University of Arizona College of Medicine Phoenix Campus, Maricopa Integrated Health System/District Medical Group, Desert Vista Behavioral Health Center, 570 West Brown Road, Mesa, AZ 85201, USA.
J Behav Ther Exp Psychiatry. 2011 Sep;42(3):405-13. doi: 10.1016/j.jbtep.2011.02.002. Epub 2011 Mar 31.
There is no clear gold standard treatment for childhood posttraumatic stress disorder (PTSD). An annotated bibliography and meta-analysis were used to examine the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL).
A literature search produced 21 studies; of these, 10 utilized the CBCL but only eight were both 1) randomized; and 2) reported pre- and post-intervention scores.
The annotated bibliography revealed efficacy in general of CBT for pediatric PTSD. Using four indices of the CBCL, the meta-analysis identified statistically significant effect sizes for three of the four scales: Total Problems (TP; -.327; p = .003), Internalizing (INT; -.314; p = .001), and Externalizing (EXT; -.192; p = .040). The results for TP and INT were reliable as indicated by the fail-safe N and rank correlation tests. The effect size for the Total Competence (TCOMP; -.054; p = .620) index did not reach statistical significance.
Limitations included methodological inconsistencies across studies and lack of a randomized control group design, yielding few studies for meta-analysis.
The efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.
目前，针对儿童创伤后应激障碍（PTSD），尚无明确的金标准治疗方法。本研究通过文献综述和荟萃分析，使用儿童行为检查表（CBCL）的结果数据，评估认知行为疗法（CBT）治疗儿童 PTSD 的疗效。
文献检索共产生 21 项研究；其中，10 项研究使用了 CBCL，但只有 8 项研究同时满足以下 2 个条件：1）随机分组；2）报告了干预前后的评分。
文献综述表明 CBT 对儿童 PTSD 一般有效。使用 CBCL 的 4 个指标，荟萃分析确定了 3 个量表的统计显著效应量：总问题（TP；-.327；p=0.003）、内化问题（INT；-.314；p=0.001）和外化问题（EXT；-.192；p=0.040）。TP 和 INT 的结果是可靠的，表明失效安全 N 和等级相关检验结果均符合要求。总能力（TCOMP；-.054；p=0.620）指数的效应量未达到统计学意义。
研究间存在方法学上的不一致，且缺乏随机对照设计，因此荟萃分析的研究数量较少。
文献综述和荟萃分析支持 CBT 治疗儿童 PTSD 的疗效，为最佳实践数据提供了依据。CBT 针对内化症状（如焦虑和抑郁，CBCL 可测量）的疗效优于外化症状（如攻击和违反规则行为），这与其作为一种治疗干预的目的一致。
