Randomized Trial Comparison of Emotion Regulation and Relational Psychotherapies for PTSD with Girls Involved in Delinquency

Abstract

Posttraumatic stress disorder (PTSD) is prevalent in youth involved in delinquency, but it is often not effectively treated. A randomized clinical trial was conducted comparing the outcomes of an emotion regulation therapy (Trauma Affect Regulation: Guide for Education and Therapy, or TARGET) with a relational supportive therapy (Enhanced Treatment as Usual, or ETAU) with 59 delinquent girls (age 13-17 years) who met criteria for full or partial PTSD. Mixed model regression analyses demonstrated generally large effects for pre-post change in PTSD symptoms for both therapies but not in emotion regulation. Both therapies had small to medium effect size changes in anxiety, anger, depression, and posttraumatic cognitions. Treatment × Time interactions showed small to medium effects favoring TARGET for change in PTSD (intrusive reexperiencing and avoidance) and anxiety symptoms, posttraumatic cognitions, and emotion regulation, and favoring ETAU for change in hope and anger. Results provide preliminary support for TARGET as a potentially efficacious therapy for PTSD with delinquent girls. Relational therapies such as ETAU also may be beneficial for delinquent girls with PTSD, particularly to enhance optimism and self-efficacy and reduce anger.

Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies

“…Since the publication of the meta-analyses by Silverman et al (2008) and Gillies et al (2012), several RCTs on the efficacy of interventions for pediatric PTSD have been published (Carrion, Kletter, Weems, Berry, & Rettger, 2013;Danielson et al, 2012;Diehle, Opmeer, Boer, Mannarino, & Lindauer, 2015;Foa, McLean, Capaldi, & Rosenfield, 2013;Ford, Steinberg, Hawke, Levine, & Zhang, 2012;Jensen et al, 2014;McMullen, O'Callaghan, Shannon, Black, & Eakin, 2013;O'Callaghan, McMullen, Shannon, & Rafferty, 2015;O'Callaghan et al, 2014;O'Callaghan, McMullen, Shannon, Rafferty, & Black, 2013;Schottelkorb, Doumas, & Garcia, 2012;Tol et al, 2014). The goal of the present study was to provide an updated quantitative, meta-analytic review of the efficacy of interventions for children and adolescents suffering from PTSD.…”

Comparative Effectiveness of Interventions for Children Exposed to Nonrelational Traumatic Events

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Psychotherapeutic interventions were marked by substantial heterogeneity in components, dose, frequency, involvement of family members, and mode and method of delivery. The wide variety of approaches presented challenges in how to best combine and categorize the psychotherapeutic interventions in particular.…”

“…22,23,[25][26][27][28][29]33,[35][36][37][38] Six studies reported no improvement in one or all outcomes evaluated. 25,26,29,33,35,38 One 22 of 5 interventions reported in 6 studies 22,26,29,35,37,38 evaluating anxiety symptoms showed improvements (TF-CBT); 4 interventions reported in 5 studies 22,23,27,29,36 of 10 interventions reported in 12 studies 22,23,[25][26][27][28][29]33,35,[36][37][38] showed improvement in depression; 2 studies found no improvement in internalizing behaviors. 26,38 Two studies evaluated physical symptoms or general health outcomes; neither found evidence of benefit.…”

“…Fifteen studies reporting on a subset of outcomes for 13 different interventions met our inclusion criteria: TF-CBT, cognitive processing therapy, narrative exposure therapy (NET), grief-and trauma-focused intervention (GTFI) group and GTFI with coping skills and narrative processing, emotional regulation therapy, eye movement desensitization and reprocessing (EMDR), cognitive-behavioral intervention for trauma in schools (CBITS), trauma and grief component therapy; school group with elements of CBT; imipramine; fluoxetine; and sertraline ( 28,35 Three interventions used active comparators: 1 trial compared outcomes for NETwith meditation-relaxation therapy outcomes, 24 1 GTFI study compared group therapy with individual therapy, 25 and 1 trial examined outcomes for GTFI with coping skills and narrative processing versus GTFI with coping skills only. 38 Three of 13 interventions focused on medications: imipramine versus chloral hydrate, 31 imipramine versus fluoxetine and placebo, 32 and sertraline versus placebo.…”

Perceptions of Gangs and Crews by Justice-Involved Youth and Implications for Best Practice Work

“…The use of MI has shown positive, offending-reduction effects on justice-involved individuals (Hohman, Doran, & Koutsenok, 2009). Although there have not been specific studies examining the use of MI with identified gang or crew members, the use of MI with serious offenders has been shown to be successful, in terms of both a better client-service provider relationship and improved criminal justice compliance with males (Schwalbe & Maschi, 2011) and with females (Ford, Steinberg, Hawke, Levine, & Zhang, 2012). Further, a systematic review of MI studies shows that social service clients were more engaged and had higher retention and lower offending when MI was used (McMurran, 2009).…”