Objectives: To assess the effects of trauma-focused cognitive behavioral therapy (TF-CBT) among maltreated children, and to examine the role of potential moderators. Methods: A search of eight databases was conducted. Eighteen studies involving 11 randomized and quasi-randomized controlled trials with 965 maltreated children were included, and the effect sizes were pooled using random-effect models. Results: There were large effect sizes for posttraumatic growth and emotional management. Moderate to large effects were evident for PTSD and depression, while small effects were found for anxiety, internalizing behavior, sexualized behavior, and parenting practice. Effects were maintained at 3–12 months for some outcome domains. The effectiveness of TF-CBT was better when delivered to older children, and versions of TF-CBT, delivery format, sessions, and treatment length will not affect effectiveness. Conclusions: TF-CBT effectively reduces abuse-related symptoms and improves positive psychosocial outcomes among maltreated children.
BennettR. S.DenneM.McGuireR.HillerR. M. (2021). A systematic review of controlled-trials for PTSD in maltreated children and adolescents. Child Maltreatment, 26(3), 325–343. https://doi.org/10.1177/1077559520961176
2.
BissonJ. I.RobertsN. P.AndrewM.CooperR.LewisC. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 2013(12), CD003388. https://doi.org/10.1002/14651858.CD003388.pub4
3.
CaryC. E.McMillenJ. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757. https://doi.org/10.1016/j.childyouth.2012.01.003
4.
CochranW. G. (1954). The combination of estimates from different experiments. Biometrics, 10(1), 101–129. https://doi.org/10.2307/3001666
5.
CohenJ. (1977). Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates.
6.
*CohenJ. A.DeblingerE.MannarinoA. P.SteerR. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393–402. https://doi.org/10.1097/00004583-200404000-00005
7.
*CohenJ. A.MannarinoA. P. (1997). A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 36(9), 1228–1235. https://doi.org/10.1097/00004583-199709000-00015
8.
*CohenJ. A.MannarinoA. P. (1998). Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreatment, 3(1), 17–26. https://doi.org/10.1177/1077559598003001002
9.
CohenJ. A.MannarinoA. P. (2008). Trauma-focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158–162. https://doi.org/10.1111/j.1475-3588.2008.00502.x
10.
CohenJ. A.MannarinoA. P. (2015). Trauma-focused cognitive behavior therapy for traumatized children and families. Child and Adolescent Psychiatric Clinics of North America, 24(3), 557–570. https://doi.org/10.1016/j.chc.2015.02.005
11.
CohenJ. A.MannarinoA. P.BerlinerL.DeblingerE. (2000). Trauma-focused cognitive behavioral therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence, 15(11), 1202–1223. https://doi.org/10.1177/088626000015011007
12.
CohenJ. A.MannarinoA. P. (1996a). Factors that mediate treatment outcome of sexually abused preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 35(10), 1402–1410. https://doi.org/10.1097/00004583-199610000-00028
13.
*CohenJ. A.MannarinoA. P.IyengarS. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 165(1), 16–21. https://doi.org/10.1001/archpediatrics.2010.247
14.
*CohenJ. A.MannarinoA. P.KnudsenK. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135–145. https://doi.org/10.1016/j.chiabu.2004.12.005
15.
*CohenJ. A.MannarinoA. P. (1996b). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child & Adolescent Psychiatry, 35(1), 42–50. https://doi.org/10.1097/00004583-199601000-00011
16.
De ArellanoM. A.LymanD. R.Jobe-ShieldsL.GeorgeP.DoughertyR. H.DanielsA. S.GhoseS. S.HuangL.Delphin-RittmonM. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence. Psychiatric Services, 65(5), 591–602. https://doi.org/10.1176/appi.ps.201300255
DeblingerE.MannarinoA. P.CohenJ. A.RunyonM. K.SteerR. A. (2011). Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28(1), 67–75. https://doi.org/10.1002/da.20744
19.
*DeblingerE.MannarinoA. P.CohenJ. A.SteerR. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474–1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb
20.
*DeblingerE.StaufferL. B.SteerR. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4), 332–343. https://doi.org/10.1177/1077559501006004006
21.
*DeblingerE.SteerR. A.LippmannJ. (1999). Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse & Neglect, 23(12), 1371–1378. https://doi.org/10.1016/s0145-2134(99)00091-5
22.
DuvalS.TweedieR. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. https://doi.org/10.1111/j.0006-341x.2000.00455.x
23.
EggerM.Davey SmithG.SchneiderM.MinderC. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
24.
EhringT.WelborenR.MorinaN.WichertsJ. M.FreitagJ.EmmelkampP. M. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34(8), 645–657. https://doi.org/10.1016/j.cpr.2014.10.004
25.
*FarinaV.SalemiS.TatariF.AbdoliN.JouybariT. A.AlikhaniM.BasanjB.ZakieiA. (2018). Trauma-focused cognitive behavioral therapy a clinical trial to increase self-efficacy in abused the primary school children. Journal of Education and Health Promotion, 7(3), 33–39. https://doi.org/10.4103/jehp.jehp_80_17
26.
*FarniaV.NaamiA.ZargarY.DavoodiI.SalemiS.TatariF.KazemiA.BasanjB.JouybariT. A.AlikhaniM. (2018). Comparison of trauma-focused cognitive behavioral therapy and theory of mind: Improvement of posttraumatic growth and emotion regulation strategies. Journal of Education and Health Promotion, 7(1), 58–64. https://doi.org/10.4103/jehp.jehp_140_17
27.
*FarniaV.TatariF.SalemiS.AlikhaniM.BesanjB. (2017). Efficacy of trauma-focused cognitive behavioral therapy in facilitating posttraumatic growth and emotional management among physically abused children. Trauma Monthly, 23(2), 149–155. https://doi.org/10.5812/traumamon.62149
28.
*FarniaV.TatariF.SalemiS.KazemiA.AlikhaniM.GolshaniS.HookariS. (2017). Effect of trauma-focused cognitive behavioral therapy on reduction social and emotional maladjustment of physically abused children: A clinical trial. International Journal of Pediatrics, 5(8), 5473–5481. https://doi.org/10.22038/ijp.2017.23549.1980
29.
FragkosK. C.TsagrisM.FrangosC. C. (2014). Publication bias in meta-analysis: Confidence intervals for Rosenthal’s fail-safe number. International Scholarly Research Notices, 2014(12), 383–400. https://doi.org/10.1155/2014/825383
30.
GardnerM. J.ThomasH. J.ErskineH. E. (2019). The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. Child Abuse & Neglect, 96(10), 82–101. https://doi.org/10.1016/j.chiabu.2019.104082
31.
GilbertR.KempA.ThoburnJ.SidebothamP.RadfordL.GlaserD.MacmillanH. L. (2009). Recognising and responding to child maltreatment. The Lancet, 373(9658), 167–180. https://doi.org/10.1016/s0140-6736(08)61707-9
32.
GoemansA.VidingE.McCroryE. (2021). Child maltreatment, peer victimization, and mental health: Neurocognitive perspectives on the cycle of victimization. Trauma, Violence, & Abuse. Advance online publication. https://doi.org/10.1177/15248380211036393
33.
HansenL.JordanS. (2017). Internalizing behaviors. In V. Zeigler-Hill & T. Shackelford (Eds.), Encyclopedia of personality and individual differences (pp. 1–5). Springer International Publishing. https://doi.org/10.1007/978-3-319-28099-8
34.
HarveyS. T.TaylorJ. E. (2010). A meta-analysis of the effects of psychotherapy with sexually abused children and adolescents. Clinical Psychology Review, 30(5), 517–535. https://doi.org/10.1016/j.cpr.2010.03.006
35.
HedgesL. V.OlkinI. (1985). Statistical methods for meta-analysis. Academic Press.
36.
HerrenkohlT. I.FedinaL.HongS. H.LeeJ. O.SabaS. (2021). Associations between prospective and retrospective measures of child abuse and self-reported adult health at midlife. Child Abuse & Neglect, 120(7), 203–213. https://doi.org/10.1016/j.chiabu.2021.105203
37.
HigginsJ. P.SavovićJ.PageM. J.ElbersR. G.SterneJ. A. (2019). Assessing risk of bias in a randomized trial. In J. P. Higgins & J. Thomas (Eds.), Cochrane handbook for systematic reviews of interventions (pp. 205–228). Wiley-Blackwell.
38.
HigginsJ. P.ThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
39.
Hofmeijer-SevinkM. K.BatelaanN. M.van MegenH. J.PenninxB. W.CathD. C.van den HoutM. A.van BalkomA. J. (2012). Clinical relevance of comorbidity in anxiety disorders: A report from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 137(1–3), 106–112. https://doi.org/10.1016/j.jad.2011.12.008
40.
KaurN.PorterB.LeardMannC. A.TobinL. E.LemusH.LuxtonD. D. (2017). Evaluation of a modified version of the posttraumatic growth inventory-short form. BMC Medical Research Methodology, 17(1), 69. https://doi.org/10.1186/s12874-017-0344-2
41.
KelesS.IdsoeT. (2018). A meta-analysis of group cognitive behavioral therapy (CBT) interventions for adolescents with depression. Journal of Adolescence, 67(1), 129–139. https://doi.org/10.1016/j.adolescence.2018.05.011
42.
*KingN. J.TongeB. J.MullenP.MyersonN.HeyneD.RollingsS.MartinR.OllendickT. H. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 39(11), 1347–1355. https://doi.org/10.1097/00004583-200011000-00008
43.
LeenartsL. E.DiehleJ.DoreleijersT. A.JansmaE. P.LindauerR. J. (2013). Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: A systematic review. European Child & Adolescent Psychiatry, 22(5), 269–283. https://doi.org/10.1007/s00787-012-0367-5
44.
LewisT.McElroyE.HarlaarN.RunyanD. (2016). Does the impact of child sexual abuse differ from maltreated but non-sexually abused children? A prospective examination of the impact of child sexual abuse on internalizing and externalizing behavior problems. Child Abuse & Neglect, 51(1), 31–40. https://doi.org/10.1016/j.chiabu.2015.11.016
45.
MannarinoA. P.CohenJ. A.DeblingerE.RunyonM. K.SteerR. A. (2012). Trauma-focused cognitive-behavioral therapy for children: Sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17(3), 231–241. https://doi.org/10.1177/1077559512451787
46.
MartinC. G.EverettY.SkowronE. A.ZalewskiM. (2019). The role of caregiver psychopathology in the treatment of childhood trauma with trauma-focused cognitive behavioral therapy: A systematic review. Clinical Child and Family Psychology Review, 22(3), 273–289. https://doi.org/10.1007/s10567-019-00290-4
47.
Miller-GraffL. E.HowellK. H.Martinez-TorteyaC.GreinK. (2017). Direct and indirect effects of maltreatment and social support on children’s social competence across reporters. Child Psychiatry & Human Development, 48(5), 741–753. https://doi.org/10.1007/s10578-016-0698-4
48.
MillerperrinC. L.PerrinR. D. (1999). Child maltreatment: An introduction. Sage Publications.
49.
*NaamiA.ZargarY.DavoodiI.FarniaV.SalemiS.TatariF.KhanegiM. (2020). Comparison of trauma-focused cognitive-behavioral therapy and theory of mind on increasing social competence among abused children. Journal of Education and Health Promotion, 9(1), 81–88. https://doi.org/10.4103/jehp.jehp_380_19
50.
*O’CallaghanP.McMullenJ.ShannonC.RaffertyH.BlackA. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359–369. https://doi.org/10.1016/j.jaac.2013.01.013
51.
PetersJ. L.SuttonA. J.JonesD. R.AbramsK. R.RushtonL. (2007). Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity. Statistics in Medicine, 26(25), 4544–4562. https://doi.org/10.1002/sim.2889
52.
Purewal BoparaiS. K.AuV.KoitaK.OhD. L.BrinerS.Burke HarrisN.BucciM. (2018). Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Child Abuse & Neglect, 81(7), 82–105. https://doi.org/10.1016/j.chiabu.2018.04.014
RocaM.ArmengolS.García-GarcíaM.Rodriguez-BayónA.BallestaI.SerranoM. J.ComasA.GiliM. (2011). Clinical differences between first and recurrent episodes in depressive patients. Comprehensive Psychiatry, 52(1), 26–32. https://doi.org/10.1016/j.comppsych.2010.04.011
55.
RosenbergM. S. (2005). The file-drawer problem revisited: A general weighted method for calculating fail-safe numbers in meta-analysis. Evolution, 59(2), 464–468. https://doi.org/10.1111/j.0014-3820.2005.tb01004.x
56.
SchneidermanJ. U.DavisJ. P.NegriffS. (2021). Associations between psychosocial functioning and physical health in youth with maltreatment experiences. Children and Youth Services Review, 127(8), 80–89. https://doi.org/10.1016/j.childyouth.2021.106080
57.
*Shein-SzydloJ.SukhodolskyD. G.KonD. S.TejedaM. M.RamirezE.RuchkinV. (2016). A randomized controlled study of cognitive-behavioral therapy for posttraumatic stress in street children in Mexico city. Journal of Traumatic Stress, 29(5), 406–414. https://doi.org/10.1002/jts.22124
58.
ShiL.LinL. (2019). The trim-and-fill method for publication bias: Practical guidelines and recommendations based on a large database of meta-analyses. Medicine, 98(23), e15987–e15998. https://doi.org/10.1097/MD.0000000000015987
59.
SladeM. K.WarneR. T. (2016). A meta-analysis of the effectiveness of trauma-focused cognitive-behavioral therapy and play therapy for child victims of abuse. Journal of Young Investigators, 30(6), 36–43. https://doi.org/10.1016/j/chiabu.2020.104463
60.
SterneJ. A.SuttonA. J.IoannidisJ. P.TerrinN.JonesD. R.LauJ.CarpenterJ.RückerG.HarbordR. M.SchmidC. H.TetzlaffJ.DeeksJ. J.PetersJ.MacaskillP.SchwarzerG.DuvalS.AltmanD. G.MoherD.HigginsJ. P. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ, 343(22), 4002–4010. https://doi.org/10.1136/bmj.d4002
61.
SticeE.ShawH.BohonC.MartiC. N.RohdeP. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77(3), 486–503. https://doi.org/10.1037/a0015168
62.
StöcklH.MarchL.PallittoC.Garcia-MorenoC. (2014). Intimate partner violence among adolescents and young women: Prevalence and associated factors in nine countries: A cross-sectional study. BMC Public Health, 14(1), 751–765. https://doi.org/10.1186/1471-2458-14-751
63.
StrathearnL.GiannottiM.MillsR.KiselyS.NajmanJ.AbajobirA. (2020). Long-term cognitive, psychological, and health outcomes associated with child abuse and neglect. Pediatrics, 146(4), 438–453. https://doi.org/10.1542/peds.2020-0438
64.
TF-CBT Official Website. (2022). About trauma-focused cognitive behavior therapy (TF-CBT). https://tfcbt.org/about/
Van BerkelS. R.PrevooM. J. L.LintingM.PannebakkerF. D.AlinkL. R. A. (2020). Prevalence of child maltreatment in the Netherlands: An update and cross-time comparison. Child Abuse & Neglect, 103(3), 439–450. https://doi.org/10.1016/j.chiabu.2020.104439
67.
Van DisE. A. M.Van VeenS. C.HagenaarsM. A.BatelaanN. M.BocktingC. L. H.Van den HeuvelR. M.CuijpersP.EngelhardI. M. (2020). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: A systematic review and meta-analysis. JAMA Psychiatry, 77(3), 265–273. https://doi.org/10.1001/jamapsychiatry.2019.3986
68.
WangL.ChengH.QuY.ZhangY.CuiQ.ZouH. (2020). The prevalence of child maltreatment among Chinese primary and middle school students: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 55(9), 1105–1119. https://doi.org/10.1007/s00127-020-01916-7
69.
WangY.ChenX.ZhouK.ZhangH. (2022). A meta-analysis of the effects of childhood maltreatment on elderly depression. Trauma, Violence, & Abuse. Advance online publication. https://doi.org/10.1177/15248380211073838
70.
WeberS.JudA.LandoltM. A. (2016). Quality of life in maltreated children and adult survivors of child maltreatment: A systematic review. Quality of Life Research, 25(2), 237–255. https://doi.org/10.1007/s11136-015-1085-5
71.
WoodwardC.JosephS. (2003). Positive change processes and post-traumatic growth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research and Practice, 76(Pt 3), 267–283. https://doi.org/10.1348/147608303322362497
