Unburdened by false humility, postmodern trauma activists claim to have understood for the first time what drives all of human suffering
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CATEGORY: NEW RESEARCH  Nina Moner, first author Source: European Journal of Psychotraumatology Read time: 2.3 minutes This Happened A literature review summarized the state of the evidence for psychotherapy techniques to treat posttraumatic stress disorder (PTSD) in very young children (0-6 years) [1]. Who Did This? Nina Moner, is a PhD student in Clinical Psychology at the University of Côte d’Azur, France. The Premise The literature review identified seven techniques that have been studied. These included seven randomized clinical trials (RCTs) and eight single-arm studies with no control group. (1) Cognitive behavior therapy (CBT) has been tested with four RCTs. Two of these studies used active treatment control groups, one used a wait-list control group, and one compared two CBT versions. CBT was the only technique with more than one RCT. All four RCTs were effective with follow-ups from 3-12 months. Each used slightly different variations of CBT. (Disclaimer: I conducted one of these RCTs). (2) Prolonged exposure therapy, one of the most common techniques used with adults, had one RCT with a developmentally adapted version called dyadic exposure therapy (DET). It was significantly more effective than non-directive supportive therapy. (3) Child Parent Psychotherapy (CPP) had one RCT, which was effective. It is intended for children exposed to interpersonal or marital violence. CPP is a psychodynamic technique based on the premise that child psychological problems are best addressed within the attachment relationship. Studies, however, have neither demonstrated that parent-child relationships are disturbed at the start of therapy nor attempted to measure children’s symptoms and attachment security simultaneously. CPP is immensely popular in academia and some clinical circles, but it possesses the enormous drawback of being a 50-week intervention. That is logistically inconceivable for all but the most intractable, and possibly over-dependent, patients. (4) Eye movement desensitization and reprocessing (EMDR) has zero RCTs. It has one tiny (n = 9) uncontrolled study in 4-8 years-old children. The review neglected to mention that it is developmentally impossible for young children to cooperate with the bilateral eye movements. Therapists must improvise bilateral stimulation with audio, vibrators, or tapping, which I believe makes the technique unfeasible. Three other techniques had support from single studies. (5) Parent-child interaction therapy (PCIT), designed for oppositional children, not trauma, had one uncontrolled study. (6) Early Pathways, a home-based technique for families in poverty, had one RCT. (7) Eye movement integration (EMI) had one uncontrolled study. All had promising preliminary results. Play therapy had zero systematic group studies. In regards to whether young children can understand and cooperate with any of the treatment techniques, only one study attempted to measure this. One CBT study determined that children understood all the activities and performed them, with a gradient of skill from 3 to 6 years [2]. Analysis Overall, this review was a breath of fresh air. Instead of the typical ideology of oppression and lack of equipoise found in many trauma papers, this review reported facts in a straightforward fashion. This review, however, raises at least three important issues. First, the discussion included an entire section on different techniques to intervene on the parent-child relationship (CPP impacts attachment, DET for parents with their own PTSD, etc.). The authors missed an opportunity to dispel the folk myth that parents or parenting behaviors need to be treated for young children to recover from PTSD. We showed in my CBT trial that neither maternal PTSD nor depression had an impact on child improvement at the end of treatment [3]. As long as caregivers bring their children to therapy and cooperate with the methods, they all get better. Second, the inclusion criteria included children from 0 to 6 years of age, but the authors did not accurately represent the situation of children younger than 3 years of age. They noted that “we still have insufficient information about PTSD symptom presentations during the first three years,” implying that we need additional research on treating PTSD in this group. Instead, they should have stated that there are no documented cases of children in the world with full PTSD younger than three years. That is not for a lack of case reports. There are many case reports and they all illustrate absence of the full diagnosis. This is due to still-emerging cognitive, abstract, and verbal capacities in this age group. Treatment of children below three years with conditioned-responses to trauma reminders need simple parent-management advice to help avoid those reminders until the response disappears.
They tried to get Psychology Today to censor and take down my post. Despite their exaggerated claims, the fact remains that there are no credible research trials of play therapy for PTSD in any age group (see here). References [1] Moner N, Soubelet A, Villard P & Askenazy F (2024) Individual psychological interventions and therapies for posttraumatic stress disorder and posttraumatic stress symptoms in young children: a systematic review, European Journal of Psychotraumatology, 15:1, DOI: 10.1080/20008066.2024.2432161 [2] Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52, 8, 853-860. DOI: 10.1111/j.1469-7610.2010.02354.x [3] Weems CF, Scheeringa MS (2013). Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. Journal of Anxiety Disorders 27(1), 140-146. DOI: 10.1016/j.janxdix.2012.11.003. Comments are closed.
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