Meiser-Stedman Richard, Allen Leila, Ashford Polly-Anna, Beeson Ella, Byford Sarah, Danese Andrea, Farr Annie, Finn Jack, Goodall Ben, Grainger Lauren, Hammond Matthew, Harmston Rebecca, Humphrey Ayla, King Dorothy, Lofthouse Katie, Mahoney-Davies Gerwyn, Miles Sarah, Moore Jessica, Morant Nicola, Robertson Sarah, Shepstone Lee, Sims Erika, Stallard Paul, Swanepoel Annie, Trickey David, Trigg Katie, Vishwakarma Ramesh, Wilson Jon, Dalgleish Tim, Smith Patrick
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK.
World Psychiatry. 2025 Oct;24(3):422-434. doi: 10.1002/wps.21355.
Trauma-focused cognitive-behavioral therapies (TF-CBTs) are efficacious in children and adolescents with post-traumatic stress disorder (PTSD). However, there is limited evidence in youth exposed to multiple traumas, especially in real-world settings. This paper reports on a pragmatic randomized controlled trial (RCT) evaluating whether one form of TF-CBT, cognitive therapy for PTSD (CT-PTSD), was effective for PTSD following multiple trauma exposure in 8-17 year-olds attending UK mental health services, relative to treatment-as-usual (TAU). Youth with PTSD (N=120) following multiple traumas were randomly allocated to receive CT-PTSD or TAU. At baseline, complex PTSD diagnosis was common (55.0% of cases), and a large proportion of youth had comorbid mental disorders. The primary outcome was the score on the Child Revised Impact of Event Scale, 8-item version (CRIES-8) at post-treatment. Secondary outcomes included the CRIES-8 score at 11 months post-randomization, and several measures of PTSD, anxiety, depression, suicidal ideation, affect regulation, irritability, and general functioning at post-treatment and 11 months post-randomization. CT-PTSD was not found to be significantly superior to TAU on the CRIES-8 at post-treatment (adjusted difference: -3.80, 95% CI: -7.56 to -0.06, p=0.095; Hedges' g=-0.37, 95% CI: -0.78 to 0.03), but it was superior to TAU when patients who had received TF-CBT were excluded from that arm (adjusted difference: -4.60, 95% CI: -8.36 to -0.81, p=0.047; g=-0.46, 95% CI: -0.89 to -0.04). CT-PTSD was also superior to TAU on the CRIES-8 at 11 months (adjusted difference: -5.38, 95% CI: -8.88 to -1.87, p=0.003; g=-0.46, 95% CI: -0.90 to -0.02), and in a mixed-effect model incorporating all time points (p=0.007). Evidence of superiority for CT-PTSD was observed on parent-reported emotional difficulties at post-treatment and 11 months; and on child-reported total anxiety and depression, total anxiety, panic and separation anxiety, and parent-reported affect dysregulation and irritability at 11 months. Treatment withdrawal rate was low. Despite high baseline levels of comorbidity and impairment not seen in previous trials, CT-PTSD was not associated with significant deterioration or adverse events. This pragmatic trial is likely to contribute to the optimization of psychological intervention in youth with PTSD following multiple traumas, accompanied by severe comorbid mental disorders, in routine settings.
创伤聚焦认知行为疗法（TF-CBTs）对患有创伤后应激障碍（PTSD）的儿童和青少年有效。然而，对于遭受多重创伤的青少年，尤其是在现实环境中的证据有限。本文报告了一项实用随机对照试验（RCT），评估一种形式的TF-CBT，即创伤后应激障碍认知疗法（CT-PTSD），相对于常规治疗（TAU），对在英国心理健康服务机构就诊的8至17岁遭受多重创伤后PTSD的有效性。患有多重创伤后PTSD的青少年（N = 120）被随机分配接受CT-PTSD或TAU。在基线时，复杂PTSD诊断很常见（55.0%的病例），并且很大一部分青少年患有共病精神障碍。主要结局是治疗后儿童事件影响量表修订版8项版本（CRIES-8）的得分。次要结局包括随机分组后11个月的CRIES-8得分，以及治疗后和随机分组后11个月的PTSD、焦虑、抑郁、自杀意念、情绪调节、易怒和总体功能的多项测量。在治疗后，未发现CT-PTSD在CRIES-8上显著优于TAU（调整差异：-3.80，95%置信区间：-7.56至-0.06，p = 0.095；Hedges' g = -0.37，95%置信区间：-0.78至0.03），但当将接受TF-CBT的患者从该组中排除时，它优于TAU（调整差异：-4.60，95%置信区间：-8.36至-0.81，p = 0.047；g = -0.46，95%置信区间：-0.89至-0.04）。在随机分组后11个月，CT-PTSD在CRIES-8上也优于TAU（调整差异：-5.38，95%置信区间：-8.88至-1.87，p = 0.003；g = -0.46，95%置信区间：-0.90至-0.02），并且在纳入所有时间点的混合效应模型中也是如此（p = 0.007）。在治疗后和11个月时，观察到CT-PTSD在家长报告的情绪困难方面具有优势；在11个月时，在儿童报告的总焦虑和抑郁、总焦虑、惊恐和分离焦虑以及家长报告的情绪失调和易怒方面也有优势。治疗退出率较低。尽管基线时共病和功能损害水平较高，这在以前的试验中未见，但CT-PTSD与显著恶化或不良事件无关。这项实用试验可能有助于在常规环境中优化对遭受多重创伤且伴有严重共病精神障碍的PTSD青少年的心理干预。
