Skip to main content
Studie

Angst, Depression und Trauma – transdiagnostische Effekte der traumafokussierten kognitiven Verhaltenstherapie (TF-KVT)

Published Online:https://doi.org/10.1026/0942-5403/a000220

Zusammenfassung. Kinder und Jugendliche mit posttraumatischen Belastungsstörungen weisen häufig auch Angstsymptome und depressive Symptome auf. Diese Studie untersucht bei 159 Teilnehmern einer multizentrischen klinischen Studie (Alter 7 – 17 Jahre) die Vergesellschaftung posttraumatischer Stresssymptome (PTSS) mit Angst und Depression sowie das Ansprechen dieser Symptome auf traumafokussierte kognitive Verhaltenstherapie (TF-KVT). Bei Studienbeginn zeigten 121 (76 %) Patienten klinisch relevante Angstsymptome und 91 (57 %) klinisch relevante Depressionssymptome. PTSS waren signifikant mit Angst (r = .42, p < .001) sowie mit Depression (r = .49, p < .001) korreliert. Mit TF-KVT behandelte Patienten zeigten nicht nur eine deutliche Remission ihrer Stresssymptomatik, sondern auch ihrer Angst- und Depressionssymptome. Die Ergebnisse bestätigen die hohe Prävalenz klinisch relevanter Angst- und Depressionssymptome bei traumatisierten Kindern und Jugendlichen und verweisen auf transdiagnostische Effekte der TF-KVT.


Anxiety, Depression, and Trauma: Transdiagnostic Effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Abstract. Anxiety and depression are frequent comorbid symptoms in children and adolescents with posttraumatic stress disorder (PTSD). Therefore, is it important to identify treatments that are effective not only with regard to the core symptoms of PTSD, but also regarding anxiety and depression. Methods: This study investigates in a sample of 159 participants (age 7 – 17 years, 72 % female) of a randomized controlled trial: (a) the frequency of clinically relevant symptoms of anxiety and depression, (b) the correlation of symptoms of anxiety and depression with posttraumatic stress symptoms (PTSS), and (c) the remission of comorbid symptoms of anxiety and depression after 12 sessions of trauma-focused cognitive behavioral therapy (TF-CBT) compared with a waitlist group (WL). All participants had been exposed to at least one traumatic event and had developed clinically relevant PTSS. PTSS were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), whereas symptoms of anxiety were assessed via the Screen for Child Anxiety-Related Disorders (SCARED) and symptoms of depression were measured with the Child Depression Inventory (CDI). Clinical assessments were performed repeatedly at baseline and after treatment or 4 months of waiting time. Results: At baseline, 121 (76 %) of the patients showed clinically relevant symptoms of anxiety and 91 (57 %) had clinically relevant symptoms of depression. The triplet of PTSS, anxiety, and depression occurred in 78 (49 %) children and adolescents. PTSS were significantly correlated with caregiver-reported anxiety (r = .42, p < .001) and self-reported depression (r = .49, p < .001). Using repeated measures ANOVA, we found that patients treated with TF-CBT showed not only significantly greater remission of their PTSS compared with patients on the WL (F(1, 157) = 12.31, p = .001), but also of their caregiver-reported symptoms of anxiety, F(1, 147) = 6.29, p = .013, but not of their self-reported symptoms of anxiety, F(1, 155) = 2.37, p = .126. TF-CBT was also superior to WL regarding a remission of self-reported symptoms of depression, F(1, 155) = 8.11, p = .005. Beyond a large effect on PTSS (d = 1.51), TF-CBT generated moderate effects regarding symptoms of anxiety (self-report: d = 0.51; caregiver report: d = 0.51) and depression (d = 0.62). Conclusions and Relevance: Our results confirm the high prevalence of anxiety and depression in traumatized children and adolescents. Moreover, they demonstrate transdiagnostic effects of TF-CBT. Therefore, TF-CBT seems to be an appropriate treatment for traumatized children and adolescents with comorbid anxiety and depression.

Literatur

  • Alisic, E., Zalta, A. K., Wesel, F. van, Larsen, S. E., Hafstad, G. S. & Hassanpour, K., et al. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. British Journal of Psychiatry, 204, 335 – 340. First citation in articleCrossrefGoogle Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. APA. First citation in articleCrossrefGoogle Scholar

  • Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S. & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1230 – 1236. First citation in articleCrossrefGoogle Scholar

  • Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L. & Kaufman, J., et al. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545 – 553. First citation in articleCrossrefGoogle Scholar

  • Cohen, J. A., Deblinger, E., Mannarino, A. P. & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393 – 402. First citation in articleCrossrefGoogle Scholar

  • Cohen, J. A., Mannarino, A. P. & Deblinger, E. (2009). Traumafokussierte kognitive Verhaltenstherapie bei Kindern und Jugendlichen. Heidelberg: Springer. First citation in articleCrossrefGoogle Scholar

  • Diehle, J., Opmeer, B. C., Boer, F., Mannarino, A. P. & Lindauer, R. J. (2015). Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. European Child & Adolescant Psychiatry, 24, 227 – 36. First citation in articleCrossrefGoogle Scholar

  • Dorsey, S., Briggs, E. C. & Woods, B. A. (2011). Cognitive-behavioral treatment for posttraumatic stress disorder in children and adolescents. Child and Adolescent Psychiatric Clinic of North America, 20, 255 – 269. First citation in articleCrossrefGoogle Scholar

  • Fan, F., Zhang, Y., Yang, Y., Mo, L. & Liu, X. (2011). Symptoms of posttraumatic stress disorder, depression, and anxiety among adolescents following the 2008 Wenchuan earthquake in China. Journal of Traumatic Stress, 24, 44 – 53. First citation in articleCrossrefGoogle Scholar

  • Foa, E. B. & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20 – 35. First citation in articleCrossrefGoogle Scholar

  • Goldbeck, L. & Ellerkamp, T. (2012). A randomized controlled trial of multimodal music therapy for children with Anxiety Disorders. Journal of Music Therapy, 49, 395 – 413. First citation in articleCrossrefGoogle Scholar

  • Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L. & Hoaas, L. C., et al. (2014). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child and Adolescent Psychology, 43, 356 – 369. First citation in articleCrossrefGoogle Scholar

  • Kovacs M. (1992). Children’s Depression, Inventory (CDI). New York: Multi-Health Systems. First citation in articleGoogle Scholar

  • Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M. & Ommeren, M. van et al. (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. The Lancet, 381, 1683 – 1685. First citation in articleCrossrefGoogle Scholar

  • Morina, N., Koerssen, R. & Pollet, T. V. (2016). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies. Clinical Psychology Review, 47, 41 – 54. First citation in articleCrossrefGoogle Scholar

  • Perkonigg, A., Kessler, R. C., Storz, S. & Wittchen, H.-U. (2000). Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101, 46 – 59. First citation in articleCrossrefGoogle Scholar

  • Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N. & Risch, E., et al. (2017). International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). Journal of Affective Disorders, 210, 189 – 195. First citation in articleCrossrefGoogle Scholar

  • Sachser, C., Rassenhofer, M. & Goldbeck, L. (2016). Traumafokussierte kognitive Verhaltenstherapie mit Kindern und Jugendlichen – Klinisches Vorgehen, Evidenzbasis und weitere Perspektiven. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie, 44, 479 – 489. First citation in articleLinkGoogle Scholar

  • Steil, R. & Füchsel, G. (2006). Interviews zu Belastungsstörungen bei Kindern und Jugendlichen (IBS-KJ): Diagnostik der Akuten und der Posttraumatischen Belastungsstörung. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Stiensmeier-Pelster, J., Schürmann, M. & Duda, K. (2000). Depressionsinventar für Kinder und Jugendliche (2., überarb. neu norm. Aufl.). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed, R., Stein, D. J. & Seedat, S. (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50, 121 – 127. First citation in articleCrossrefGoogle Scholar