A randomized controlled study of trauma focused cognitive behavioural therapy compared to enhanced treatment as usual with patients in child mental health care traumatized from family violence

Abstract

PurposeThis study compared the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) and enhanced treatment as usual (eTAU) in children and adolescents exposed to family violence and receiving mental health services. MethodsA total of 89 children, aged 5 to 17 years, with severe trauma symptoms participated with their non-offending caregiver in a randomized controlled trial (RCT) comparing TF-CBT and eTAU. Children were assigned a DSM-IV diagnosis at treatment start and after 6 months. Self-reported trauma symptoms and parental reports of children’s psychological well-being and their own psychological symptoms were obtained at treatment start and after 6 and 12 months. Intention-to-treat analyses were performed, and the reliable change index was calculated. ResultsReports from children, parents, and clinicians showed a statistically significant reduction in trauma and other mental health symptoms among children in both the TF-CBT and eTAU groups, with no statistically significant between-group differences. Trauma symptoms and other mental health symptoms decreased, with small to medium effects after both 6 and 12 months. Clinically significant change in core symptoms was however documented in less than half of the sample. Parents’ self-reported psychiatric and trauma symptoms showed small reductions in both groups, with no between-group differences. ConclusionsContrary to findings in prior RCTs, TF-CBT did not significantly outperform the control treatment (eTAU). The non-significant between-group findings and modest positive changes for individuals in both groups may be explained by the multi-traumatized study population, the treatment delivery, and/or the study design.