Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment) and imprecise results.
A Cochrane review included 14 randomized trials with 758 children and adolescents (6-18 y) with diagnosed post traumatic stress disorder (PTSD), examining the effects of psychological therapies comparing to controls who were on waiting list. The participants had been exposed to sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. The psychological therapies used in the studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR).
Most evidence is from CBT, delivered as 4 to 25 weekly sessions of 45 minutes. CBT relieves the symptoms of PTSD and results in more frequent cure, at least in 3 months follow-up, compared to the patients on waiting list. The evidence of effect for depression and anxiety are less convincing. CBT was superior to supportive counseling: 75% of patients improved with CBT compared to 49% with supportive counseling (based on 2 studies). The evidence for all the other therapies was inconclusive. No data on possible adverse effects were reported. There were no clear differences in the efficacy between patients with different types of trauma
| Outcome | Number of participants (trials) | Control: Waiting list | Intervention: CBT | Effect size (95 % CI) |
|---|---|---|---|---|
| *Calculated as a weighted mean of [mean score (intervention group)/mean score (control group) *100] | ||||
| Improvement from the diagnosis of PTSD at 1 month | 49 (2) | 7/22 (32%) | 20/27 (74%) | OR 8.6 (2.0 to 37.1) |
| Improvement at 3 months | 25 (1) | 2/10 (20%) | 10/15 (67%) | OR 8.0 (1.2 to 52.7) |
| Normalized control score* | % of normalized control score | |||
| PTSD symptom score at 1 month | 98 (3) | 100 | 57 | SMD -1.34 (-1.79 to -0.89) |
| PTSD symptom score at 3 months | 36 (1) | 100 | 73 | SMD -0.73 (-1.44 to -0.01) |
| Anxiety at 1 month | 59 (2) | 100 | 70 | SMD -0.66 (-1.33 to 0.01) |
| Anxiety at 3 months | 36 (1) | 100 | 83 | SMD -0.63 (-1.34 to 0.08) |
| Depression at 1 month | 98 (3) | 100 | 60 | SMD -0.80, ( -1.47 to -0.13) |
| Depression at 3 months | 36 (1) | 100 | 89 | SMD -0.19 (-0.88 to 0.51) |
The follow up of three months makes it difficult to estimate the actual clinical benefit.
NoteDate of latest search: 30.12.2011