Although 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
"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
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
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
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.▪