Efficacy and Feasibility of a Therapist-Guided Internet-Based Intervention for Older Persons with Childhood Traumatization: A Randomized Controlled Trial

Knaevelsrud, Christine; Böttche, Maria; Pietrzak, Robert H.; Freyberger, Harald J.; Kuwert, Philipp

doi:10.1016/j.jagp.2017.02.024

Cited by 61 publications

(80 citation statements)

References 32 publications

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“…We included 116 studies (115 papers) in the systematic review. Of these, 50 were conducted in hospital settings , 24 were delivered in a community setting , seven were delivered in military clinics for veterans or active military personnel [103][104][105][106][107][108][109], five were conducted in refugee camps [110][111][112][113][114], four used remote delivery via web-based or telephone platforms [115][116][117][118], four were conducted in specialist trauma clinics [119][120][121][122], two were delivered in home settings [123,124], and two were delivered in primary care clinics [125,126]; clinical setting was not reported in 17 studies [127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…32-35, 37, 39-41, 43-48, 50-54, 56, 58, 60-63, 66-71, 73, 74, 76, 77, 82, 90, 100, 103, 104, 106-108, 115, 116, 121, 123, 124, 127, 128, 132, 133, 136, 143]; war-related (16 studies; 15 papers)[30,79,80,86,96,101,102,109,117,118,122,125,126,134,139]; childhood sexual abuse (17 studies)[36,38,49, 55, 57, 59,72,84,91,95,97,98,129,135,141,142]; refugees(19 studies) [29, 64, 65, 75, 81, 83, 87-89, 94, 99, 110-114, 119, 120, 140]; domestic violence (5 studies)…”

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confidence: 99%

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Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

et al. 2020

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Background Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events.

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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

et al. 2020

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“…Compared with younger cohorts, older adults present higher arousal and lower avoidance levels. 4 Preliminary controlled trials on the efficacy of trauma-focused interventions for older adultssample mean ages from 57 to 71 years [5][6][7][8] revealed mixed results for PTSD. The experimental interventions included narrative exposure therapy (NET), virtual reality exposure therapy and therapist-guided internetbased therapy; the controls included psychoeducation, wait lists and present-centred therapy (PCT), originally developed as Present Centered Therapy.…”

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confidence: 99%

Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

et al. 2019

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BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

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“…This RCT is, to our knowledge, the first to investigate a psychotherapy programme for Holocaust survivors, and the third to investigate a PTSD treatment approach in old age. The two previous RCTs investigated an internet-based writing therapy called Integrative Testimonial Therapy (ITT) with WWII survivors combining cognitive-behavioural and life review elements [8,9] and a prolonged exposure therapy with older veterans with military service-related PTSD [10,11]. While the latter did not try to modify the prolonged exposure approach to this age group, ITT integrates trauma-focused and life review elements, which is similar in our approach.…”

Section: Discussionmentioning

confidence: 99%

“…We identified two RCTs that examined this age group. An internet-based writing therapy called Integrative Testimonial Therapy (ITT) with WWII survivors combining cognitive-behavioural and life review elements found moderate decreases in PTSD symptoms [8,9]. A prolonged exposure therapy with older veterans with PTSD as a result of their military service found treatment gains from pre-to posttest, but those gains were lost in the follow-up [10,11].…”

Section: State Of Treatment Research Established Ptsd Treatmentsmentioning

confidence: 99%

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

Forstmeier

Hal²,

Auerbach³

et al. 2020

BMC Psychiatry

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Background: The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. Methods: The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). Discussion: Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples.

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Efficacy and Feasibility of a Therapist-Guided Internet-Based Intervention for Older Persons with Childhood Traumatization: A Randomized Controlled Trial

Cited by 61 publications

References 32 publications

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

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