Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action / Richard MEISER-STEDMAN in Journal of Child Psychology and Psychiatry, 58-5 (May 2017)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 58-5 (May 2017) . - p.623-633 Titre : Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action Type de document : Texte imprimé et/ou numérique Auteurs : Richard MEISER-STEDMAN, Auteur ; Patrick SMITH, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; David TRICKEY, Auteur ; Anke EHLERS, Auteur ; David M. CLARK, Auteur ; Adrian BOYLE, Auteur ; Peter WATSON, Auteur ; Ian GOODYER, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.623-633 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  cognitive therapy Index. décimale : PER Périodiques Résumé : Background Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). Methods Twenty-nine youth (8–17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2–6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. Results Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04–.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. Conclusions This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of ‘watchful waiting’ into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required. En ligne : http://dx.doi.org/10.1111/jcpp.12673 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=306 [article] Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action [Texte imprimé et/ou numérique] / Richard MEISER-STEDMAN, Auteur ; Patrick SMITH, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; David TRICKEY, Auteur ; Anke EHLERS, Auteur ; David M. CLARK, Auteur ; Adrian BOYLE, Auteur ; Peter WATSON, Auteur ; Ian GOODYER, Auteur ; Tim DALGLEISH, Auteur . - p.623-633. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 58-5 (May 2017) . - p.623-633 Mots-clés : Post-traumatic stress disorder  cognitive therapy Index. décimale : PER Périodiques Résumé : Background Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). Methods Twenty-nine youth (8–17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2–6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. Results Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04–.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. Conclusions This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of ‘watchful waiting’ into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required. En ligne : http://dx.doi.org/10.1111/jcpp.12673 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=306

Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder / Ifigeneia MAVRANEZOULI in Journal of Child Psychology and Psychiatry, 61-6 (June 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-6 (June 2020) . - p.699-710 Titre : Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder Type de document : Texte imprimé et/ou numérique Auteurs : Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; David TRICKEY, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Stephen PILLING, Auteur Article en page(s) : p.699-710 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  decision-analytic modelling  economic evaluation  intervention Index. décimale : PER Périodiques Résumé : BACKGROUND: PTSD in youth may lead to long-lasting psychological implications, educational difficulties and increased healthcare costs. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of psychological interventions for children and young people with PTSD. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life years (QALYs) of 10 psychological interventions and no treatment for children and young people with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS: Cognitive therapy for PTSD, a form of individual trauma-focused cognitive behavioural therapy (TF-CBT), appeared to be the most cost-effective intervention for children and young people with PTSD (with a probability of .78 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by narrative exposure (another form of individual TF-CBT), play therapy, and other forms of individual TF-CBT. After excluding cognitive therapy from the analysis, narrative exposure appeared to be the most cost-effective option with a .40 probability of being cost-effective amongst the remaining 10 options. EMDR, parent training and group TF-CBT occupied middle cost-effectiveness rankings. Family therapy and supportive counselling were less cost-effective than other active interventions. There was limited evidence for some interventions, in particular cognitive therapy for PTSD and parent training. CONCLUSIONS: Individual forms of TF-CBT and, to a lesser degree, play therapy appear to be cost-effective in the treatment of children and young people with PTSD. Family therapy and supportive counselling are unlikely to be cost-effective relative to other interventions. There is a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of psychological treatments for children and young people with PTSD. En ligne : http://dx.doi.org/10.1111/jcpp.13142 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426 [article] Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder [Texte imprimé et/ou numérique] / Ifigeneia MAVRANEZOULI, Auteur ; Odette MEGNIN-VIGGARS, Auteur ; David TRICKEY, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin DALY, Auteur ; Sofia DIAS, Auteur ; Sarah STOCKTON, Auteur ; Stephen PILLING, Auteur . - p.699-710. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-6 (June 2020) . - p.699-710 Mots-clés : Post-traumatic stress disorder  decision-analytic modelling  economic evaluation  intervention Index. décimale : PER Périodiques Résumé : BACKGROUND: PTSD in youth may lead to long-lasting psychological implications, educational difficulties and increased healthcare costs. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost-effectiveness of a range of psychological interventions for children and young people with PTSD. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life years (QALYs) of 10 psychological interventions and no treatment for children and young people with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS: Cognitive therapy for PTSD, a form of individual trauma-focused cognitive behavioural therapy (TF-CBT), appeared to be the most cost-effective intervention for children and young people with PTSD (with a probability of .78 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by narrative exposure (another form of individual TF-CBT), play therapy, and other forms of individual TF-CBT. After excluding cognitive therapy from the analysis, narrative exposure appeared to be the most cost-effective option with a .40 probability of being cost-effective amongst the remaining 10 options. EMDR, parent training and group TF-CBT occupied middle cost-effectiveness rankings. Family therapy and supportive counselling were less cost-effective than other active interventions. There was limited evidence for some interventions, in particular cognitive therapy for PTSD and parent training. CONCLUSIONS: Individual forms of TF-CBT and, to a lesser degree, play therapy appear to be cost-effective in the treatment of children and young people with PTSD. Family therapy and supportive counselling are unlikely to be cost-effective relative to other interventions. There is a need for well-conducted studies that examine the long-term clinical and cost-effectiveness of a range of psychological treatments for children and young people with PTSD. En ligne : http://dx.doi.org/10.1111/jcpp.13142 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=426

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