827).…”

“…The following instruments were utilized at baseline, posttreatment, 6MFU, and 12MFU: the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA, version for DSM-IV), the Children's Global Assessment Scale (CGAS), the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for Children and Adolescents (UCLA), the Child Posttraumatic Cognitions Inventory (CPTCI), the Children's Depression Inventory (CDI), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Child Behavior Checklist/4-18 (CBCL), and the Quality of Life Inventory for Children and Adolescents (ILK) [2]. …”