Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence
Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence
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DOI：
10.1176/appi.ps.201300255
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发表时间：
2014-05-01
影响因子：
3.8
通讯作者：
Delphin-Rittmon, Miriam E.
中科院分区：
文献类型：
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作者：
de Arellano, Michael A. Ramirez;Lyman, D. Russell;Delphin-Rittmon, Miriam E.
目的：以创伤为中心的认知行为疗法（TF-CBT）是由 Cohen、Mannarino 和 Deblinger 开发的一种联合亲子治疗方法，利用认知行为原则和暴露技术来预防和治疗创伤后应激、抑郁和行为问题。该综述定义了 TF-CBT，将其与其他模型区分开来，并评估了证据基础。方法：作者回顾了荟萃分析、综述和个体研究（1995 年至 2013 年）。调查的数据库包括 PubMed、PsycINFO、应用社会科学索引和摘要、社会学摘要、社会服务摘要、PILOTS、ERIC 和 CINAHL。他们根据研究数量和方法质量的基准从三个级别的研究证据（高、中、低）中进行选择。他们还描述了有效性的证据。结果：根据 10 项随机对照试验，TF-CBT 的证据水平被评为高，其中 3 项是独立进行的（不是由 TF-CBT 开发人员进行的）。 TF-CBT 在减少创伤后应激障碍症状方面已显示出积极的成果，尽管尚不清楚 TF-CBT 是否能有效减少行为问题或抑郁症状。这些研究的局限性包括对研究者偏见和排除弱势群体的担忧。结论：TF-CBT 是一种可行的治疗方法，可以减少一些经历过创伤的儿童及其无冒犯性的照顾者的创伤相关症状。基于这一证据，TF-CBT 应作为健康计划的承保服务提供。需要进行持续的研究，以进一步确定 TF-CBT 在各种环境下、针对来自不同种族和民族背景、具有不同创伤史、症状以及智力、社交和情感发展阶段的个人的最佳实践。
Objective: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat post-traumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. Methods: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. Results: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. Conclusions: TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.