Outcome of psychotherapy among early adolescents after trauma

Abstract

O n December 7, 1988, an earthquake with a magnitude of 6.9 on the Richter scale struck Armenia (population 3.5 million). It caused the destruction of four cities and 350 villages and killed at least 25,000 people in a region populated by approximately 550,000 people. The second largest city of Armenia, Gumri, was 20 miles from the epicenter. At least 18,000 people (7% of the city's total population) were killed in this city. Approximately 50% of the buildings in Gumri were destroyed. The earthquake occurred late in the morning when children and adolescents were in school. Nearly all of the children experienced extreme direct threats to their life and were exposed to horrifying sights and sounds during the earthquake and for several days thereafter.The literature indicates that there can be serious and long-lasting psychiatric consequences among children and adolescents after natural and man-made disasters (1-3). Our previous studies in Armenia have documented severe posttraumatic reactions and high rates of comorbid depression 1 1 ⁄2 years after the earthquake among children and adolescents in cities that were close to the epicenter (4, 5). The severity of their symptoms was attributable to extreme disaster-related experiences during, and in the aftermath of, the earthquake. Such findings indicate the need for provision of mental health services.To date, there is a paucity of controlled treatment outcome studies in children or adolescents after disasters (6, 7). After the 1980 earthquake in Italy, Galante and Foa used monthly structured classroom interventions over 1 academic year and reported a reduction in earthquake-related fears (8). This study did not specifically measure posttraumatic stress or depressive reactions. Yule (2) reported results of cognitive-behavioral treatment among girls after the sinking of the cruise ship Jupiter. After 5-9 months, the group who received treatment had lower scores on the Impact of Event Scale and on a fear survey. These findings would have been more definitive had the baseline scores for subjects not given treatment been included in a treatment-by-time interaction analysis.The Psychiatric Outreach Program of the Armenian

Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence

“…One of the AHRQ reviews provided a thorough comparative effectiveness study of cognitive-behavioral interventions for children and adolescents that address trauma other than maltreatment or family violence, but it did not cover the specific TF-CBT model defined here (19). The literature search for this AHRQ review merged individual and school group models (21,22) and included only one study of what was described as “cognitive-behavioral therapy” for trauma among children and adolescents (23). The second AHRQ review targeted maltreatment (20).…”

Cognitive Behavioral Therapy for Symptoms of Trauma and Traumatic Grief in Refugee Youth

“…Layne, W.S. Saltzman, N. Savjak, and colleagues, unpublished manual, 2001) are covered in another article in this issue [51,52]. A different CBT model [53] was used by Ehntholt and colleagues [54] in a controlled study with 26 refugee youth in a school, compared with wait-list control.…”

“…CBT for PTSD has been evaluated quite extensively in nonrefugee youth [51,58–61] and is considered one of the most efficacious and well-supported interventions for traumatized youth. There has been a growing research literature testing the efficacy of mental health interventions with traumatized child populations, and some recent reviews have examined varying levels of empiric support [33,62–64].…”

The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial

“…Cognitive-behavioral therapy (CBT) is one of the approaches that have been studied extensively with trauma survivors, including children with PTSD resulting from earthquakes (Goenjian et al, 1997; Giannopoulou et al, 2006), hurricanes (Chemtob et al, 2002), motor vehicle accidents (Stallard et al, 1998), and sexual abuse (King et al, 2000; Cohen et al, 2004). Murray, Davidson, and Schweitzer (Murra et al, 2008) advocated for the implementation of CBT with traumatized refugee children because of its skill-oriented and time-limited nature.…”