Child-centered Therapy Research Articles

Implementation of Learn to Play Therapy for Children in Special Schools.

Play is the primary occupation in childhood and fundamental to occupational therapy practice. To evaluate a play intervention in special school settings. Pre- and postinvolvement of a 7-mo play program. Four special schools in Victoria, Australia, for children with IQs < 70. Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists. Learn to Play Therapy for 1 hr per week over a 7-mo period. Pre-post outcome measures included children's pretend play skills, language, social skills, emotional regulation, and academic competence. Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children's pretend play (p = .03), ability to recall sentences (p = .02), social skills (p = .022), and academic competence (p = .012). Learn to Play had a large effect on children's narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p < .001), narrative mean language utterance (MLU; p = .015), social skills (p < .001), and academic competence (p < .001); elaborate play at baseline plus time influenced social skills (p < .001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p = .009), and academic competence (p = .001). Embedding pretend play within practice positively influenced children's language, narrative, social, and academic skills. Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child's play and understands the child's play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child's ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children's pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools.

Predictors of treatment initiation, completion, and selection among youth offered trauma-informed care.

Few studies have investigated determinants of trauma-informed care (TIC) in vulnerable youth populations. The purpose of the present study was to investigate factors associated with initiation, completion, and selection of type of TIC treatment among a sample of 128 treatment-seeking youth who experienced crime or violence. This retrospective medical record review study used data collected through routine clinical care at an outpatient, no-cost community mental health clinic. We found that 69.5% of treatment-seeking youth (n = 89) initiated treatment, defined as attending at least 1 TIC session. Among youth who initiated treatment, 61.8% (n = 55) completed a TIC treatment. Predisposing and need characteristics were not significantly associated with initiating or completing treatment in adjusted models. Youth assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) were more likely to complete treatment compared with those assigned to child-centered therapy (CCT) approaches (odds ratio [OR] = 4.48, 95% CI [1.35, 14.91], p = .014). Logistic regression analyses suggested therapists were less likely to select TF-CBT for children with higher externalizing symptoms (OR = 0.92, 95% CI [0.85, 0.99], p = .035). Findings suggest among youth who called in for treatment, many successfully initiated treatment, and of those who initiated, most completed treatment. Empirically supported treatments such as TF-CBT may further promote treatment completion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Longitudinal Follow-up Study Examining Adolescent Depressive Symptoms as a Function of Prior Anxiety Treatment

Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre-/early adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who responded positively to cognitive-behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to treatment nonresponders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment. Participants were 80 adolescents ages 11 to 17 years who had previously completed a randomized trial comparing predictors of treatment response to CBT and child-centered therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time of treatment. The present study was a prospective naturalistic 2-year follow-up examining trajectories toward depression, in which participants were reassessed for depressive symptoms 2 years after anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator-rated anxiety severity on the Pediatric Anxiety Rating Scale after treatment. As hypothesized, lower levels of depressive symptoms were observed in anxious youth who responded to CBT for anxiety (β=-0.807, p= .004) but not CCT (β= 0.254, p= .505). Sensitivity analyses showed that the effects were driven by girls. Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT programs targeting anxiety in youth.

Error-related brain activity in pediatric anxiety disorders remains elevated following individual therapy: a randomized clinical trial.

Anxiety disorders are associated with an overactive action monitoring system as indexed by a larger error-related negativity (ERN). This study tests whether ERN magnitude changes following treatment, predicts response to treatment, and varies by treatment type. The sample included 130 youth (9-14years): youth with an anxiety disorder (ANX; n=100) and healthy control (HC; n=30) youth with no lifetime DSM-IV disorders. ANX youth were randomized to either a manualized cognitive-behavior therapy (CBT) or a comparison child-centered therapy (CCT). The ERN was assessed before and after 16 sessions of treatment and within a comparable interval for HC. Subjective ratings about making errors on the task were obtained following each testing session. The ClinicalTrials.gov identifier is NCT00774150. The ERN was larger in ANX than HC youth but ERN magnitude did not significantly change following treatment in the ANX youth, regardless of treatment type, and baseline ERN did not predict treatment response. Post-task ratings revealed that ANX youth worried more about task performance feedback than HC. Like the ERN, mean ratings did not significantly change following treatment. However, these ratings were not correlated with ERN amplitude. Findings of greater ERN in pediatric anxiety disorders are replicated in a larger sample. More importantly, findings from this randomized control trial show that a larger ERN and feeling worried about performance feedback remain unchanged following treatment and are unrelated to treatment response. Such findings suggest that action monitoring systems remain overactive in anxious youth treated with psychotherapy, suggesting the need for future investigation of whether novel complimentary cognitive and emotional training programs can modify these systems would be warranted.

The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment

Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one's mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.

A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders

This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9–14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.

Family-Based Interpersonal Psychotherapy for Depressed Preadolescents: Examining Efficacy and Potential Treatment Mechanisms

To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. Preadolescents with depression (N= 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2)= 0.35, ΔR(2)= 0.22; B=-8.15, SE= 2.61, t[37]=-3.13, p= .002, F(2)= 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms. Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study ofFamily Based Interpersonal Psychotherapy (FB-IPT) forDepressed Preadolescents; http://clinicaltrials.gov; NCT02054312.

“You can do it!”: The role of parental encouragement of bravery in child anxiety treatment

Individual cognitive-behavioral therapy (CBT) provides anxious youth with skills and experiences to increase “brave” behavior in the face of feared situations. This study addresses whether parental encouragement of bravery during an anxiety provoking and potentially avoidable naturalistic speech task (a) differs between parents of youth (ages 9–13) with anxiety disorders (N=47) and parents of healthy non-anxious controls (N=20); (b) influences response to treatment; and (c) changes during treatment for anxious youth randomized to receive CBT (N=30) or Child-Centered Therapy (CCT; a non-directive active comparison treatment; N=17). Parent–child dyads were videotaped during a discussion of whether or not the child should complete an optional speech task. Parents of anxious youth showed less encouragement of bravery than parents of controls. Encouragement of bravery increased from pre- to post-treatment for youth who received CBT but not CCT, and pre-treatment encouragement of bravery predicted a better response to treatment, particularly for youth receiving CBT.

Community Treatment of Posttraumatic Stress Disorder for Children Exposed to Intimate Partner Violence

To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms. Randomized controlled trial conducted using blinded evaluators. Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009. Of 140 consecutively referred 7- to 14-year-old children, 124 participated. Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy). Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems). Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events. Community TF-CBT effectively improves children's IPV-related PTSD and anxiety. clinicaltrials.gov Identifier: NCT00183326.

A Follow-up Study of a Multisite, Randomized, Controlled Trial for Children With Sexual Abuse-Related PTSD Symptoms

To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT.

In Treating Childhood Trauma, One Therapy Stands Out

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessIn Treating Childhood Trauma, One Therapy Stands OutJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:4 Jun 2004https://doi.org/10.1176/pn.39.11.0390041Although supportive, child-centered, and eclectic therapies are used most often to treat sexually abused children, trauma-focused cognitive-behavioral therapy (CBT) is more effective for them, various researchers have found.Now another study, with a much larger and more diverse subject sample, suggests the same thing.It was headed by Judith Cohen, M.D., a professor of psychiatry at Drexel University College of Medicine in Pittsburgh and an authority on posttraumatic stress disorder (PTSD) treatment for children. Results were published in the April Journal of the American Academy of Child and Adolescent Psychiatry.“Clinical implications are that for posttraumatic stress disorder and related symptoms [in children], trauma-focused cognitive-behavioral therapy interventions should be tried or included as a prominent part of therapy,” Cohen told Psychiatric News.The study included 229 youngsters, aged 8 to 14, who had been sexually abused. The children had significant symptoms of PTSD, with 89 percent meeting full DSM-IV criteria. More than 90 percent of the youngsters had experienced traumatic events in addition to sexual abuse. Compared with previous studies on the subject, the subject sample was not only considerably larger, but included greater gender diversity and subjects from two—rather than one—geographic regions. (The sample also included both white and African-American youngsters, but few Hispanic and no Asian children, which reflected the ethnic populations in the geographic areas studied.)Half the subjects received child-centered therapy, which is similar to the type of therapy used in rape crisis centers. The therapist listened, empathized, and encouraged both the traumatized children and their parents to talk about the trauma the children had experienced, yet let them set the pace in this regard. The therapist also encouraged both the children and their parents to formulate their own strategies for behavioral change rather than dictate it to them.The other half of the subjects received trauma-focused CBT—a form of therapy that has been found to be highly effective for adult PTSD (Psychiatric News, December 7, 2001). As sessions proceeded, the children were encouraged to confront increasingly detailed and distressing abuse-related reminders and memories. Children created narratives of their sexual abuse experiences, usually by writing and illustrating a book, which was shared with their parents in parallel therapy sessions.Three joint parent-child sessions were also used to optimize comfortable communication, provide education about personal safety and healthy sexuality, and allow the children and their parents to share and discuss the children's trauma narratives together.A limitation of the study was the absence of a treatment control group, Cohen and her coworkers pointed out in their study report. “We chose not to include such a group because of ethical concerns, and also because previous studies have demonstrated little or no symptom improvement in sexually abused children during wait-list periods,” they explained.After subjects received an average of either 11 sessions of child-centered therapy or 11 sessions of trauma-focused CBT, the researchers compared their psychological status at the start of therapy with that at the end. Subjects in both therapy groups had improved significantly. The researchers then compared the improvement of the children in both groups and found that the CBT group had improved significantly more than the child-centered therapy group.For example, at the start of therapy, there were comparable numbers of youngsters in each therapy group with PTSD. Yet by the end of therapy, of the 91 youngsters who had received child-centered therapy and for whom complete data were available, 42 (46 percent) still had PTSD at the end of therapy, compared with 19 of the 89 youngsters (21 percent) who had received trauma-focused CBT.Results also showed that subjects assigned to trauma-focused CBT showed significantly more improvement with regard to depression, behavioral problems, and shame. Similarly, parents of the trauma-focused CBT group showed greater improvement than parents of the child-centered therapy group in terms of depression, abuse-related distress, and psychological support for their children.These findings thus reinforce those from earlier studies that short-term, trauma-focused CBT is highly effective for sexually abused children.“ Given the mounting research documenting the severe and long-lasting risks associated with child sexual abuse, it is critical that we provide sexually abused children with the most effective treatment as early as possible,” Cohen and her team concluded.An abstract of the study, “A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms,” can be accessed online at<www.jaacap.com> by clicking on “Archive” and the April 2004 issue.▪ ISSUES NewArchived

A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms

To examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse. Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse. A series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. This study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.