Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Out of the Box Plot & Tilburg University, Tilburg, the Netherlands.
Eur J Psychotraumatol. 2024;15(1):2416288. doi: 10.1080/20008066.2024.2416288. Epub 2024 Oct 25.
Effective and appropriate care and treatment for children in order to decrease the psychosocial problems that arose after experiencing child abuse and neglect (CAN) is of vital importance, given the severity of symptomatology that may develop. The purpose of the present study was to examine whether attachment style and core cluster Posttraumatic Stress Disorder symptoms acted as moderators for treatment outcomes of a new integrative treatment model for trauma and attachment. In this treatment model, family therapy is combined with EMDR and obstacles for trauma processing are tackled first. we included children, ages 6-12 years, with a history of CAN, who did not respond to evidence-based trauma treatment. Target treatment outcomes were problems in attachment, posttraumatic stress symptoms, behaviour, and emotion regulation. We conducted a multiple-baseline ABC Single-Case Experimental Design (SCED). We categorized 12 participants into four groups of attachment style and core cluster PTSD symptoms: (1) non-disorganized & re-experiencing; (2) non-disorganized & avoidance/hyperarousal; (3) disorganized & re-experiencing; & (4) disorganized & avoidance/hyperarousal. We compared the four groups with each other and across time, and the interaction between groups and effect over time. We conducted non-parametric permutation tests and estimated -values for false discovery rate control. Children with a disorganized attachment style had more severe symptomatology in general, except for posttraumatic stress symptoms. The treatment appeared more effective in targeting and successfully treating children with a non-disorganized attachment style, and specifically children with a non-disorganized attachment style and re-experiencing as core cluster PTSD symptoms. Our study underlines the complexity of treating children who developed a complicated combination of symptomatology after CAN and calls for the continuous development of innovative interventions.
为了减少儿童遭受虐待和忽视后出现的心理社会问题，为儿童提供有效和适当的护理和治疗至关重要，因为他们可能会出现严重的症状。本研究的目的是检验依恋风格和核心 PTSD 症状群是否作为一种调节因素，影响一种新的创伤与依恋整合治疗模式的治疗效果。在这种治疗模式中，家庭治疗与 EMDR 相结合，首先解决创伤处理的障碍。我们纳入了有虐待和忽视史、对循证创伤治疗无反应的 6-12 岁儿童。目标治疗结果是依恋问题、创伤后应激症状、行为和情绪调节。我们采用了多基线 ABC 单病例实验设计（SCED）。我们根据依恋风格和核心 PTSD 症状群将 12 名参与者分为四组：（1）非组织型且再体验组；（2）非组织型且回避/警觉增高组；（3）组织型且再体验组；（4）组织型且回避/警觉增高组。我们比较了四组之间以及随时间的变化，并比较了组间的相互作用和随时间的效果。我们进行了非参数置换检验，并估计了错误发现率控制的效值。除了创伤后应激症状外，具有非组织型依恋风格的儿童一般症状更严重。该治疗方法在针对和成功治疗非组织型依恋风格的儿童，特别是非组织型依恋风格且核心 PTSD 症状群为再体验的儿童方面似乎更有效。我们的研究强调了治疗遭受虐待和忽视后出现复杂症状的儿童的复杂性，并呼吁不断开发创新干预措施。
