Preface
Treatment of PTSD in adults who have experienced child abuse
PTSD is a common negative consequence of child abuse that many adults who have experienced child abuse suffer from. This makes it important to study how people who suffer from PTSD can be treated best. The tricky part here is that the people who suffer from PTSD treatment are underrepresented in many effect studies. There is currently no consensus in the literature as to whether the current interventions of PTSD as a result of trauma during adulthood also apply to PTSD as a result of trauma during childhood. This study therefore focuses on the effectiveness of PTSD treatments in adult victims of child abuse.
Is PTSD a consequence of child abuse?
There is extensive evidence that people who have been victims of child abuse exhibit a high degree of complex symptoms of PTSD. Many researchers confirm this finding, but the jury does not yet agree that a different approach to treatment is required for this group.
Are trauma-oriented treatments suitable for victims of child abuse?
There is consistent evidence that trauma-focused treatments lead to a significantly greater effect than non-trauma-focused treatments. Interventions that focus on trauma related memories have the greatest effect, since memory processes play a role in PTSD during development. However, victims of child abuse with PTSD are underrepresented in most studies. As a result, it remains unclear whether trauma-oriented treatments also have an effect on this specific group. One of the main objectives of this meta-analysis was to study whether the general findings of the literature on PTSD treatment can be replicated.
Goals and hypothesis
The first aim of the study was to assess the effectiveness of psychological interventions for PTSD in adult victims of child abuse. It was expected that psychological treatments would have a medium to substantial effect size in this group. Secondly, an attempt was made to study whether trauma-centered treatments differed from non-trauma-centered treatments with regard to relative efficacy. A higher return was expected for trauma-oriented treatments. Finally, the relative efficacy of individual treatments versus group treatments was examined. The expectation was that individual treatments would have a larger effect.
Method
The following criteria were used in this meta-analysis:
Randomized trial, with at least one control condition and one experimental condition (active treatment)
PTSD symptoms are the most important target in the treatment
Participants are at least 18
At least 90% of the sample is a victim of child abuse or similar trauma
Outcome measures included the severity of PTSD symptoms
At least 10 participants per condition
Published in a peer review
Results
Active treatments have been shown to lead to a considerably higher effect compared to a control group. It has also been found that a follow-up within five months showed a significantly larger pre-follow-up effect size compared to when the follow-up took place after more than six months. There was also a medium to large effect in the after treatment of the active treatments, compared to a placebo after treatment in the control groups.
Trauma-oriented treatments versus non-trauma-oriented treatments
The results showed that the outcomes of trauma-focused treatments had a significantly higher effect size than non-traumatic treatments. However, this effect was only visible when a placebo treatment was used in the control group. So not when a similar treatment was used.
Individual treatments versus group treatments
Individual treatments were found to have a considerably higher effect size than group treatments. Here, the effect applied only when the control group used a placebo treatment.
Discussion
This meta-analysis showed that psychological interventions for PTSD are effective in adult victims of child abuse. For all active treatments, a moderate to high effect size has been found for the reduction of PTSD and the severity of symptoms. In addition, trauma-oriented treatments were found to lead to a significantly higher effect size than non-trauma-oriented treatments. These findings are in line with current treatment guidelines. The importance of processing trauma related memories is emphasized in a PTSD treatment. The effectiveness of PTSD treatments depends on the extent to which the treatment helps to process the memory of the traumatic event. Furthermore, individual treatments proved to be more effective than group treatments.
Limitations
The methodological quality of the included studies varied per study
There was a higher heterogeneity in the trauma-focused treatment groups than in the non-trauma-focused treatment groups. As a result, there was not enough statistical power to draw conclusions about this.
No research has been done on the effect of different PTSD treatments on different types of trauma, only on one type of trauma: child abuse during childhood
There was a large publication bias, so effect sizes may be overestimated
Conclusion
Despite the limitations present, the current findings prove that PTSD can be treated effectively in adult victims of child abuse. In addition, the results suggest individual trauma-focused treatments as first-line interventions for PTSD in this specific group. However, this meta-analysis also showed that the results of the research into the treatment of PTSD as a result of child abuse are lagging behind the general PTSD treatment. As a result, more research is needed to increase the knowledge about providing the right treatment for this specific group of people.
Summaries per article with of Psychological and Neurobiological Consequences of Child Abuse at Leiden University 21/22
Summaries per article with of Psychological and Neurobiological Consequences of Child Abuse at Leiden University 21/22
Kindermishandeling & Jeugdzorg: samenvattingen van de beste wetenschappelijke artikelen
Of je nu meer wil weten over de forensisch-medische aspecten van kindermishandeling, of benieuwd bent naar hoe desinformatie in het geheugen geplant kan worden - bij de top 40 van samenvattingen van de wetenschappelijke artikelen over kindermishandeling wordt kindermishandeling en jeugdzorg vanuit een breed spectrum bestudeerd en behandeld.
Kindermishandeling & Jeugdzorg: een selectie van ongeveer 40 samenvattingen van de beste wetenschappelijke artikelen (alfabetische volgorde), gebaseerd op diverse vakken rond dit thema zoals aangeboden aan de Universiteiten van Leiden, Utrecht en Groningen voor de studies Pedagogiek en Psychologie.
De opgesomde titels zijn in de meeste gevallen vrije vertalingen van de originele Engelstalige titels:
- Begrijpen van de adolescentie als een periode van sociale en affectieve betrokkenheid en flexibiliteit wat betreft doelen - Crone, Dahl
- Behandeling voor chronische depressie met een schema therapie - Renner et al
- Bijwerkingen van jeugdervaringen in het leven van vrouwelijke zedendelinquenten - Levenson
- Consequenties van kindermishandeling in landen met hoge inkomens - Gilbert et al
- De cumulatieve effecten van de risico- en beschermende factoren van moeders op storend gedrag van hun dochters - van der Molen et al
- De ontwikkeling van de communicatieve en narratieve vaardigheden bij peuters en kleuters: lessen van forensische interviews over kindermishandeling - Hershkowitz
- DNA-methylatie, Gedrag en tegenspoed in Early Life - Szyf
- Einstein op de bank? Gebrek aan wetenschappelijk bewijs om rechtszaken van kindermishandeling te kunnen beoordelen - Moreno
- Emotiemodulatie bij PTSD: klinisch en neurobiologisch bewijs voor een dissociatief subtype - Lanius et al
- Forensisch-medische aspecten van kindermishandeling - Kemp
- Genetische gevoeligheid voor het milieu - Caspi et al
- Geriatrische forensische evaluees: een studie - Lewis et al
- Gezondheidseffecten van kindermishandeling - Kendall-Tackett
- Het geheugen van kinderen als ooggetuigen: de invloed van cognitieve en sociaal-emotionele factoren - Goodman et al
- Het probleem met kinderartsen - Williams
- Het seksueel welzijn van vrouwen die seksueel misbruik hebben ervaren - Lemieux et al
- Jeugd stress heeft aanhoudende effecten op het functioneren van de amygdala en de ontwikkeling van muizen en mensen - Cohen et al
- Jeugdige en volwassen zedendelinquenten - Hendriks, Bijleveld
- Kindermishandeling en DSM-VI mentale stoornissen van volwassenen - Scott et al
- Kindermishandeling voorspelt een ongunstig depressiebeloop en ongunstige behandeluitkomsten bij depressieve mensen: een meta-analyse - Nanni et al
- Meta-analyse van psychologische behandelingen voor PTSS bij volwassenslachtoffers van kindermishandeling - Ehring et al
- Neurobiologische en psychiatrische consequenties van kindermishandeling en verwaarlozing - Heim et al
- Neurologische kijk op kindermishandeling: een kritische review - Hart, Rubia
- Onthullingen van seksueel misbruik van kinderen - London et al
- Onvoorspelbaarheid van vroege ervaringen op mentale stoornissen - Baram et al
- Openbaarmaking van seksueel misbruik bij kinderen: een model - Goodman-Brown et al
- Overtreding onder ouderen - Curtice et al
- Scheidingservaringen in de kindertijd voorspellen hormonale respons van de HPA as in late volwassenheid - Pesonen et al
- Seksueel misbruik bij kinderen en zwangerschap tijdens de adolescentie - Noll et al
- Seksueel misbruik bij kinderen, een case study - Leander et al
- Seksuele problemen en PTSS na seksueel trauma: Een meta-analyse - O'Driscoll et al
- Telomeren en tegenspoed:
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