Structured Trauma-Focused CBT and Unstructured Play/Experiential Techniques in the Treatment of Sexually Abused Children: A Field Study With Practicing Clinicians
Structured Trauma-Focused CBT and Unstructured Play/Experiential Techniques in the Treatment of Sexually Abused Children: A Field Study With Practicing Clinicians
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DOI：
10.1177/1077559516681866
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发表时间：
2017-05-01
影响因子：
5.1
通讯作者：
Hoskowitz, Natalie Armstrong
中科院分区：
文献类型：
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作者：
Allen, Brian;Hoskowitz, Natalie Armstrong
结构化的、以创伤为中心的认知行为治疗（CBT）技术被广泛认为是对遭受性虐待的儿童的有效干预措施。然而，非结构化（即，非指导性）游戏/体验技术具有更长的广泛推广历史，并且被许多执业临床医生所偏好。然而，没有证据可以确定这些技术的整合如何影响治疗结果。在这项研究中，社区为基础的临床医生接受了结构化的，以创伤为中心的认知行为干预培训，管理治疗前和治疗后的评估，以260名性虐待儿童呈现创伤后应激障碍。此外，他们还完成了一份调查问卷，描述了对每个孩子实施的治疗技术。总体而言，6项临床结局均观察到显著改善。回归分析表明，技术的选择是一个显着的因素，治疗后的创伤后应激反应，分离，焦虑，愤怒/侵略。一般来说，结构化CBT技术的更大利用率与较低的治疗后评分相关，而较高的游戏/体验技术频率与较高的治疗后评分相关。然而，没有观察到相互作用效应。研究这些发现对临床实践和未来研究的影响。
Structured, trauma-focused cognitive-behavioral therapy (CBT) techniques are widely considered an effective intervention for children who experienced sexual abuse. However, unstructured (i.e., nondirective) play/experiential techniques have a longer history of widespread promotion and are preferred by many practicing clinicians. No evidence is available, however, to determine how the integration of these techniques impacts treatment outcome. In this study, community-based clinicians who received training in a structured, trauma-focused cognitive-behavioral intervention administered pretreatment and posttreatment evaluations to 260 sexually abused children presenting with elevated posttraumatic stress. In addition, they completed a questionnaire describing the treatment techniques implemented with each child. Overall, significant improvement was observed for each of the six clinical outcomes. Regression analyses indicated that technique selection was a significant factor in posttreatment outcome for posttraumatic stress, dissociation, anxiety, and anger/aggression. In general, a greater utilization of the structured CBT techniques was related to lower posttreatment scores, whereas a higher frequency of play/experiential techniques was associated with higher posttreatment scores. However, no interaction effects were observed. The implication of these findings for clinical practice and future research are examined.