Trauma-focused cognitive behavioral therapy for children and young people who have experienced forms of child maltreatment other than child sexual abuse: A review of the evidence

Trauma-focused cognitive behavioral therapy (TF-CBT) developed by Judith Cohen, Anthony Mannarino, and Esther Deblinger, is one of the most widely researched and best supported psychological treatments for posttraumatic stress in children and young people who have experienced traumatic events. However, as TF-CBT was originally developed to treat posttraumatic stress symptoms in children who had experienced sexual abuse, the literature is focused on samples experiencing trauma from child sexual abuse. A review of the effectiveness of TF-CBT for trauma symptoms associated with non-sexual abuse related child maltreatment including physical abuse, emotional abuse, neglect, and domestic violence has not been specifically addressed in the literature. This review reports on the results of a systematic search of the literature for controlled and uncontrolled studies (pre-post minimum) that quantitatively examine the effectiveness or efficacy of TF-CBT for children and young people (0–18 years) who had experienced child maltreatment (>50 % of sample) where the included population was not overrepresented by sexual abuse (determined by a cut-off of <31 % of sample). Cochrane Library, Embase (via Ovid), ProQuest Central, MEDLINE (via Ovid), PsycINFO (via Ovid), and Scopus were searched in August 2021 for peer-reviewed literature. JBI checklists for RCTs and quasi-experimental studies were used to assess quality of the literature. Four randomized controlled trials (representing 446 participants) and four uncontrolled trials (representing 345 participants) were eligible for inclusion. Narrative synthesis was undertaken to present the results from this small body of literature which focuses mainly on physical abuse and domestic violence. Results suggested that TF-CBT, delivered in a variety of ‘real-world’ settings is an effective intervention for a range of non-sexual abuse related trauma symptoms in children and young people. The included RCTs showed that TF-CBT had a positive effect on posttraumatic stress symptoms, anxiety, strengths, functional impairment, and also potentially depression and emotional and behavioral difficulties (with mixed effect). Based on the recorded trauma symptoms of the included samples, treatment effects are applicable to threat-based experiences (e.g., physical abuse and domestic violence), and cannot be generalized to deprivation-based experiences (e.g., neglect). The findings from this review suggest that a flexible approach to implementation and employing engagement strategies to minimize high attrition rates could be beneficial. Limitations of the included evidence comprise small sample sizes, self-report measures, and mixed trauma types.