Stability of Treatment Effects and Caregiver-Reported Outcomes: A Meta-Analysis of Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents

The efficacy of trauma-focused treatments for children and adolescents is well researched. However, less is known about the long-term and caregiver-reported effects. Searched databases were PsychInfo, MEDLINE, Cochrane Library, PTSDPubs, PubMed, Web of Science, and OpenGrey. Treatment effects of trauma-focused cognitive behavioral therapy (TF-CBT) were computed at 12-month follow-up with posttraumatic stress symptoms (PTSS) as primary outcome and symptoms of depression, anxiety, and grief as secondary outcomes. Concordance between participant and caregiver ratings were investigated. TF-CBT showed large improvements across all outcomes from pre-treatment to 12-month follow-up (PTSS: g = 1.71, CI 1.27–2.15) and favorable results compared to active treatments and treatment as usual at 12-month follow-up (PTSS: g = .35, CI .13–.56). More pronounced effects were found in group settings. No significant differences were detected between participant and caregiver ratings with high reliability across almost all outcomes and assessment points. TF-CBT is a reliable treatment for pediatric PTSS and secondary symptoms with stable results at 12-month follow-up.

Anxiety Pre-FU III Within-Group Effect Size.
Grief Pre-FU III Within-Group Effect Size.
PTSS FU II-FU III Within-Group Effect Size.
Depression FU II-FU III Within-Group Effect Size.
Anxiety FU II-FU III Within-Group Effect Size.
c Analysis includes high risk of bias studies (calculation otherwise not possible due to low number of studies).b Analysis includes high risk of bias studies (calculation otherwise not possible due to low number of studies).
c Recalculated with imputed studies (trim and fill method according to Duval and Tweedie).Everything that can be considered treatment as usual and is not highly controlled

Funnel
Plot of Standard Error by Hedges's g for Grief (RCTs only, pre-FU III) High risk of bias studies are excluded; n = number of included TF-CBT conditions; Individual = TF-CBT conducted in an individual treatment setting; Group = TF-CBT conducted in a group setting.* p < .05;** p < .01;*** p < .001. a Recalculated with imputed studies (trim and fill method according to Duval and Tweedie).
57 0 Note.High risk of bias studies are excluded; n = number of included comparisons; PTSS = Posttraumatic Stress Symptoms; TAU/AT = Treatment as usual/active treatment control conditions; WL = Wait-list control conditions; Effectiveness = Effectiveness RCTs only; Efficacy = Efficacy RCTs only; Individual = RCTs conducted in an individual treatment setting; Group = RCTs conducted in a group setting.* p < .05;** p < .01;*** p < .001. a Fixed model assumed due to non-significant Q-value.
Note.TF-CBT = Trauma Focused Cognitive Behavioral Therapy; TAU = Treatment As Usual; AT = Active treatment; WL = Wait-List; SC-TF-CBT = Stepped Care Trauma Focused Cognitive Behavioral Therapy; PTSS = Posttraumatic Stress Symptoms.a SC-TF-CBT was excluded from analyses as some participants received TF-CBT while others did not.reported result Note.TF-CBT = Trauma Focused Cognitive Behavioral Therapy; TAU = Treatment As Usual; AT = Active treatment; WL = Wait-List; PTSS = Posttraumatic Stress Symptoms.

Table 9 .
Depression Pre-FU III Within-Group Effect Size.

Study name Condition Outcome Statistics for each study Hedges's g and 95% CI Hedges's Standard Lower Upper g error Variance limit limit Z-Value p-Value
AAT = Animal-Assisted Therapy; KR = Kenia Rural; KU = Kenia Urban; TR = Tanzania Rural; TU = Tanzania Urban.

Table 16 .
Depression Pre-Post Proxy-Reported Within-Group Effect Size.

Table 17 .
Anxiety Pre-Post Proxy-Reported Within-Group Effect Size.

Table 18 .
PTSS Pre-FU III Proxy-Reported Within-Group Effect Size.

Table 19 .
PTSS FU III Between-Group Effect Size.

Table 20 .
Depression FU III Between-Group Effect Size.

Table 21 .
Anxiety FU III Between-Group Effect Size.

Table 22 .
Grief FU III Between-Group Effect Size.

Table 24 .
Depression Post-Treatment Proxy-Reported Between-Group Effect Size.

Table 26
Pre-FU II Within-Group Effect Sizes for PTSS, Depression and Anxiety.Note.High risk of bias studies are excluded; n = number of included TF-CBT conditions.* p < .05;** p < .01;*** p < .001.Recalculated with imputed studies (trim and fill method according to Duval and Tweedie).
a b Fixed model assumed due to non-significant Q-value.http://mc.manuscriptcentral.com/childmaltreatmentChild Maltreatment

Table 27
Pre-Post Within-Group Effect Sizes for PTSS, Depression, Anxiety and Grief.

Table 28
Pre-Post Within-Group Effect Sizes for Proxy-Reported PTSS and Depression.High risk of bias studies are excluded; n = number of included TF-CBT conditions; Individual = TF-CBT conducted in an individual treatment setting; Group = TF-CBT conducted in a group setting.* p < .05;** p < .01;*** p < .001.Analysis includes high risk of bias studies (calculation otherwise not possible due to low number of studies).

Table 29
Post-treatment Between-Group Effect Sizes for PTSS, Depression, Anxiety and Grief.

Table 30
Pre-FU I and FU II Within-Group Effect Sizes for PTSS, Depression and Anxiety With High Risk of Bias Studies.High risk of bias studies included; n = number of included TF-CBT conditions.* p < .05;** p < .01;*** p < .001 a Recalculated with imputed studies (trim and fill method according to Duval and Tweedie).

Table 31
Within-Group and Between-Group Effect Sizes for Proxy-Reported PTSS, Depression and Anxiety With High Risk of Bias Studies.Note.High risk of bias studies included; n = number of included comparisons; PTSS = Posttraumatic Stress Symptoms.