Unproven therapies commonly given to traumatized kids

[David Baxter PhD]

Unproven therapies commonly given to traumatized kids, report finds
Tuesday, September 9, 2008
CBC News

Children and teens suffering trauma are often given unproven approaches such as drugs, art or play therapy when talk therapy is effective, U.S. scientists said in a report Tuesday.

Cognitive therapy is a type of talk therapy that uses a trained counsellor who focuses on changing a person's distorted thinking patterns. It aims to replace negative thoughts and beliefs that influence mood and actions.

"The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," said study author Robert Hahn of the U.S. Centers for Disease Control and Prevention's Community Guide Branch.

"We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Childhood trauma can be brought on by physical or sexual abuse, witnessing violence, or natural disasters.

In the September issue of the American Journal of Preventive Medicine, Hahn and his colleagues concluded there is not enough scientific evidence to support the use of art therapy, play therapy, drug therapy, and psychological debriefing for childhood trauma.

Long-term consequences
"Many kids with symptoms of trauma go undiagnosed, which can lead to unhealthy behaviors in adulthood such as smoking and alcohol or drug abuse," Hahn said in a release.

"Increased screening to identify trauma symptoms in children can help these kids get the therapy they need and lessen the likelihood they will engage in these risky health behaviors when they become adults."

In play therapy, a child uses toys or imagination to "express experiences, thoughts, feelings, and desires that might be more threatening if addressed directly," the report said.

Similarly, proponents of art therapy argue that trauma is stored in the memory as an image, and that using expressive art techniques helps process and resolve traumatic issues.

Psychological debriefing, also called critical incident stress management, is a group meeting offered within 72 hours of a traumatic event. It allows people to share their thoughts and feelings in the hopes of preventing adverse reactions.

The report reviews dozens of studies conducted by the Task Force on Community Preventive Services, an independent group of scientists partially funded by the U.S. government

 

[Banned]

I have mixed feelings on this. While the author may classify certain therapies as unproven, it doesn't mean that they are detrimental. I went to a CBT therapist for years and got nowhere. I switched to another therapist who uses many, many different approaches and experienced tremendous approach and healing. Some of her approaches are "unproven" or unconventional, but they worked for me. CBT is undoubtedly highly effective for most of the people most of the time, but "unproven therapies" can also be highly effective for some of the people some of the time. For people like me, though we're possibly a minority, it is a lifesaver to have something else to work off of.

 

[David Baxter PhD]

There is some evidence that the type of therapy is at least sometimes less important than characteristics of the therapist or the rapport between client and therapist.

However, the article is specifically talking about the use of certain therapies in traumatized children.

 

[Daniel E.]

Cognitive Behavioral Therapy Effective for Trauma Symptoms in Children

Another article about the same report:

Cognitive Behavioral Therapy Effective for Trauma Symptoms in Children
Medscape Medical News

by Marlene Busko

September, 18, 2008 — A new review by the Task Force on Community Preventive Services has found strong evidence supporting the use of individual and group cognitive behavioral therapy (CBT) to reduce psychological harm among children and adolescents exposed to trauma.

CBT was effective in reducing depressive disorders, anxiety, posttraumatic stress disorder (PTSD), and other symptoms in these children, their review of the literature shows.

It appears, however, that more than 75% of clinicians who treat children with PTSD use art, play, drug, or other therapies that lack sufficient proof of efficacy, the authors write.

The review, by members of the task force appointed by the Centers for Disease Control and Prevention (CDC), is published in the September issue of the American Journal of Preventive Medicine.

"The population of kids exposed to trauma is large, and many practitioners are using interventions for which we have found insufficient evidence, and many are not using interventions for which we believe there is strong evidence, so we hope our findings will reshape practice," Robert Hahn, PhD, coordinating scientist at the CDC, in Atlanta, Georgia, and an author of the task report, told Medscape Psychiatry.

Although some children appear to be unharmed or only transiently affected by traumatic exposure — which can range from sexual abuse to school shootings to natural disasters such as hurricanes — other untreated children might develop PTSD, depression, anxiety, substance-abuse problems, or even suicidal behavior, he noted.

Widespread Problem

Exposure to traumatic events such as physical or sexual abuse, domestic or community violence, and natural disasters is common among children in the United States, the review authors write. According to a recent national survey of children aged 2 to 17 years, 1 in 8 experienced maltreatment such as abuse, bullying, or neglect, and 1 in 12 experienced sexual abuse.

Given the high rates of exposure to traumatic events and the potential for long-term consequences of untreated exposure, this review aimed to examine common interventions to determine which ones were effective, based on the best available evidence.

The reviewers looked at published studies of children and adolescents age 21 years and younger who were living in high-income countries and who were exposed to trauma. To be included in the review, studies had to assess common psychological consequences such as PTSD, anxiety, depression, externalizing disorders such as disruptive behavior, or internalizing disorders such as being fearful or withdrawn.

Evidence Supports Talk Therapy

Eleven studies of individual CBT and 10 studies of group CBT met the review criteria. Children included in these studies had received 2 to 20 individual therapy sessions or 1 to 10 group therapy sessions.

The studies presented strong evidence that both individual and group CBT is associated with decreases in psychological harm. "This is very exciting because it provides an effective way to treat these kids," said Dr. Hahn.

On the other hand, the investigators found insufficient evidence of effectiveness and only a limited number of studies (1 to 4 each) for the other 5 therapies: play, art, psychodynamic therapies, pharmacologic therapies, and psychological debriefing.

"The lack of information on drugs and the fact that many clinicians are not trained in evidence-based practice is disappointing," said Dr. Hahn. The group hopes that clinicians will adopt treatments based on the best available scientific evidence and that researchers will undertake studies that will provide new evidence on unproven interventions, he added.

They also note the need for more screening to identify trauma symptoms in children, which could be done in schools, to help these children get the therapy they require.

A summary of this review — the last of 6 reviews that looked at interventions designed to reduce or prevent violence by and against children and adolescents — is available on a CDC Web site.

Journal article:
The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review [Am J Prev Med. 2008]