Support for Early Treatment With CBT in Youth With PTSD

This trial indicates that in most cases, youth who are diagnosed with PTSD 2 to 6 months after the initial trauma are likely to require treatment.
This trial indicates that in most cases, youth who are diagnosed with PTSD 2 to 6 months after the initial trauma are likely to require treatment.

Researchers have found preliminary support for the efficacy and acceptability of cognitive therapy as an early treatment for posttraumatic stress disorder (PTSD) in children and adolescents.

This trial's results also do not support the extension of "watchful waiting" into 2 to 6 months posttrauma, as significantly more participants who received cognitive therapy for PTSD were free of PTSD posttreatment compared with those who were put on a waitlist.

Richard Meiser-Stedman, PhD, from the Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, and the University of East Anglia, Norwich, United Kingdom, and colleagues recruited 29 youth (ages 8-17 years) who had PTSD (according to age-appropriate Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or International Statistical Classification of Diseases and Related Health Problems, Tenth Edition, diagnostic criteria) after a single-event trauma in the previous 2 to 6 months. They randomly assigned the participants to either cognitive therapy (n = 14) or a waiting list (n = 15) for 10 weeks.

The researchers found that significantly more participants no longer had PTSD after cognitive therapy (71%) compared with those on the waitlist (27%; intent-to-treat, 95% CI for difference, 0.04-0.71).

They also found that:

  • Those who participated in cognitive therapy showed greater improvements on child-report questionnaire measures of PTSD, depression, and anxiety, as well as on clinician-rated functioning outcomes and on parent-reported outcomes;
  • After cognitive therapy, recovery was maintained at 6 and 12 months posttreatment;
  • The benefits of cognitive therapy were shown through changes in appraisals and safety-seeking behaviors; and
  • Cognitive therapy for PTSD was found to be acceptable, given low dropout rates and high treatment credibility and therapist alliance ratings.

"This is the first study to show the efficacy of a psychological treatment over natural recovery for the early treatment of PTSD in youth, and the first study to show the efficacy of any treatment for PTSD in youth in the early post-trauma window of 2-6 months," the researchers wrote.

Although youth in the waitlist group experienced some recovery (33% experienced clinically significant improvements), this trial indicates that in most cases, youth who are diagnosed with PTSD 2 to 6 months after the initial trauma are likely to require treatment.

"This was particularly apparent when considering functioning and depression data, which showed considerable improvement in the [cognitive therapy group,] but no change in the [waitlist group]," the investigators noted.

Summary

"In summary, these data suggest [cognitive therapy] is a potentially powerful and acceptable early treatment for youth with PTSD that may yield sustained improvements and benefit broader mental health and functioning," the researchers wrote.

However, further research is needed to determine how treatment in this time frame might be delivered more cost-effectively, and careful attention should be paid to recruitment to attempt to recruit a larger and more diverse population of participants.

Limitations

  • A limited sample size with unbalanced ethnicity and socioeconomic characteristics made the study susceptible to bias.
  • The study only had 27% males as participants.

Reference

Meiser-Stedman R, Smith P, McKinnon A, et al. 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 [published online December 15, 2016]. J Child Psychol Psychiatry. doi: 10.1111/jcpp.12673

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