Posttraumatic stress disorder (PTSD), one of the possible consequences of sexual abuse of children and adolescents, may be found in about 40% to 50% of the cases.
Conduct a systematic review of studies investigating the use of cognitive behavioral therapy (CBT) for the treatment of sexually abused children and adolescents with PTSD.
A search for randomized clinical trials that evaluated PTSD in children and adolescents from 1980 to February 1, 2006 was conducted in the following databases: MedLine, EMBASE, LILACS, PsycLIT, PsycINFO, Cochrane Depression, Anxiety and Neurosis Group Database of Trials, Cochrane Controlled Trials Register, Science Citation Index (SciSearch), and PILOTS. References in all clinical trials selected were hand-searched.
Of the 43 studies initially selected, only three met inclusion criteria. The following comparisons were found in the studies: CBT to treat child and family member versus no treatment (waiting list); CBT to treat only child, only parents, or both versus community care; and trauma-focused CBT versus child-centered therapy (CCT). Results for CBT treatment of PTSD were better than no treatment (waiting list) (p < 0.05), community care (p < 0.01) and CCT (p < 0.01). The comparison of child-only CBT and family CBT (parents or caretakers and children) did not reveal any significant differences in efficacy, and both showed significant improvement of symptoms. A meta-analysis was conducted to compare the efficacy of CBT (child-only and family) versus no treatment (waiting list and community care) in the remission of patients who completed treatment. Remission rates in treatment and control groups were 60% and 20%, and this difference in favor of CBT was statistically significant (RR = 0.51; 95%CI 0.29-0.88; p = 0.02). No controlled studies were found that compared CBT and pharmacotherapy.
Treatment with CBT reduces PTSD symptoms in sexually abused children and adolescents, with no differences between therapy with only the victim or with the victim and a family member. No studies compared CBT and pharmacotherapy or the efficacy of combined treatments.
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