Due to the negative impact of exposure to traumatic events (DePrince, Weinzierl, & Combs, 2009), effective treatments are necessary to prevent/improve negative outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for youth exposed to traumatic events (American Psychological Association [APA], 2008). Past meta-analyses showed larger effect sizes for youth who received general CBT and trauma-focused CBT (TF-CBT) when compared to control groups (Gutermann et al., 2016; Kowalik, Weller, Venter, & Drachman, 2011) and other forms of treatment (e.g., play therapy; Silverman et al., 2008; Slade & Warne, 2016). Despite the varying meta-analyses available examining trauma treatments, there is a paucity of research examining moderating and mediating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of study design, research study setting, trauma type, and cultural (i.e., demographic) variables (i.e., race, age, gender) on youth posttraumatic stress symptom, anxiety symptom, and depression symptom outcomes. In addition, the mediating effect of treatment components on youth outcomes (e.g., parental involvement, treatment delivery, inclusion of other treatment techniques) within CBT studies was also examined. A search using PsycINFO, EBSCO, ERIC, and ProQuest Dissertations and Theses identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was an effective treatment for youth exposed to traumatic events. Posttraumatic stress symptoms (d = -.57, p < .001), anxiety symptoms (d = -.40, p < .001), and depression symptoms (d = -.40, p < .001) were all found to be positively impacted by CBT. CBT subtreatments did not produce significantly different results from one another (posttraumatic stress symptoms: p = .073; depression symptoms: p = .296). All subtreatments, except for Game-Based CBT (d = -.38, p = .117), resulted in significant reductions in symptoms. Moderators significantly impacting CBT treatment outcomes for posttraumatic stress symptoms were trauma type (i.e., Q = 24.09, p = .004) and gender (i.e., Q = 10.68, p = .005) while moderators impacting treatment outcomes for depression were study design (i.e., Q = 10.95, p = .004) and treatment setting (i.e., Q = 10.98, p = .004). None of the variables examined moderated anxiety symptom outcomes. Further, no mediators were found to significantly impact posttraumatic stress symptom, anxiety symptom, and depression symptom outcomes. The implications of these findings for research and practice are discussed.
Read
