A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents
Abstract
This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.
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Appendices
| Study | N | Age (M) | Study and sample characteristics | Assessment externalizing behavior | Assessment trauma symptoms | Experimental condition | Control condition |
|---|---|---|---|---|---|---|---|
| Cohen et al. (2005) | 82 | 11.40 | USA, RCT, clinical sample, completer analysis, 68% girls | CBCL-PRF TSCC (anger) | TSCC (PTS total symptoms) | TF-CBT (n = 41) | NST (TAU) (n = 41) |
| Farkas et al. (2010) | 40 | 14.3 | USA, RCT, clinical sample, completer analysis, 62.5% girls | DISC, CBCL-PRF, TSCC (anger) | DISC, TSCC (PTS total symptoms) | EMDR + MASTR (n = 19) | WL with routine care (TAU) (n = 21) |
| Goldbeck et al. (2016) | 159 | 13.03 | Europe, RCT, clinical sample (exp) and community sample (ctrl), intention-to-treat analysis, 71% girls | CBCL-PRF | CAPS-CA, UCLA-PTSD RI, CPTCI | TF-CBT (n = 76) | WL (NT) (n = 83) |
| King et al. (2000) | 24 | 11.40 | USA, RCT, clinical sample, intention-to-treat analysis, 69% girls | CBCL-PRF | ADIS-C, CBCL-PTSD schaal | TF-CBT + parents (n = 12) | WL (NT) (n = 12) |
| TF-CBT (indiv) (n = 12) | |||||||
| McMullen et al. (2013) | 48 | 15.80 | Africa, RCT, clinical sample, completer analysis, 100% boys | AYPA (conduct scale) | UCLA-PTSD RI (revised), | TF-CBT (n = 24) | WL with routine care (TAU) (n = 24) |
| O’Callaghan et al. (2015) | 50 | 14.88 | Africa, RCT, community sample, intention-to-treat analysis, 42% girls | AYPA (conduct scale) | UCLA PTSD-RI (revised) | TF-CBT (n = 26) | CFS (TAU) (n = 24) |
| WL (NT) (n = 22) | |||||||
| O’Callaghan et al. (2013) | 52 | 16.02 | Africa, RCT, community sample, intention-to-treat analysis, 100% girls | AYPA—conduct scale | UCLA-PTSD RI (revised) | TF-CBT (n = 24) | WL (NT) (n = 28) |
| Shein-Szydlo et al. (2016) | 99 | 14.89 | USA, RCT, clinical sample, completer analysis, 64% girls | STAXI | CPTS-RI, CPSS | TF-CBT (n = 50) | WL (NT) (n = 49) |
Note. RCT = Randomized Controlled Trail; TF-CBT = Trauma-Focused Cognitive Behavioral Therapy; NST = Non-directive Supportive Therapy; EMDR = Eye Movement Desensitization and Reprocessing; MASTR = Motivation-Adaptive Skills-Trauma Resolution; TAU = Treatment as Usual; WL = waiting list; NT = No treatment; CFS = Child Friendly Spaces: a non trauma based psychosocial intervention; CBCL-PRF = Child Behavior Checklist Parent Report Form; ADIS-C = Anxiety Disorder Interview Schedule Children; CAPS-CA = Clinician-Administered PTSD Scale for Children and Adolescents; TSCC = Trauma Symptom Checklist for Children; UCLA-PTSD RI = University of California at Los Angeles PTSD Reaction Index; SDQ = Strength and difficulties questionnaire; CPTCI = Child Post-Traumatic Cognitions Inventory; CPTS-RI = Child Posttraumatic Stress Reaction Index; CPSS = Child PTSD Symptom Scale; AYPA = African Youth Psychosocial Assessment; STAXI = State Trait Anger Expression Inventory; DISC = Diagnostic Interview Schedule for Children.
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Article first published online: April 26, 2021
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