Hetzel-Riggin Melanie D, Brausch Amy M, Montgomery Brad S
Western Illinois University, Department of Psychology, 100 Waggoner Hall, Macomb, IL 61455-1390, USA.
Child Abuse Negl. 2007 Feb;31(2):125-41. doi: 10.1016/j.chiabu.2006.10.007. Epub 2007 Feb 15.
The purpose of the current study was to investigate the independent effects of different treatment elements on a number of secondary problems related to childhood and adolescent sexual abuse, as well as investigate a number of different moderators of treatment effectiveness.
Twenty-eight studies that provided treatment outcome results for children and adolescents who had been sexually abused were included in the meta-analysis. Different aspects of psychological treatment, such as specific treatment modalities (individual, cognitive-behavioral, etc.) or secondary problems (behavior problems, psychological distress, etc.) were investigated.
The overall mean weighted effect size for the meta-analysis was d=.72 (SE=.02). The results indicate that psychological treatment after childhood or adolescent sexual abuse tended to result in better outcomes than no treatment. There was significant heterogeneity in the effectiveness of the various psychological treatment elements. Play therapy seemed to be the most effective treatment for social functioning, whereas cognitive-behavioral, abuse-specific, and supportive therapy in either group or individual formats was most effective for behavior problems. Cognitive-behavioral, family, and individual therapy seemed to be the most effective for psychological distress, and abuse-specific, cognitive-behavioral, and group therapy appeared to be the most effective for low self-concept.
The choice of therapy modality should depend on the child's main presenting secondary problem. Further research should be conducted investigating other possible moderators and secondary problem outcomes.
本研究旨在调查不同治疗要素对一系列与儿童及青少年性虐待相关的继发问题的独立影响,并探究治疗效果的若干不同调节因素。
荟萃分析纳入了28项针对遭受性虐待的儿童和青少年提供治疗结果的研究。对心理治疗的不同方面进行了调查,如特定治疗方式(个体、认知行为等)或继发问题(行为问题、心理困扰等)。
荟萃分析的总体平均加权效应量为d = 0.72(标准误 = 0.02)。结果表明,儿童或青少年遭受性虐待后的心理治疗往往比不治疗能带来更好的结果。各种心理治疗要素的有效性存在显著异质性。游戏治疗似乎是对社交功能最有效的治疗方法,而团体或个体形式的认知行为、针对性虐待及支持性治疗对行为问题最有效。认知行为、家庭及个体治疗似乎对心理困扰最有效,针对性虐待、认知行为及团体治疗似乎对低自尊最有效。
治疗方式的选择应取决于儿童主要呈现的继发问题。应开展进一步研究,调查其他可能的调节因素及继发问题结果。