Skip to main content
SpringerLink
Log in

Users’ experiences of trauma-focused cognitive behavioural therapy for children and adolescents: a systematic review and metasynthesis of qualitative research

  • Review
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Trauma-focused cognitive behavioural therapy (TF-CBT) is an effective intervention for post-traumatic stress disorder, yet implementation may be hindered by practitioners’ concerns about how treatment is experienced by users. This metasynthesis systematically reviews qualitative evidence on youth and caregivers’ experiences of TF-CBT to better understand user perspectives on process and outcomes of treatment. A systematic review and metasynthesis were undertaken for qualitative studies of treatment experience related to TF-CBT. Data were extracted according to Evidence for Policy and Practice Information and Coordinating Centre guidelines, and studies were critically appraised using Critical Appraisal Skills Programme checklists. Findings from included studies were coded and synthesized using thematic synthesis methodology. Eight studies were selected after a full-text review of 39 papers. Findings were organised around nine sub-themes, under three broad thematic categories: ‘engagement in TF-CBT’; ‘experience of treatment components’; and ‘therapeutic outcomes’. Youth were often unclear about what to expect from treatment and concerned about (in)compatibility with their therapist. Youth reports indicated how such misgivings can be addressed through early psychoeducation and efforts to strengthen the therapeutic alliance. Once underway, treatment was viewed as a place of refuge and validation, aided by therapist competence and confidentiality. Youth and caregivers felt that constructing a trauma narrative was instrumental for recovery. Cognitive-behavioural coping techniques were useful during treatment and in the long-term. While participants in TF-CBT may begin treatment with unclear expectancies, careful attention to early engagement and other process issues can optimise process and outcomes. Implications for clinical practice and further research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cohen JA, Mannarino AP, Deblinger E (2006) Treating trauma and traumatic grief in children and adolescents. Guilford Press, New York

    Google Scholar 

  2. Fairbank JA, Fairbank DW (2009) Epidemiology of child traumatic stress. Curr Psychiatry Rep 11(4):289–295. https://doi.org/10.1007/s11920-009-0042-9

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  4. NICE (2005a) Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. The Royal College of Psychiatrists and the British Psychological Society (Vol. 346). http://doi.org/10.1016/j.amepre.2013.01.013

  5. Alisic E, Zalta AK, Van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, Smid GE (2014) Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry 204(5):335–340. https://doi.org/10.1192/bjp.bp.113.131227

    Article  PubMed  Google Scholar 

  6. NICE (2013) Post-traumatic stress disorder (PTSD) Evidence Update December 2013 (December)

  7. Bisson Jonathan I, Roberts Neil P, Andrew M, Cooper R, Lewis C (2013) Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. http://doi.org/10.1002/14651858.CD003388.pub4

  8. Cary CE, McMillen JC (2012) The data behind the dissemination: a systematic review of trauma-focused cognitive–behavioural therapy for use with children and youth. Child Youth Serv Rev 34(4):748–757. https://doi.org/10.1016/j.childyouth.2012.01.003

    Article  Google Scholar 

  9. Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, Amaya-Jackson L (2008) Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol 37(1):156–183. https://doi.org/10.1080/15374410701818293

    Article  PubMed  Google Scholar 

  10. Ehlers A, Clark DM (2000) A cognitive model of posttraumatic stress disorder. Behav Res Ther 38(4):319–345

  11. Cohen JA, Mannarino AP, Deblinger E (2013) Trauma-focused CBT for children and adolescents. The Guildford Press, New York

  12. Cohen JA, Mannarino AP (2008) Trauma-focused cognitive–behavioural therapy for children and parents. Child Adolesc Ment Health 13(4):158–162. https://doi.org/10.1111/j.1475-3588.2008.00502.x

    Article  Google Scholar 

  13. Allen B, Johnson JC (2012) Utilization and implementation of trauma-focused Cognitive–behavioural therapy for the treatment of maltreated children. Child Maltreatment 17(1):80–85. https://doi.org/10.1177/1077559511426333

    Article  PubMed  Google Scholar 

  14. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Hensley M et al (2011) Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res 38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7

    Article  Google Scholar 

  15. Becker CB, Zayfert C, Anderson E (2004) A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behav Res Ther 42(3):277–292. https://doi.org/10.1016/S0005-7967(03)00138-4

    Article  PubMed  Google Scholar 

  16. van Minnen A, Hendriks L, Olff M (2010) When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behav Res Ther 48(4):312–320. https://doi.org/10.1016/j.brat.2009.12.003

    Article  PubMed  Google Scholar 

  17. Ruzek JI, Eftekhari A, Rosen CS, Crowley JJ, Kuhn E, Foa EB, Karlin BE (2014) Factors related to clinician attitudes toward prolonged exposure therapy for PTSD. J Trauma Stress 27(4):423–429. https://doi.org/10.1002/jts.21945

    Article  PubMed  Google Scholar 

  18. Deblinger E, Mannarino AP, Cohen JA, Runyon MK, Steer RA (2011) Trauma-focused cognitive–behavioural therapy for children: impact of the trauma narrative and treatment length. Depress Anxiety 28(1):67–75. https://doi.org/10.1002/da.20744

    Article  PubMed  Google Scholar 

  19. Day C (2008) Children’s and young people’s involvement and participation in mental health care. Child Adolesc Ment Health 13(1):2–8. https://doi.org/10.1111/j.1475-3588.2007.00462.x

    Article  Google Scholar 

  20. O’Reilly M, Lester JN, Muskett T (2016) Children’s claims to knowledge regarding their mental health experiences and practitioners’ negotiation of the problem. Patient Educ Couns 99(6):905–910. https://doi.org/10.1016/j.pec.2015.10.005

    Article  PubMed  Google Scholar 

  21. Bone C, O’Reilly M, Karim K, Vostanis P (2014) They’re not witches … .’ Young children and their parents’ perceptions and experiences of Child and Adolescent Mental Health Services. Child Care Health Dev. http://doi.org/10.1111/cch.12161

  22. Day C (2006) Children’s key concerns: piloting a qualitative approach to understanding their experience of mental health care. Clin Child Psychol Psychiatry 11(1):139–155. https://doi.org/10.1177/1359104506056322

    Article  PubMed  Google Scholar 

  23. Tong A, Flemming K, McInnes E, Oliver S, Craig J (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 12(1):181. https://doi.org/10.1186/1471-2288-12-181

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cooke A, Smith D, Booth A (2012) Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res 22(10):1435–1443. https://doi.org/10.1177/1049732312452938

    Article  PubMed  Google Scholar 

  25. World Health Organization (2014) Adolescent development. http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/. Accessed 18 July 2017

  26. Newman M, Elbourne D, Leask M (2004) Improving the usability of educational research: guidelines for the reporting of empirical primary research studies in education. TLRP Ann Conf (March 2012). http://www.leeds.ac.uk/educol/documents/00003932.htm. Accessed 18 July 2017

  27. NICE (2012) Methods for the development of NICE public health guidance. https://www.nice.org.uk/process/pmg4/resources/methods-for-the-development-of-nice-public-health-guidance-third-edition-pdf-2007967445701. Accessed 18 July 2017

  28. EPPI-Centre (2007) EPPI-centre methods for conducting systematic review. Evidence for policy and practice. information and co-ordinating centre (March 2007). https://eppi.ioe.ac.uk/cms/LinkClick.aspx?fileticket=hQBu8y4uVwI=&tabid=88. Accessed 18 June 2017

  29. Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A (2005) Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 10(1):45–53. https://doi.org/10.1177/135581960501000110

    Article  PubMed  Google Scholar 

  30. Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8(1):45. https://doi.org/10.1186/1471-2288-8-45

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bass J, Bearup L, Bolton P, Murray L, Skavenski S (2011) Implementing trauma focused cognitive–behavioural therapy (TF-CBT) among formerly trafficked-sexually exploited and sexually abused girls in cambodia: a feasibility study. Retrieved from https://www.mensenhandelweb.nl/system/files/documents/30%20Sep%202015/TF-CBT_Feasibility_Report_Cambodia_2011.pdf. Accessed 18 July 2017

  32. Damra JKM, Nassar YH, Ghabri TMF (2014) Trauma-focused cognitive–behavioural therapy: cultural adaptations for application in Jordanian culture. Couns Psychol Q 27(3):308–323. https://doi.org/10.1080/09515070.2014.918534

    Article  Google Scholar 

  33. Dittmann I, Jensen TK (2014) Giving a voice to traumatized youth-Experiences with trauma-focused cognitive–behavioural therapy. Child Abus Negl 38(7):1221–1230. https://doi.org/10.1016/j.chiabu.2013.11.008

    Article  Google Scholar 

  34. Murray LK, Skavenski S, Michalopoulos LM, Bolton PA, Bass JK, Familiar I, Cohen J (2014) Counselor and client perspectives of trauma-focused cognitive–behavioural therapy for children in Zambia: a qualitative study. J Clin Child Adolesc Psychol 43(6):902–914. https://doi.org/10.1080/15374416.2013.859079

    Article  PubMed  PubMed Central  Google Scholar 

  35. Salloum A, Dorsey CS, Swaidan VR, Storch EA (2015) Parents’ and children’s perception of parent-led trauma-focused cognitive–behavioural therapy. Child Abus Negl 40:12–23. https://doi.org/10.1016/j.chiabu.2014.11.018

    Article  Google Scholar 

  36. Santiago CD, Fuller AK, Lennon JM, Kataoka SH (2016) Parent perspectives from participating in a family component for CBITS: acceptability of a culturally informed school-based program. Psychol Trauma Theory Res Pract Policy 8(3):325. https://doi.org/10.1037/tra0000076

    Article  Google Scholar 

  37. Cox J, Davies DR, Burlingame GM, Campbell JE, Layne CM, Katzenbach RJ (2007) Effectiveness of a trauma/grief–focused group intervention: a qualitative study with war–exposed Bosnian adolescents. Int J Group Psychother 57(3):319–345. https://doi.org/10.1521/ijgp.2007.57.3.319

    Article  PubMed  Google Scholar 

  38. Pernebo K, Almqvist K (2016) Young children’s experiences of participating in group treatment for children exposed to intimate partner violence: a qualitative study. Clin Child Psychol Psychiatry 21(1):119–132. https://doi.org/10.1177/1359104514558432

    Article  PubMed  Google Scholar 

  39. Finfgeld-Connett D (2010) Generalizability and transferability of meta-synthesis research findings. J Adv Nurs 66(2):246–254. https://doi.org/10.1111/j.1365-2648.2009.05250.x

    Article  PubMed  Google Scholar 

  40. Ehlers A, Clarke DM, Dunmore E, Jaycox L, Meadows E, Foa EB (1998) Predicting response to exposure treatment in posttraumatic stress disorder: role of mental defeat and alienation. J Trauma Stress 11(3):457–471. https://doi.org/10.1023/A:1024448511504

    Article  CAS  Google Scholar 

  41. National Child Traumatic Stress Network (NCTSN) (2004) How to implement cognitive–behavioural therapy (TF-CBT), 1–68. http://www.nctsnet.org/nctsn_assets/pdfs/TF-CBT_Implementation_Manual.pdf. Accessed 18 July 2017

  42. Smith P, Perrin S, Yule W (1999) Cognitive behaviour therapy for posttraumatic stress disorder. Child Adolesc Ment Health 4(4):177–182. https://doi.org/10.1111/1475-3588.00273

    Article  Google Scholar 

  43. Midgley N, Holmes J, Parkinson S, Stapley E, Eatough V, Target M (2016) Just like talking to someone about like shit in your life and stuff, and they help you: hopes and expectations for therapy among depressed adolescents. Psychother Res 26(1):11–21. https://doi.org/10.1080/10503307.2014.973922

    Article  PubMed  Google Scholar 

  44. Freake H, Barley V, Kent G (2007) Adolescents’ views of helping professionals: a review of the literature. J Adolesc 30(4):639–653. https://doi.org/10.1016/j.adolescence.2006.06.001

    Article  PubMed  Google Scholar 

  45. Persson S, Hagquist C, Michelson D (2017) Young voices in mental health care: exploring children’s and adolescents’ service experiences and preferences. Clin Child Psychol Psychiatry 22(2017-01-01):140–151. https://doi.org/10.1177/1359104516656722

  46. Gibson K, Cartwright C, Kerrisk K, Campbell J, Seymour F (2016) What young people want: a qualitative study of adolescents’ priorities for engagement across psychological services. J Child Fam Stud 25(4):1057–1065. https://doi.org/10.1007/s10826-015-0292-6

    Article  Google Scholar 

  47. Donnellan D, Murray C, Harrison J (2013) An investigation into adolescents’ experience of cognitive–behavioural therapy within a child and adolescent mental health service. Clin Child Psychol Psychiatry 18(2):199–213. https://doi.org/10.1177/1359104512447032

    Article  PubMed  Google Scholar 

  48. Jee SH, Conn A-M, Toth S, Szilagyi MA, Chin NP (2014) Mental health treatment experiences and expectations in foster care: a qualitative investigation. J Public Child Welf 8(5):539–559. https://doi.org/10.1080/15548732.2014.931831

    Article  Google Scholar 

  49. Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M (2005) Cognitive therapy for post-traumatic stress disorder: development and evaluation. Beh Res Ther 43(4):413–431. https://doi.org/10.1016/j.brat.2004.03.006

    Article  Google Scholar 

  50. Wilson KR, Hansen DJ, Li M (2011) The traumatic stress response in child maltreatment and resultant neuropsychological effects. Aggress Violent Behav 16(2):87–97. https://doi.org/10.1016/j.avb.2010.12.007

    Article  Google Scholar 

  51. National Child Traumatic Stress Network (2003) Complex trauma in children and adolescents. White Paper (Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services). http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf. Accessed 18 July 2017

  52. NICE (2005b) Post-traumatic stress disorder: management, clinical guideline (March). https://www.nice.org.uk/guidance/cg26/resources/posttraumatic-stress-disorder-management-975329451205. Accessed 18 July 2017

  53. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New York

    Google Scholar 

  54. Shirk SR, Karver M (2003) Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review. J Consult Clin Psychol 71(3):452–464. https://doi.org/10.1037/0022-006X.71.3.452

    Article  PubMed  Google Scholar 

  55. Zorzella KPM, Muller RT, Cribbie RA (2015) The relationships between therapeutic alliance and internalizing and externalizing symptoms in trauma-focused cognitive–behavioural therapy. Child Abus Negl 50:171–181. https://doi.org/10.1016/j.chiabu.2015.08

    Article  Google Scholar 

Download references

Acknowledgements

This manuscript is based on a dissertation originally submitted by Lakshmi Neelakantan in partial fulfilment of the MSc in Evidence-Based Social Intervention and Policy Evaluation at University of Oxford. Ms. Neelakantan was sponsored by the Chevening Scholarships, the UK Government’s global scholarship programme, funded by the Foreign and Commonwealth Office (FCO) and partner organisations.

Author information

Authors and Affiliations

  1. Moray House School of Education, The University of Edinburgh, Edinburgh, UK

    Lakshmi Neelakantan

  2. Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

    Sarah Hetrick

  3. Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Sarah Hetrick

  4. Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Daniel Michelson

Authors
  1. Lakshmi Neelakantan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Hetrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Michelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Michelson.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest. The authors report that they have no clinical or financial interests as trainers or providers of TF-CBT.

Ethical standards

All human and animal studies have been approved by the Departmental Research Ethics Committee (DREC), Department of Social Policy and Intervention, University of Oxford and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 68 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neelakantan, L., Hetrick, S. & Michelson, D. Users’ experiences of trauma-focused cognitive behavioural therapy for children and adolescents: a systematic review and metasynthesis of qualitative research. Eur Child Adolesc Psychiatry 28, 877–897 (2019). https://doi.org/10.1007/s00787-018-1150-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-018-1150-z

Keywords

Search

Navigation