Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.

Journal

The Lancet. Child & adolescent health
ISSN: 2352-4650
Titre abrégé: Lancet Child Adolesc Health
Pays: England
ID NLM: 101712925

Informations de publication

Date de publication:
Jan 2024
Historique:
received: 24 03 2023
revised: 07 09 2023
accepted: 18 09 2023
pubmed: 20 11 2023
medline: 20 11 2023
entrez: 19 11 2023
Statut: ppublish

Résumé

Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. Swiss National Science Foundation.

Sections du résumé

BACKGROUND BACKGROUND
Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators.
METHODS METHODS
This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954.
FINDINGS RESULTS
We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ
INTERPRETATION CONCLUSIONS
This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress.
FUNDING BACKGROUND
Swiss National Science Foundation.

Identifiants

DOI: 10.1016/S2352-4642(23)00253-5 PMID: 37980918
pubmed: 37980918
pii: S2352-4642(23)00253-5
doi: 10.1016/S2352-4642(23)00253-5
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

28-39

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests RM-S received personal payment for teaching on the delivery of cognitive therapy for post-traumatic stress disorder for children and young people at various UK universities and training bodies, and he is an unpaid council member of the UK Trauma Council. EBF received payment for contributing to a post-traumatic stress disorder manual and workbook and for post-traumatic stress disorder workshops, lectures, and meetings. JDF served as a consultant for Advanced Trauma Solutions Professionals. SK received minor side income from lecturing in a clinical training program for Narrative Exposure Therapy (University of Turku, Turku, Finland). PS received a share of royalties from Routledge publishers from publication of a cognitive therapy for post-traumatic stress disorder manual for young people; he was an unpaid member of the research committee of the Children and War Foundation (a non-profit based in Norway) and an unpaid trustee of the Children and War UK (a non-profit based in the UK). CHi received personal payment for writing an article regarding treatment of therapy for post-traumatic stress disorder in preschool-aged children from the Aeon Media Group. TD received personal payment for teaching on the delivery of cognitive therapy for post-traumatic stress disorder for children and young people at various UK universities and training bodies. All other authors declare no competing interests.

Auteurs

Anke de Haan (A)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland. Electronic address: anke.dehaan@mrc-cbu.cam.ac.uk.

Richard Meiser-Stedman (R)

Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.

Markus A Landolt (MA)

Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.

Isla Kuhn (I)

Medical Library, University of Cambridge, Cambridge, UK.

Melissa J Black (MJ)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.

Kristel Klaus (K)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.

Shivam D Patel (SD)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.

David J Fisher (DJ)

MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.

Christina Haag (C)

Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

Obioha C Ukoumunne (OC)

National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK.

Benjamin G Jones (BG)

National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK; Exploristics, Belfast, UK.

Ashraf Muwafaq Flaiyah (AM)

College of Education Ibn Rushd for Humanities, University of Baghdad, Baghdad, Iraq.

Claudia Catani (C)

Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.

Katie Dawson (K)

School of Psychology, University of New South Wales, Sydney, NSW, Australia.

Richard A Bryant (RA)

School of Psychology, University of New South Wales, Sydney, NSW, Australia.

Carlijn de Roos (C)

Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands.

Verena Ertl (V)

Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.

Edna B Foa (EB)

Department of Psychiatry, University of Pennsylvania Medical School, Philadelphia, PA, USA.

Julian D Ford (JD)

Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA.

Eva Gilboa-Schechtman (E)

Emotional Processing Laboratory, Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel.

Dunja Tutus (D)

Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.

Katharin Hermenau (K)

University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University Medical Centre EWL, Bielefeld University, Bielefeld, Germany.

Tobias Hecker (T)

Division of Clinical Developmental Psychopathology, Department of Psychology, Bielefeld University, Bielefeld, Germany.

Ole Hultmann (O)

Department of Psychology, University of Gothenburg, Gothenburg, Sweden.

Ulf Axberg (U)

Faculty of Social Studies, VID Specialized University, Oslo, Norway.

Nasrin Jaberghaderi (N)

Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Tine K Jensen (TK)

Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Silje M Ormhaug (SM)

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Justin Kenardy (J)

School of Psychology, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.

Ramon J L Lindauer (RJL)

Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands; Department of Child and Adolescent Psychiatry, Public Mental Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.

Julia Diehle (J)

WODC-Research and Documentation Centre, Ministry of Justice and Security, The Hague, Netherlands.

Laura K Murray (LK)

Department of Mental Health and International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.

Jeremy C Kane (JC)

Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA.

Kirsi Peltonen (K)

INVEST Research Flagship Centre, University of Turku, Turku, Finland.

Samuli Kangaslampi (S)

Faculty of Social Sciences, Psychology, Tampere University, Tampere, Finland.

Katy Robjant (K)

Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany.

Anke Koebach (A)

Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Development Research Group, Department of Politics and Administration, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany.

Rita Rosner (R)

Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.

Jaco Rossouw (J)

Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; Centre for Cognitive-Behavioural Therapy, Cape Town, South Africa.

Patrick Smith (P)

Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Bruce J Tonge (BJ)

Centre for Developmental Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia.

Caitlin Hitchcock (C)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.

Tim Dalgleish (T)

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. Electronic address: tim.dalgleish@mrc-cbu.cam.ac.uk.

Classifications MeSH