John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Children who are exposed to trauma can experience serious mental health problems and a variety of psychological therapies have been tried to prevent these outcomes. In October 2016, Donna Gillies from the Western Sydney Local Health District in Australia and colleagues brought the evidence together in a new Cochrane Review and she tells us more in this podcast.

Donna: This review was a follow-up to our earlier review of psychological therapies for children and adolescents diagnosed with posttraumatic stress disorder. The aim of this new review was to see if these therapies might be effective in preventing negative outcomes, including PTSD, in children and adolescents who had been exposed to trauma.

We included 51 trials, which had recruited a total of more than 6000 participants. Twenty trials included children, two were limited to preschool children, and ten to adolescents. The rest included both children and adolescents.

The trials included participants exposed to a variety of different traumas. The most common were sexual abuse in 12 trials, and war or community violence in ten. They were involved in a natural disaster in six trials; undergone physical trauma in six; and exposed to interpersonal violence in three trials. One trial each included participants who had had a life-threatening illness; been physically abused; or maltreated. The remaining trials included a range of traumas.

We had hoped to concentrate on trials where therapy had started within a year of the trauma but this was not possible as most trials did not report the time between trauma exposure and therapy.
The most commonly used psychological therapy was cognitive behavioural therapy, or CBT. Other therapies were family therapy, exposure, debriefing, psychoeducation, skills training, narrative therapy, supportive therapy, and a technique known as EMDR. Despite this wide range of psychological therapies, several psychotherapeutic elements were common to most. In particular, psychoeducation and coping skills were included in many.

Overall, we found children and adolescents receiving psychological therapies were less likely to display symptoms of, or be diagnosed with, PTSD, compared to those not receiving therapy. We also found some evidence that CBT might be more effective than other psychological therapies. However, we did not find evidence that psychological therapies prevented other negative outcomes such as depression, anxiety, or behavioural changes. Unfortunately, because most studies only reported outcomes up to one month, there was no evidence for the long-term effectiveness of psychological therapies.

There were some indications that different types of trauma may be more responsive to psychological therapies. Symptoms were decreased in trials which included children and adolescents exposed to sexual abuse, community violence, interpersonal violence and natural disaster; but not when the exposure was physical trauma or a life-threatening illness. As there were only single studies of a number of types of trauma, we cannot yet be sure whether these differences are real.

In summary, although it is not yet clear whether benefits will be maintained in the long term, the existing evidence allows us to recommend that children and adolescents exposed to trauma should be offered psychological therapies to prevent the clinical symptoms of trauma exposure.

John: If you would like to read more about the types of therapy, and the types of trauma in Donna’s review, you can find it online at Cochrane Library dot com. Just go to the website and run a search for ‘psychological therapies and trauma in children’.