Chinese Medicine | |
The change and the mediating role of parental emotional reactions and depression in the treatment of traumatized youth: results from a randomized controlled study | |
Tore Wentzel-Larsen3  Tine K Jensen1  Tonje Holt2  | |
[1] Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway;Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), P.O. Box 181, Nydalen, 0409 Oslo, Norway;Center for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O.Box 4623, Nydalen, 0405 Oslo, Norway | |
关键词: Children and adolescents; Trauma treatment; Emotional reactions; Parents; | |
Others : 790489 DOI : 10.1186/1753-2000-8-11 |
|
received in 2013-12-18, accepted in 2014-03-31, 发布年份 2014 | |
【 摘 要 】
Background
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown to efficiently treat children and youth exposed to traumatizing events. However, few studies have looked into mechanisms that may distinguish this treatment from other treatments. The objective of this study was to investigate whether the parents’ emotional reactions and depressive symptoms change over the course of therapy in the treatment conditions of TF-CBT and Therapy as Usual (TAU), and whether changes in the reactions mediate the difference between the treatment conditions on child post-traumatic stress (PTS) symptoms and child depressive symptoms.
Method
A sample of 135 caregivers of 135 traumatized children and youth (M age = 14.8, SD = 2.2, 80% girls) was randomly assigned to receive either TF-CBT or TAU. The parents’ emotional reactions were measured using the Parental Emotional Reaction Questionnaire (PERQ), and their depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). The children’s outcomes were post-traumatic stress (PTS) reactions and depression, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Mood and Feelings Questionnaire (MFQ), respectively.
Results
The parents’ emotional reactions and depressive symptoms decreased significantly from pre- to post-therapy, but no significant differences between the two treatment conditions were found. The changes in reactions did not significantly mediate the treatment difference between TF-CBT and TAU on child PTS symptoms. However a mediating effect was found on child depressive symptoms.
Conclusion
The results showed that although the parents experienced reductions in emotional reactions and depressive symptoms when their child received therapy, this was only significantly related to the difference in outcome between TF-CBT and TAU on child depressive symptoms. Possible explanations for these results are discussed along with the implications for clinicians and suggestions for future research.
Trial registration
Clinical Trials identifier: NCT00635752
【 授权许可】
2014 Holt et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140705000943877.pdf | 329KB | download | |
Figure 2. | 30KB | Image | download |
Figure 1. | 91KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]La Greca AM, Silverman WK, Vernberg EM, Prinstein MJ: Symptoms of posttraumatic stress in children after Hurricane Andrew: a prospective study. J Consult Clin Psychol 1996, 64:712-723.
- [2]Pynoos RS, Steinberg AM, Wraith R: A developmental model of childhood traumatic stress. In Developmental Psychopathology, Volume 2. Edited by Cicchetti D, Cohen DJ. Oxford, England: John Wiley & Sons; 1995:72-95.
- [3]Scheeringa MS, Zenah CH: A relational perspective on PTSD in early childhood. J Trauma Stress 2001, 14:799-815.
- [4]Dyb G, Jensen TK, Nygaard E: Children’s and parents’ posttraumatic stress reactions after the 2004 tsunami. Clin Child Psychol Psychiatry 2011, 16:1-14.
- [5]Morris A, Delahanty D: The Association Between Parent PTSD/Depression Symptoms and Child PTSD Symptoms: A Meta-Analysis. J Pediatr Psychol 2012, 37:1076-1088.
- [6]Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP: A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 2012, 32:122-138.
- [7]Cohen JA, Mannarino AP, Deblinger E: Treating Trauma and Traumatic Grief in Children and Adolescents. New York: Guilford Publications; 2006.
- [8]Pine DS, Cohen JA: Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biol Psychiatry 2002, 51:519-531.
- [9]Silverman WK, Kurtines WM, Ginsburg GS, Weems CF, Lumpkin PW, Carmichel DH: Treating anxiety disorders in children with group cognitive-behavioral therapy: a randomized clinical trial. J Consult Clin Psychol 1999, 67:995-1003.
- [10]Weems CF, Scheeringa MS: Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. J Anxiety Disord 2013, 27:140-146.
- [11]Cohen JA, Bukstein O, Walter H, Benson RS, Chrisman A, Farchione TR, Hamilton J, Keable H, Kinlan J, Schoettle U, Siegal M, Medicus J, Stock S, Medicus J: Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 2010, 49:414-430.
- [12]NICE: NICE clinical guideline on post-traumatic stress disorder. 2005. http://www.nice.org.uk/Guidance/CG26 webcite
- [13]Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko D, Putman FW, Amaya-Jackson L: Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol 2008, 37:156-183.
- [14]Holt T, Cohen J, Mannarino A: Parental emotional response to children’s traumas. J Aggress Maltreat Traumain press
- [15]Elliot AN, Carnes CN: Reactions of nonoffending parents to the sexual abuse of their child: a review of the literature. Child Maltreat 2001, 6:314-331.
- [16]Cohen JA, Mannarino AP: Factors that mediate treatment outcome of sexually abused preschool children. J Am Acad Child Adolesc Psychiatry 1996, 35:1402-1410.
- [17]Cohen JA, Deblinger E, Mannarino AP, Steer RA: A multisite randomized controlled trial for children with sexual abuse related PTSD symptoms. J Am Acad Child Adolesc Psychiatry 2004, 43:393-402.
- [18]Carrión VG, Kletter H, Weems CF, Berry RR, Rettger JP: Cue-centered treatment for youth exposed to interpersonal violence: A randomized controlled trial. J Trauma Stress 2013, 26:654-662.
- [19]Deblinger E, Lippman J, Steer R: Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreat 1996, 1:310-321.
- [20]King NJ, Tonge BJ, Mullen P, Myerson N, Heyne D, Rollings S, Martin R, Ollendick T: Treating sexually abused children with posttraumatic stress symptoms: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2000, 39:1347-1355.
- [21]Jensen TK, Holt T, Ormhaug SM, Egeland K, Granly L, Hoaas L, Hukkelberg SS, Indregaard T, Stormyren S, Wentzel-Larsen T: A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. J Clin Child Adolesc Psychol 2013, 0(0):1-14.
- [22]Foa EB, Johnson KM, Feeny NC, Treadwell KR: The Child PTSD Symptom Scale:a preliminary examination of its psychometric properties. J Clin Child Psychol 2001, 30:376-384.
- [23]Ribbe D: Psychometric review of Traumatic Event Screening Instrument for Children (TESI-C). In Measurement of Stress, Trauma, And Adaptation. Edited by Stamm BH. Lutherville, MD: Sidran Press; 1996:386-387.
- [24]Deblinger E, Cohen JA, Mannarino AP, Murray LA, Epstein C: TF-CBT Fidelity Checklist. Stratford, NJ: UMDNJ-SOM CARES Institute; 2008. Unpublished instrument
- [25]Mannarino AP, Cohen JA: Family-related variables and psychological symptom formation in sexually abused girls. J Child Sex Abus 1996, 5:105-120.
- [26]Cohen JA, Mannarino AP: Predictors of treatment outcome in sexually abused children. Child Abuse Negl 2000, 24:983-994.
- [27]Cohen JA, Mannarino AP, Knudsen K: Treating childhood traumatic grief: a pilot study. J Am Acad Child Adolesc Psychiatry 2004, 43:1225-1233.
- [28]Deblinger E, Mannarino AP, Cohen JA, Steer RA: A Follow-up study of a mutisite, randomized, controlled trial for children with sexual abuse-related PTSD Symptoms. J Am Acad Child Adolesc Psychiatry 2006, 45:1474-1484.
- [29]Radloff LS: The CES-D Scale: a self report depression scale for research in the general population. Appl Psych Meas 1977, 1:384-401.
- [30]Nader K, Kriegler JA, Blake DD, Pynoos RS, Newman E, Weathers F: Clinician Administered Ptsd Scale, Child And Adolescent Version. White River Junction, VT: National Center for PTSD; 1996.
- [31]Nader K, Newman E, Weathers F, Kaloupek DG, Kriegler J, Blake D: Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Los Angeles, CA: Western Psychological Press; 2004.
- [32]Angold A, Costello EJ, Messer SC, Pickles A: Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 1995, 5:237-249.
- [33]Fairclough DL: Design and Analysis of Quality of Life Studies in Clinical Trials. Boca Raton, FL: Chapman and Hall/CRC; 2010.
- [34]Pinheiro J, Bates D: Mixed Effects Models in S and S-Plus. New York: Springer-Verlag; 2000.
- [35]Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008, 40:879-891.
- [36]MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V: A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 2002, 7:83-104.
- [37]Muthén BO, Muthén LK: Mplus User’s Guide. 6th edition. Los Angeles, CA: Muthén & Muthén; 2010.
- [38]Guo S: Analyzing grouped data with hierarchical linear modeling. Child Youth Serv Rev 2005, 27:637-652.
- [39]Heinrich CJ, Lynn LE: Means and ends: A comparative study of empirical methods for investigating governance and performance. J Public Admin Res Theory 2001, 11:109-138.
- [40]Constantino MJ, Arnkoff DB, Glass CR, Ametrano RM, Smith JZ: Expectations. J Clin Psychol 2011, 67:184-192.
- [41]Devilly GJ, Borkovec TD: Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry 2000, 31:73-86.
- [42]Goossens ME, Vlaeyen JW, Hidding A, Kole-Snijders A, Evers SM: Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clin J Pain 2005, 21:18-26.
- [43]La Greca AM, Silverman WK, Lochman JE: Moving beyond efficacy and effectiveness in child and adolescent intervention research. J Consult Clin Psychol 2009, 77:373-382.
- [44]Smith P, Yule W, Perrin S, Tranah T, Dalgleish T, Clark D: Cognitive behavior therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2007, 46:1051-1061.
- [45]Ehlers A, Clark DM: A cognitive model of posstraumatic stress disorder. Behav Res Ther 2000, 38:319-345.