Article summary of Meta-analysis of psychological treatments for post-traumatic stress disorder in adult survivors of childhood abuse by Ehring et al. - Chapter

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.