Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

99P Does the Hype Match the Data? A Systematic Review of TF-CBT for Use with Traumatized Youth

Saturday, January 14, 2012
Independence F - I (Grand Hyatt Washington)
* noted as presenting author
Colleen E. Cary, LMSW, Doctoral Student, University of Chicago, Chicago, IL
J. Curtis McMillen, PhD, Professor, University of Chicago, Chicago, IL
Purpose: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (Cohen, Mannarino & Deblinger, 2006) is one of the most frequently utilized therapeutic interventions used to treat children and adolescents who are experiencing post-traumatic stress. Despite its prevalence, a systematic review has not yet been conducted to measure its effects in randomized controlled trials. Previous systematic reviews conducted on highly touted child mental health interventions have proven to be illuminating, raising integral questions about such interventions and their ability to effectively improve the mental health of children. The purpose of this study is to systematically review the evidence of TF-CBT's ability to reduce symptoms of post-traumatic stress, depression and problematic externalizing behaviors in traumatized youth.

Method: Upon initial exploration, the authors discovered that the team that developed and branded this intervention was overstating the number of trials that had employed TF-CBT, interchanging TF-CBT in its current, manualized form and earlier interventions similar to TF-CBT. For this reason, a literature search was conducted to locate studies that evaluated either the manualized TF-CBT or highly similar interventions (HSI) that were based on the following five components: (1) gradual exposure; (2) cognitive reprocessing; (3) stress management; (4) caregiver intervention and (5) psychoeducation. Searches were conducted in 8 databases yielding 2,680 articles for review. Abstracts from all of these articles were read by two reviewers (both authors) and studies were read in full if either reviewer believed the study evaluated TF-CBT or a HSI in a controlled, randomized trial. Of those that were read in full (N= 81), 6 studies (8 articles) met all of the following criteria for final inclusion: (1) use of TF-CBT or a HSI; (2) participants experienced at least one traumatic episode; (3) randomized and controlled trial; and (4) evaluated symptoms of PTSD, depression and externalizing behaviors. Meta Analysis software was used to determine the effect sizes for symptoms of PTSD, depression and problematic externalizing behaviors in 3 comparison groups: (1) experimental treatment condition vs. attention control (post); (2) experimental treatment condition vs. attention control (12 months); (3) experimental treatment condition vs. another active treatment (post).

Results: The data show that TF-CBT is more effective than an attention control at reducing symptoms of PTSD (Hedges G = .61), depression (Hedges G = .37) and problematic externalizing behaviors (Hedges G = .25) in youth immediately after termination of treatment. At 12 months post termination, however, TF-CBT was only more effective than the attention control at reducing symptoms of PTSD (Hedges G = .51); its ability to maintain reductions in symptoms of depression and problematic externalizing behaviors did not hold. Lastly, data did not show TF-CBT to be more effective than other active treatment conditions at reducing symptoms of PTSD, depression or problematic externalizing behaviors.

Implications: The ubiquity of this intervention makes the pursuit of establishing its effectiveness very important. It will be highly beneficial for clinicians and program administrators to be aware of the disorders it treats most effectively and the duration of effectiveness, particularly in light of the cost and time associated with training.