Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T11:02:26.210Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying, assessing and treating complicated post-traumatic stress disorder in adolescence: a single-case quasi-experimental design with clinical case report

Published online by Cambridge University Press:  03 March 2017

Megan Cowles  and
Jennifer Davis
Megan Cowles*
Affiliation:
Department of Psychology, University of Bath, Claverton Down Road, Bath BA2 7AY, UK
Jennifer Davis
Affiliation:
Salisbury District Community CAMHS, Oxford Health NHS Foundation Trust, Block 132, Salisbury Community Hospital, Salisbury SP2 8BJ, UK
*
*Author for correspondence: Megan Cowles, Department of Psychology, University of Bath, Claverton Down Road, Bath BA2 7AY, UK (email: m.cowles@bath.ac.uk).
Get access Rights & Permissions [Opens in a new window]

Abstract

The far-reaching impact of post-traumatic stress disorder (PTSD) on a person's life is well documented, yet PTSD often goes undetected and untreated. Previous literature suggests that there may be particular challenges in assessing PTSD in children and adolescents. There is evidence that once PTSD has been identified, a trauma-focused cognitive behavioural therapy (TF-CBT) approach is effective at treating PTSD in young people. Where PTSD in adolescents presents in response to multiple traumas it may be necessary to make some modifications to treatment protocols. This might include offering more sessions, extending the stabilization period, addressing common trauma themes, and tackling additional issues that may arise beyond a simple PTSD presentation. This single-case quasi-experimental design (n = 1) details the assessment (phase A) and treatment with individualized TF-CBT (phase B) of previously undiagnosed PTSD in response to multiple events in an adolescent girl who had been seen by several mental health professionals previously. The paper is also a clinical case report, paying particular attention to how PTSD was assessed and what other factors, for example emotion regulation, self-esteem and relationships, were found to be important. Trauma, anxiety and depression were measured with the Child PTSD Symptom Scale and the Revised Children's Anxiety and Depression Scale. Scores reduced from clinically significant to non-clinical levels by the end of treatment, with these gains being maintained at 3-month follow-up. Suggestions are made around assessing and treating trauma responses in young people, especially where PTSD exists in response to multiple traumas.

Keywords

PTSDsingle case quasi-experimental designchildren and adolescentstraumacognitive behavioural therapy
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 10 , 2017 , e1
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended follow-up reading

Cohen, JA, Mannarino, AP, Kliethermes, M, Murray, LA (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse and Neglect 36, 528–541.Google Scholar
de Arellano, MA, Lyman, DR, Jobe-Shields, L, George, P, Dougherty, RH, Daniels, AS et al. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric Services 65, 591–602. doi:10.1176/appi.ps.201300255 Google Scholar
Hales, S, Blackwell, SE, Di Simplicio, M, Iyadurai, L, Young, K, Holmes, EA (2015). Imagery-based cognitive-behavioural assessment. In Brown, GP and Clark, DA (eds), Assessment in Cognitive Therapy, pp. 69–93. Guilford Press.Google Scholar
Smith, P, Perrin, S, Yule, W, Clark, DM (2009). Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People. Routledge.Google Scholar
Young, K, Grey, N (2016). Michael: a case study of post-traumatic stress disorder. In Corrie, S, Townend, M and Cockx, A (eds), Assessment and Case Formulation in Cognitive Behavioural Therapy, pp. 206–223. SAGE Publications Ltd.Google Scholar

References

Bickman, L, Kelley, SD, Breda, C, de Andrade, AR, Riemer, M (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial. Psychiatric Services 62, 1423–1429. doi:10.1176/appi.ps.002052011 CrossRefGoogle ScholarPubMed
Chorpita, BF, Moffitt, CE, Gray, J (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy 43, 309–322. doi:10.1016/j.brat.2004.02.004 CrossRefGoogle Scholar
Clark, DB, Kirisci, L (1996). Post-traumatic stress disorder, depression, alcohol use disorders and quality of life in adolescents. Anxiety 2, 226–233. doi:10.1002/(sici)1522-7154(1996)2:5<226::aid-anxi4>3.0.co;2-k 3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Cohen, JA, Mannarino, AP (2011). TF-CBT for youth in residential treatment facilities: Preliminary treatment outcome findings. Data reported in NIMH grant application Number R01MH95208 funded to Allegheny Singer Research Institute, July 2011.Google Scholar
Cohen, JA, Mannarino, AP, Deblinger, E (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. Guildford Press.Google Scholar
Cohen, JA, Mannarino, AP, Kliethermes, M, Murray, LA (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse and Neglect 36, 528–541. doi:10.1016/j.chiabu.2012.03.007 Google Scholar
Cohen, JA, Scheeringa, MS (2009). Post-traumatic stress disorder diagnosis in children: challenges and promises. Dialogues in Clinical Neuroscience 11, 91–99.CrossRefGoogle ScholarPubMed
de Arellano, MA, Lyman, DR, Jobe-Shields, L, George, P, Dougherty, RH, Daniels, AS et al. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric Services 65, 591–602. doi:10.1176/appi.ps.201300255 CrossRefGoogle ScholarPubMed
Donlon-Ramsdell, K, Smith, AJ, Hildenbrand, AK, Marsac, ML (2015). Post-traumatic stress in school-age children and adolescents: medical providers’ role from diagnosis to optimal management. Pediatric Health, Medicine and Therapeutics 2015:6, 167–180. doi:https://doi.org/10.2147/PHMT.S68984 Google Scholar
Ehlers, A, Clark, DM (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy 38, 319–345.CrossRefGoogle Scholar
Foa, EB, Johnson, KM, Feeny, NC, Treadwell, KRH (2001). The child PTSD symptom scale: a preliminary examination of psychometric properties. Journal of Clinical Child and Adolescent Psychology 30, 376–384. doi:10.1207/S15374424JCCP3003_9 CrossRefGoogle Scholar
Foa, EB, Riggs, DS, Dancu, CV, Rothbaum, BO (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459–473. doi:10.1002/jts.2490060405 Google Scholar
Friedman, MJ (2014). Literature on DSM-5 and ICD-11. PTSD Research Quarterly 25, 1–10.Google Scholar
Gerson, R, Rappaport, N (2013). Traumatic stress and post-traumatic stress disorder in youth: recent research findings on clinical impact, assessment, and treatment. Journal of Adolescent Health 52, 137–143. doi:10.1016/j.jadohealth.2012.06.018 Google Scholar
Gillies, D, Taylor, F, Gray, C, O'Brien, L, D'Abrew, N (2012). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database of Systematic Reviews 8, 1004–1116. doi:10.1002/14651858.CD006726.pub2 Google Scholar
Hales, S, Blackwell, SE, Di Simplicio, M, Iyadurai, L, Young, K, Holmes, EA (2015). Imagery-based cognitive-behavioural assessment. In Brown, GP and Clark, DA (eds), Assessment in Cognitive Therapy, pp. 69–93. Guildford Press.Google Scholar
Hayes, SC, Strosahl, KD, Wilson, KG (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change (109 pp.). New York: Guilford Press.Google Scholar
Herman, JL (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress 5, 377–391. doi:10.1002/jts.2490050305 Google Scholar
Kennerley, H (1996). Cognitive therapy of dissociative symptoms associated with trauma. British Journal of Clinical Psychology 35, 325–340. doi:10.1111/j.2044-8260.1996.tb01188.x CrossRefGoogle ScholarPubMed
Kilpatrick, DG, Ruggiero, KJ, Acierno, R, Saunders, BE, Resnick, HS, Best, CL (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. Journal of Consulting and Clinical Psychology 71, 692–700.CrossRefGoogle ScholarPubMed
Lanius, RA, Vermetten, E, Pain, C (2010). The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge University Press.Google Scholar
Lawson, D, Hight, S (2015). Treating complex trauma: an evidence-based case example of severe childhood abuse. Journal of Child and Adolescent Trauma 8, 211–225. doi:10.1007/s40653-015-0054-z Google Scholar
Murray, H, Merritt, C, Grey, N (2016). Clients’ experiences of returning to the trauma site during PTSD treatment: an exploratory study. Behavioural and Cognitive Psychotherapy 44, 420–430. doi:10.1017/s1352465815000338 Google Scholar
Nader, KO, Newman, E, Weathers, F, Kaloupek, DG, Kriegler, JA, Blake, DD (2004). National Center for PTSD Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) Interview Booklet. Los Angeles, CA: Western Psychological.Google Scholar
NICE (2005). Post-Traumatic Stress Disorder: Management. NICE guideline [CG26].Google Scholar
Nixon, RDV, Meiser-Stedman, R, Dalgleish, T, Yule, W, Clark, DM, Perrin, S, Smith, P (2013). The Child PTSD Symptom Scale: an update and replication of its psychometric properties. Psychological Assessment 25, 1025–1031. doi:10.1037/a0033324 CrossRefGoogle ScholarPubMed
Nooner, KB, Linares, LO, Batinjane, J, Kramer, RA, Silva, R, Cloitre, M (2012). Factors related to post-traumatic stress disorder in adolescence. Trauma, Violence and Abuse 13, 153–166. doi:10.1177/1524838012447698 CrossRefGoogle ScholarPubMed
Panagioti, M, Gooding, PA, Triantafyllou, K, Tarrier, N (2015). Suicidality and post-traumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology 50, 525–537. doi:10.1007/s00127-014-0978-x CrossRefGoogle ScholarPubMed
Schauer, M, Elbert, T (2010). Dissociation following traumatic stress: etiology and treatment. Journal of Psychology 218, 109–127.Google Scholar
Smith, P, Perrin, S, Yule, W, Clark, DM (2009). Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People. Routledge.Google Scholar
Stallworthy, P (2013). Cognitive therapy for people with post-traumatic stress disorder to multiple events: working out where to start. In Grey, N (ed), A Casebook of Cognitive Therapy for Traumatic Stress Reactions, pp. 194–312. Routledge.Google Scholar
Strait, JR (2013). Do You Know What I Know? Examining the Therapist’s Internal Experience when a Patient Dissociates in Session (Doctorate in Social Work), University of Pennsylvania. Retrieved from: http://repository.upenn.edu/edissertations_sp2/36 Google Scholar
Suliman, S, Mkabile, SG, Fincham, DS, Ahmed, R, Stein, DJ, Seedat, S (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry 50, 121–127. doi:10.1016/j.comppsych.2008.06.006 Google Scholar
Tate, RL, Perdices, M, Rosenkoetter, U, McDonald, S, Togher, L, Shadish, W et al. (2016a). The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016: Explanation and elaboration. Archives of Scientific Psychology 4, 10–31. doi:10.1037/arc0000027 Google Scholar
Tate, RL, Perdices, M, Rosenkoetter, U, Shadish, W, Vohra, S, Barlow, DH et al. (2016b). The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 statement. Archives of Scientific Psychology 4, 1–9. doi:10.1037/arc0000026 Google Scholar
van der Kolk, B (2009). Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Praxis der Kinderpsychologie und Kinderpsychiatrie 58, 572–586. doi:info:pmid/19961123Google ScholarPubMed
Wamser-Nanney, R, Vandenberg, BR (2013). Empirical support for the definition of a complex trauma event in children and adolescents. Journal of Traumatic Stress 26, 671–678.Google Scholar
Weiner, D, Schneider, A, Lyons, J (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Children and Youth Services Review 31, 1199–1205. doi:10.1016/j.childyouth.2009.08.013 Google Scholar
Wethington, HR, Hahn, RA, Fuqua-Whitley, DS, Sipe, TA, Crosby, AE, Johnson, RL et al. (2008). The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. American Journal of Preventive Medicine 35, 287–313. doi:10.1016/j.amepre.2008.06.024 Google Scholar
World Health Organization (2016). ICD-11 Beta Draft. Retrieved from: http://apps.who.int/classifications/icd11/browse/f/en Google Scholar
Young, K, Grey, N (2016). Michael: a case study of post-traumatic stress disorder. In Corrie, S, Townend, M and Cockx, A (eds), Assessment and Case Formulation in Cognitive Behavioural Therapy, pp. 206–223. SAGE Publications Ltd.Google Scholar
Zimmerman, M, Mattia, JI (1999). Is post-traumatic stress disorder underdiagnosed in routine clinical settings? Journal of Nervous and Mental Disease 187, 420–428.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.