Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany.
Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.
J Trauma Stress. 2020 Jun;33(3):208-217. doi: 10.1002/jts.22499. Epub 2020 Mar 26.
Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.
儿童经历丧失是一种常见的创伤性事件。尽管丧失经历可能导致创伤后应激症状（PTSS），但对于创伤性丧失后与其他创伤性事件后的 PTSS 水平知之甚少。我们调查了一项针对创伤聚焦认知行为疗法（TF-CBT）与等待对照组儿童创伤后应激症状的随机对照试验（RCT）的数据。在二次分析中，我们将报告创伤性丧失作为其索引事件的参与者（n = 23）与 RCT 中报告的两个最常见索引事件的参与者进行比较：性虐待（SA；n = 59）和身体暴力（PV；n = 55）。根据参与者在儿童和青少年创伤后应激障碍临床医生管理量表上报告的最痛苦创伤事件对索引事件进行评分。经历创伤性丧失的参与者报告的 PTS 症状较少，一般功能较好，而报告 SA 的参与者则较少。一项亚组 RCT（n = 19）表明，TF-CBT 在减少创伤性丧失病例中的 PTS 症状方面非常有效，d = 1.69。PTSS 的效应大小表明，所有三组创伤组均受益于 TF-CBT。在等待对照组中，SA 和 PV 的 PTS 症状均有所改善，ds 分别为 0.76 和 0.98，但创伤性丧失组则没有，d = 0.23。这些发现表明，TF-CBT 是一种可行且有前途的治疗方法，适用于经历创伤性丧失后出现 PTS 症状的儿童。这些结果受到分析后质量和 RCT 中缺乏悲伤测量的限制。
