| 1. |
- de Haan, Anke, et al.
(author)
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Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials
- 2024
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In: The Lancet Child and Adolescent Health. - 2352-4642. ; 8:1, s. 28-39
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Journal article (peer-reviewed)abstract
- Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=−13·17, 95% CI −17·84 to −8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=−0·15, 95% CI −0·29 to −0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. Funding: Swiss National Science Foundation.
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| 2. |
- Deeprose, Catherine, et al.
(author)
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Imagery in the aftermath of viewing a traumatic film : Using cognitive tasks to modulate the development of involuntary memory
- 2012
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In: Journal of Behavior Therapy and Experimental Psychiatry. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0005-7916 .- 1873-7943. ; 43:2, s. 758-764
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Journal article (peer-reviewed)abstract
- Background and objectives: Involuntary autobiographical memories that spring unbidden into conscious awareness form part of everyday experience. In psychopathology, involuntary memories can be associated with significant distress. However, the cognitive mechanisms associated with the development of involuntary memories require further investigation and understanding. Since involuntary autobiographical memories are image-based, we tested predictions that visuospatial (but not other) established cognitive tasks could disrupt their consolidation when completed post-encoding. Methods: In Experiment 1, participants watched a stressful film then immediately completed a visuospatial task (complex pattern tapping), a control-task (verbal task) or no-task. Involuntary memories of the film were recorded for 1-week. In Experiment 2, the cognitive tasks were administered 30-min post-film. Results: Compared to both control and no-task conditions, completing a visuospatial task post-film reduced the frequency of later involuntary memories (Expts 1 and 2) but did not affect voluntary memory performance on a recognition task (Expt 2). Limitations: Voluntary memory was assessed using a verbal recognition task and a broader range of memory tasks could be used. The relative difficulty of the cognitive tasks used was not directly established. Conclusions: An established visuospatial task after encoding of a stressful experience selectively interferes with sensory-perceptual information processing and may therefore prevent the development of involuntary autobiographical memories. (C) 2011 Elsevier Ltd. All rights reserved.
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| 3. |
- Holmes, Emily A., et al.
(author)
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Positive interpretation training : Effects of mental imagery versus verbal training on positive mood
- 2006
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In: Behavior Therapy. - : ELSEVIER INC. - 0005-7894 .- 1878-1888. ; 37:3, s. 237-247
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Journal article (peer-reviewed)abstract
- Therapists often assume a special association between mental imagery and emotion, though empirical evidence has been lacking. Using an interpretation training paradigm, we previously found that imagery had a greater impact on anxiety than did verbal processing of the same material (Holmes & Mathews, 2005). Although the finding of a differential impact of imagery versus verbal processing of negative material was replicated, findings did not extend to benign material. Results therefore left open the question of whether there may be a special association between imagery and positive emotion. The current experiment examined positive interpretation training. Numerous scenarios were presented with initial ambiguity as to positive outcome or not, with final information then yielding consistently positive resolutions. Participants were asked to either imagine these positive events or to listen to the same descriptions while thinking about their verbal meaning. Those participants in the imagery condition reported greater increases in positive affect and rated new descriptions as being more positive than did those in the verbal condition. Results suggest that positive training can be enhanced through imagery as opposed to verbal processing. This study also provides the first test of a standardized intervention using an "interpretive bias training" paradigm to improve positive mood.
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| 4. |
- Holmes, Emily A., et al.
(author)
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The causal effect of mental imagery on emotion assessed using picture-word cues
- 2008
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In: Emotion. - : AMER PSYCHOLOGICAL ASSOC. - 1528-3542 .- 1931-1516. ; 8:3, s. 395-409
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Journal article (peer-reviewed)abstract
- The hypothesis that mental imagery is more likely to elicit emotion than verbal processing of the same material was investigated in two studies. Participants saw a series of pictures, each accompanied by a word, designed to yield a negative or benign meaning when combined. Participants were either free to combine the picture and word as they wished (Experiment 1) or instructed to integrate them using either a descriptive sentence or a mental image (Experiment 2). Emotional response was consistently greater following imagery than after producing a sentence. Experiment 2 also demonstrated the causal effect of imagery on emotion and evaluative learning. Additional participants in Experiment 2 described aloud their images/sentences. Independent ratings of descriptions indicated that, as well as being more emotional, images differed from sentences elicited by identical cues by greater similarity to memories, and greater involvement of sensations and specific events. Results support the hypothesis that imagery evokes stronger affective responses than does verbal processing, perhaps because of sensitivity of emotional brain regions to imagery, the similarity of imagery to perception, and to autobiographical episodes.
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| 5. |
- Nixon, Reginald, et al.
(author)
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The Child PTSD Symptom Scale: An Update and Replication of Its Psychometric Properties
- 2013
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In: Psychological Assessment. - : American Psychological Association (APA). - 1040-3590 .- 1939-134X. ; 25:3, s. 1025-1031
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Journal article (peer-reviewed)abstract
- The psychometric properties of the Child PTSD Symptom Scale (CPSS) were examined in 2 samples. Sample 1 (N 185, ages 6–17 years) consisted of children recruited from hospitals after accidental injury, assault, and road traffic trauma, and assessed 6 months posttrauma. Sample 2 (N 68, ages 6–17 years) comprised treatment-seeking children who had experienced diverse traumas. In both samples psychometric properties were generally good to very good (internal reliability for total CPSS scores .83 and .90, respectively). The point-biserial correlation of the CPSS with posttraumatic stress disorder (PTSD) diagnosis derived from structured clinical interview was .51, and children diagnosed with PTSD reported significantly higher symptoms than non-PTSD children. The CPSS demonstrated applicability to be used as a diagnostic measure, demonstrating sensitivity of 84% and specificity of 72%. The performance of the CPSS Symptom Severity Scale to accurately identify PTSD at varying cutoffs is reported in both samples, with a score of 16 or above suggested as a revised cutoff.
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| 6. |
- Patrick, Smith, et al.
(author)
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Treatment of Posttraumatic Stress Disorder in Children and Adolescents
- 2013
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In: Current Opinion in Psychiatry. - 0951-7367. ; 26:1, s. 66-72
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Research review (peer-reviewed)abstract
- Purpose of review: We review recent evidence regarding risk factors for childhood posttraumatic stress disorder (PTSD) and treatment outcome studies from 2010 to 2012 including dissemination studies, early intervention studies and studies involving preschool children.Recent findings: Recent large-scale epidemiological surveys confirm that PTSD occurs in a minority of children and young people exposed to trauma. Detailed follow-up studies of trauma-exposed young people have investigated factors that distinguish those who develop a chronic PTSD from those who do not, with recent studies highlighting the importance of cognitive (thoughts, beliefs and memories) and social factors. Such findings are informative in developing treatments for young people with PTSD. Recent randomized controlled trials (RCTs) confirm that trauma-focused cognitive behaviour therapy (TF-CBT) is a highly efficacious treatment for PTSD, although questions remain about effective treatment components. A small number of dissemination studies indicate that TF-CBT can be effective when delivered in school and community settings. One recent RCT shows that TF-CBT is feasible and highly beneficial for very young preschool children. Studies of early intervention show mixed findings. Summary: Various forms of theory-based TF-CBT are highly effective in the treatment of children and adolescents with PTSD. Further work is needed to replicate and extend initial promising outcomes of TF-CBT for very young children. Dissemination studies and early intervention studies show mixed findings and further work is needed.
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| 7. |
- Woud, Marcella L., et al.
(author)
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Ameliorating Intrusive Memories of Distressing Experiences Using Computerized Reappraisal Training
- 2012
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In: Emotion. - : AMER PSYCHOLOGICAL ASSOC. - 1528-3542 .- 1931-1516. ; 12:4, s. 778-784
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Journal article (peer-reviewed)abstract
- The types of appraisals that follow traumatic experiences have been linked to the emergence of posttraumatic stress disorder (PTSD). Could changing reappraisals following a stressful event reduce the emergence of PTSD symptoms? The present proof-of-principle study examined whether a nonexplicit, systematic computerized training in reappraisal style following a stressful event (a highly distressing film) could reduce intrusive memories of the film, and symptoms associated with posttraumatic distress over the subsequent week. Participants were trained to adopt a generally positive or negative poststressor appraisal style using a series of scripted vignettes after having been exposed to highly distressing film clips. The training targeted self-efficacy beliefs and reappraisals of secondary emotions (emotions in response to the emotional reactions elicited by the film). Successful appraisal induction was verified using novel vignettes and via change scores on the Post Traumatic Cognitions Inventory. Compared with those trained negatively, those trained positively reported in a diary fewer intrusive memories of the film during the subsequent week, and lower scores on the Impact of Event Scale (a widely used measure of posttraumatic stress symptoms). Results support the use of computerized, nonexplicit, reappraisal training after a stressful event has occurred and provide a platform for future translational studies with clinical populations that have experienced significant real-world stress or trauma.
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| 8. |
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- 2019
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Journal article (peer-reviewed)
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