Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK.
J Child Psychol Psychiatry. 2020 Jan;61(1):18-29. doi: 10.1111/jcpp.13094. Epub 2019 Jul 17.
Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood.
We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment.
We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence.
Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence.
创伤后应激障碍（PTSD）是一种潜在的慢性和致残性疾病，影响了创伤后暴露于创伤的少数青年。先前的研究得出结论，创伤焦点认知行为疗法（TF-CBT）是治疗青少年 PTSD 的有效方法，但不同心理疗法的相对优势知之甚少。
我们对针对 PTSD 儿童和青少年的心理和心理社会干预措施进行了系统评价和网络荟萃分析。结果包括治疗后和 1-4 个月随访时 PTSD 症状变化评分，以及治疗后缓解率。
我们纳入了 32 项试验，涉及 17 种干预措施和 2260 名参与者。总体而言，证据质量为中低。直接证据和间接证据之间没有不一致。与等待名单相比，个体形式的 TF-CBT 在治疗后降低 PTSD 症状方面显示出一致的大效果。按效果大小降序排列的干预措施顺序如下：创伤后认知疗法（SMD-2.94，95%CrI-3.94 至-1.95），综合躯体/认知疗法，儿童-父母心理疗法，综合 TF-CBT/父母训练，冥想，叙事暴露，暴露/延长暴露，游戏疗法，科恩 TF-CBT/认知加工疗法（CPT），眼动脱敏再处理（EMDR），父母训练，团体 TF-CBT，支持性咨询和家庭治疗（SMD-0.37，95%CrI-1.60 至 0.84）。父母训练、支持性咨询和家庭治疗的结果尚无定论。科恩 TF-CBT/CPT、团体 TF-CBT 和支持性咨询的证据基础最大。由于证据有限，关于治疗后随访时 PTSD 症状变化和缓解的结果不确定。
创伤焦点认知行为疗法，特别是个体形式，似乎是治疗青少年 PTSD 的最有效方法。EMDR 是有效的，但效果较小。支持性咨询似乎没有效果。结果表明，情感自由技术、儿童-父母心理疗法、综合 TF-CBT/父母训练和冥想有很大的积极影响，但需要进一步的研究来证实这些发现，因为这些发现基于非常有限的证据。
