Violence: Psychological Harm from Traumatic Events Among Children and Adolescents – Psychodynamic Therapy

The Task Force finding is based on evidence from a systematic review of 1 study (search period through March 2007). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to violence prevention.

Psychodynamic therapy seeks to allow the traumatized individual to release unconscious thoughts and emotions and to integrate the traumatic event into his/her understanding of life and self-concept.

One study was included in the systematic review.

• Following the treatments, compared to case management, child–parent psychotherapy was associated with a significant reduction in PTSD symptoms among children in the study.

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps from these reviews on reducing psychological harms from traumatic events: Individual CBT; Group CBT; Play Therapy; Art Therapy; Psychodynamic Therapy; Pharmacological Therapy; Psychological Debriefing.

• Identification of robust predictors of transient and enduring symptoms following traumatic events would allow for better screening of exposed children and adolescents and more efficient allocation of treatment resources.
• The optimal timing of cognitive behavioral therapy (CBT) intervention following the exposure and the onset of symptoms is important to assess.
• It would be useful to stratify the outcomes of CBT treatment by the severity of patient PTSD symptoms and history. For example, it would be useful to know whether children and adolescents with multiple traumatic exposures require more intensive or longer treatment.
• One study with long term follow-up indicates that it may take a year after the end of the intervention for benefits to appear. This outcome should be replicated. If confirmed, it suggests that follow-up periods of less than one year are not adequate and may erroneously indicate intervention ineffectiveness.
• The cost effectiveness and differential cost effectiveness of individual and group CBT among children and adolescents should be explored.
• The effectiveness of individual and group CBT among minority populations, especially in communities in which violence is prevalent, should be further explored.
• Adaptations of CBT involving the recruitment, training, deployment, and supervision of nonprofessionals should be evaluated, and their applicability to low-income countries should also be explored.

Furthermore, the finding of insufficient evidence to determine the effectiveness of several of the interventions reviewed highlights the need for additional well-controlled studies of these interventions. Because CBT has been found to be an effective intervention, and because research funds are limited, it would be useful to adopt CBT as a comparison in future evaluations. Because of harms reported for psychological debriefing among adults, caution should be taken in research on this intervention with children and adolescents.

• Study participants were children ages 3–5 years who had been exposed to violence between their parents.
• Sessions were held weekly for 50 weeks.
• The intervention used a manual for implementation and assessed fidelity as part of its evaluation.
• Control subjects received case management plus individual psychotherapy; they were phoned at least monthly to check on their well-being, and they were referred for psychotherapy when it was indicated.