Trauma‐focused cognitive behavioral therapy for children and youth in low and middle‐income countries: A systematic review

Thomas, Fiona C.; Puente-Durán, Sofía; Mutschler, Christina; Monson, Candice M.

doi:10.1111/camh.12435

Cited by 9 publications

(8 citation statements)

References 57 publications

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“…Although interventions focused on reducing internalized stigma are nascent, there is promising evidence in support of psychoeducation (such as addressing gender equity and rape myths in post‐rape counselling) and cognitive–behavioural interventions to modify self‐stigmatizing beliefs (Alonso et al, 2019). Apart from the potential impact on internalized stigma, cognitive interventions may also address the underlying factors that increase risk of rape stigma, namely, childhood trauma (Thomas et al, 2020). Apart from reducing stigma, there is also good evidence to support the use of cognitive–behavioural therapy/cognitive processing therapy (CBT/CPT) interventions in rape survivors, and trauma‐focused CBT interventions (CBT/CPT) have been shown to accelerate recovery in rape survivors who have acute stress disorder (ASD) (Lomax & Meyrick, 2020).…”

Section: Discussionmentioning

confidence: 99%

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort

Jewkes

Mhlongo

Chirwa

et al. 2021

Clin Psychology and Psychoth

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Rape stigma, both external and self-stigmatization (self-blame), is associated with adverse health outcomes. Understanding its origins and resilience factors is critical for reducing and preventing it. We describe the prevalence of rape stigma, the characteristics of women experiencing it and the pathways to experiencing greater stigma. The Rape Impact Cohort Evaluation study enrolled 852 women aged 16-40 years who had been raped from post-rape care centres in Durban, South Africa. We present a descriptive analysis of the baseline data, a multinomial logistic regression model of factors associated with different levels of stigma and a structural equation model (SEM). Most women reported stigmatizing thoughts or experiences, with self-stigmatizing thoughts being more prevalent than external stigmatization. The multinomial model showed that experiences of childhood or other trauma, emotional intimate partner violence (IPV), having less gender equitable attitudes and food insecurity were significantly associated with medium or high versus low levels of stigma. Internal and external stigma were significantly associated with each other. Women who had been previously raped reported less stigma. The SEM showed a direct path between food insecurity and rape stigma, with poorer women experiencing more stigma. Indirect paths were mediated by more traditional gender attitudes and childhood trauma experience and other trauma exposure. Our findings confirm the intersectionality of rape stigma, with its structural drivers of food insecurity and gender inequality, as well as its strong association with prior trauma exposure. Rape survivors may benefit from gender-empowering psychological support that addresses blame and shame.

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Section: Discussionmentioning

confidence: 99%

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort

Jewkes

Mhlongo

Chirwa

et al. 2021

Clin Psychology and Psychoth

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“…Outcomes from a subset of PACTS patients over the course of 9 years (2013-2021) revealed that youths receiving TF-CBT saw significant PTSD symptom improvements. Our effectiveness findings add to the robust evidence base establishing TF-CBT's effectiveness for diverse and underresourced youth experiencing significant social stressors and ongoing adversity (Dorsey et al, 2017;Orengo-Aguayo et al, 2022;Patel et al, 2022;Thomas et al, 2022).…”

Section: Discussionmentioning

confidence: 60%

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Last,

Johnson,

Dallard

et al. 2023

Implementation Research and Practice

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Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.

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“…Continuing longer-term psychological work to finish addressing issues identified in the mind-body formulation (e.g., addressing illness-promoting psychological processes with a CBT intervention, or addressing unresolved loss or trauma with a trauma-focused intervention such as eye-movement desensitization, trauma-focused CBT, radical exposure tapping, or accelerated resolution therapy) 96–99 …”

Section: Step 7: Taking the Program Home To Maintain Resilience And P...mentioning

confidence: 99%

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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Learning objectives:• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND) • Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions Abstract: Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.

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Trauma‐focused cognitive behavioral therapy for children and youth in low and middle‐income countries: A systematic review

Cited by 9 publications

References 57 publications

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

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