Among just the 75 completers, greater improvements also were seen for TF-CBT vs. child-centered therapy in hyperarousal and total PTSD on the K-SADS and total PTSD on the RI. The difference in RI was a clinically meaningful reduction of 7.3 points with TF-CBT. Anxiety scores on the SCARED were 7.1 lower with TF-CBT, compared with child-centered therapy, and IQ on the KBIT was an average 11.45 points higher (where 100 is average) with TF-CBT.
Remission of PTSD diagnosis occurred in 24 of 32 TF-CBT completers (75%), vs. 8 of 18 who completed CCT (44%). Serious adverse events–such as reportable child abuse, serious violence episodes, or hospitalization of the child for suicidal behavior–occurred in 2 of 43 in the TF-CBT group (5%), compared with 10 of 32 with child-centered therapy (31%), also a significant difference.
In addition to the NIMH funding, Dr. Cohen has also received research grants from the Substance Abuse and Mental Health Administration, and royalties from “Treating Trauma and Traumatic Grief in Children and Adolescents” (New York: Guilford Press, 2006), a book on TF-CBT treatment.
My Take
Focus on Hyperarousal Makes Sense
This information is very relevant to my public practice. I'm a child psychiatrist and recently became medical director of a very large family-centered mental health clinic in southeast Washington, D.C. Psychiatry has been privatized here to a great degree, so we have received a very large caseload. We need more effective treatments. We have the support and the personnel, but I don't think we have the method. As I work with this more closely, I think the issue is having a method that's both acceptable and effective. To me, “treatment as usual” is not effective.
We have homeless people; we have domestic violence, hyperaroused children, drug abuse, you name it. I really like how Dr. Cohen talked about hyperarousal probably being a target symptom, because that really leads to dysfunction in all the domains.
As the psychiatrist, clients come to me for medication management. They do use community support workers, but they don't come to the therapist, so there's a big disconnect. The community support workers are basically bachelor's level. I advocate that type of treatment to get people services, but the method has to be consistent. That's where we are right now.
TERRY L. JARRETT, M.D., is medical director of Universal Healthcare Management Services Foundation, Washington, and also has a private practice in adult and child psychiatry.
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