Efficacy of trauma-focused cognitive behavioral therapy for children and adolescents

Background: Trauma-focused cognitive behavioral therapy (TF-CBT) according to Cohen et al. (2009) is consistently recommended by international guidelines for the treatment of children and adolescents with posttraumatic stress disorder (PTSD). Since the publication of the German guidelines in 2019, new therapy effect studies and meta-analyses have been published. Objective: Update and replication of the previous results based on published meta-analyses, with a focus on the mean effects of TF-CBT according to Cohen et al. (2009) with respect to PTSD symptoms as well as the extent and cause of the heterogeneity of the studies. Material and methods: The reanalysis was carried out based on the study pools of pre-existing meta-analyses. Random effects (regression) models with the type of control conditions and the age of the children and adolescents as possible moderator variables were estimated in a two-step procedure, initially with all primary studies and in a second step only with those that followed the TF-CBT manual. To avoid potential bias, weightings were assigned to studies based on the sample size. Results: The study included 9 meta-analyses and a total of 46 primary studies. The reported effect sizes of the meta-analyses showed considerable variation. In the first part of the reanalysis, effect sizes of g = -0.88 were found compared to a wait list control group and g = -0.26 compared to other forms of trauma treatment. The studies following the TF-CBT manual showed effect sizes of g = -0.60 (wait list control group) and g = -0.18 (trauma treatment). Conclusion: The findings of previous meta-analyses are supported, the TF-CBT according to Cohen et al. (2009) is effective; however, studies on different age groups, types of trauma and dismantling studies are necessary.