Dataset Information

Does the therapist matter? Therapist characteristics and their relation to outcome in trauma-focused cognitive behavioral therapy for children and adolescents.

ABSTRACT:

Background

There is a broad evidence-base for the effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in treating children and adolescents with posttraumatic stress disorder (PTSD). The effect of therapist characteristics on patient symptoms has been neglected in psychotraumatology research and necessitates further investigation.

Objective

This study aims to investigate the impact of therapist characteristics (gender, clinical experience and theoretical background) on posttraumatic stress symptoms (PTSS) in a heterogeneous and international sample of traumatized children and adolescents.

Method

Data from two RCTs on the effectiveness of TF-CBT in Norway and Germany were included, comprising N = 52 therapists (78.8% female) and N = 153 patients (72.3% female). All therapists underwent thorough training and continuous supervision in TF-CBT. The Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) assessed pre- and post-treatment served as the outcome variable in a linear mixed-effects model with therapists' theoretical background, prior clinical experience and gender as independent variables, adjusted for patient gender, measurement time and country. The possibility of an interaction between therapist and patient gender was investigated subsequently.

Results

None of the therapist characteristics were significantly related to PTSS. There was no indication of an interaction between patient and therapist gender (p =.878).

Conclusion

The lack of evidence for a relationship of therapists' theoretical orientation and clinical experience with outcome suggests that a wider dissemination of TF-CBT may be warranted. More studies with larger therapist and patient sample sizes and including only community practice are needed.

SUBMITTER: Pfeiffer E

PROVIDER: S-EPMC7473296 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundIt has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques.MethodsTE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients' and caregivers' TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients' and caregivers' working alliance, as well as patients' collaboration were assessed at mid-treatment, patients' PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores.ResultsPatients' or caregivers' TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients' or caregivers' TE via patients' collaboration or patients' or caregivers' working alliance. Caregivers' working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: β = - 0.553; p < 0.001; PTSS difference score: β = 0.335; p = 0.031).ConclusionsTE seems less important than caregivers' working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.

Project description:BackgroundThe effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia.MethodsData were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment.ResultsTreatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment.ConclusionsThis study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible.

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