Effectiveness of trauma-focused cognitive behavioral therapy for Japanese children and adolescents in community settings: a multisite randomized controlled trial.

BACKGROUND: Trauma-focused cognitive behavioural therapy (TF-CBT) is an efficacious treatment model for children and adolescents with trauma-related disorders. However, few studies have been conducted in community settings, and there have been no randomized controlled trials in Asian countries. OBJECTIVE: To evaluate the effectiveness of TF-CBT in regular community settings in Japan through comparison with a waitlist with minimal services control condition. METHOD: Thirty Japanese children and adolescents with posttraumatic stress disorder symptoms (22 females, eight males, mean age = 13.90, range = 6-18) were randomly assigned to 12 sessions of TF-CBT or the waitlist control condition. The primary outcome measure was the Kiddie Schedule for Affective Disorders and Schizophrenia score assessed by blinded evaluators one month later. RESULTS: The mean number of sessions was 12 (range: 11-13) in the TF-CBT group and 4.87 (range: 3-7) in the control group. Intention to treat analysis showed that the TF-CBT group achieved significantly greater symptom reduction than did the control group. The effect size (Cohen's d) between the TF-CBT and control groups was 0.96 (p =.014) for posttraumatic symptoms and 1.15 (p =.004) for depressive symptoms. However, the TF-CBT group did not show better results than the control group with regard to improvements in anxiety symptoms, psychosocial functioning, and behavioural problems. CONCLUSIONS: The findings provided preliminary evidence of the effectiveness of TF-CBT for treating youth with trauma in community mental health facilities. TF-CBT in the Japanese context proved identical to the original, demonstrating that it is also suitable for use with children and adolescents in non-Western settings.

Antecedentes: La Terapia Cognitivo Conductual Centrada en el Trauma (TF-CBT en su sigla en inglés) es un modelo de tratamiento eficaz para niños y adolescentes con trastornos relacionados con el trauma. Sin embargo, hasta la fecha solo se han realizado unos pocos estudios en entornos comunitarios y no se han realizado ensayos controlados aleatorios en países asiáticos.Objetivo: Este estudio buscó evaluar la efectividad de la TF-CBT en entornos comunitarios regulares en Japón, en comparación con el tratamiento habitual (TAU en su sigla en inglés).Métodos: Treinta niños y adolescentes japoneses (22 mujeres, 8 hombres, promedio de edad = 13.90, rango = 6-18) fueron asignados aleatoriamente a 12 sesiones de la TF-CBT o al grupo TAU. La medida de resultado primaria fue el puntaje K-SADS (Calendario Kiddie para Trastornos Afectivos y Esquizofrenia) evaluado por evaluadores cegados un mes después del tratamiento.Resultados: El análisis de 'intención de tratar' mostró que el grupo TF-CBT logró una reducción significativa de síntomas, mayor que el grupo control. El tamaño del efecto (d de Cohen) entre el grupo TF-CBT y el grupo TAU fue de 0.96 (p =.014) para los síntomas postraumáticos y 1.15 (p =.004) para los síntomas depresivos.Conclusión: Los hallazgos revelaron que la TF-CBT es eficaz para tratar a jóvenes traumatizados en centros comunitarios de salud mental y podría implementarse con éxito en Japón.

Long-term psychological recovery process and its associated factors among survivors of the Great Hanshin-Awaji Earthquake in Japan: a qualitative study.

OBJECTIVES: The 1995 Great Hanshin-Awaji Earthquake had an enormous negative impact on survivors' health. Many survivors experienced psychological distress and their long-term psychological recovery process remains unclear. Our objective was thus to explore this long-term psychological recovery process. DESIGN: Qualitative study. SETTING: From January to December 2015, face-to-face interviews were conducted in Kobe, Japan. PARTICIPANTS: 20 affected survivors (55% female; ages ranged from 7 to 60 at the time of the disaster)-10 volunteer storytellers, six first responders (firefighters/public health nurses) and four post-traumatic stress disorder patients. OUTCOME MEASURES: We asked participants about their experiences and psychological distress relating to the earthquake and what facilitated or hindered their psychological recovery. We analysed interview data using constructivist grounded theory. RESULTS: Participants experienced diverse emotional reactions immediately after the disaster and often hyperfocused on what they should do now. This hyperfocused state led to both mental and physical health problems several months after the disaster. Months, and sometimes years, after the disaster, guilt and earthquake narratives (ie, expressing thoughts and feelings about the earthquake) played key roles in survivors' psychological recovery: guilt suppressed their earthquake narrative; conversely, the narrative alleviated feelings of distress about the earthquake. In time, participants reconsidered their earthquake experiences both alone and through social interaction. This alleviated their emotional reactions; however, participants still experienced attenuated emotional reactions, and some hid their feelings of distress even 20 years postdisaster. Interpersonal relationships modified this psychological process both positively and negatively. CONCLUSIONS: Future psychosocial support plans for disaster survivors may need to (1) include both mental and physical care in the transition from the acute phase to the recovery phase; (2) facilitate supportive interpersonal relationships for survivors during the mid-term recovery phase and (3) provide long-term psychological support to the most traumatised survivors, even if they appear to be functioning normally.

Feasibility and psychometric properties of the UCLA PTSD reaction index for DSM-5 in japanese youth: A multi-site study.

The purpose of this study was to determine the reliability and validity of the UCLA PTSD Reaction Index for DSM-5 (PTSD-RI-5) among Japanese youth. This is the first study to explore psychometrics of the DSM-5 version of the PTSD-RI-5, as well as the first multisite study of an Asian population. This article presents psychometric characteristics of the PTSD-RI-5 derived from a sample of Japanese children and adolescents (N = 318). The PTSD-RI-5 total scale displayed good internal consistency reliability (α = 0.85). Correlations of PTSD-RI scores with the posttraumatic stress scores on the TSCC-A for the entire sample provided evidence of convergent validity. The four-factor structure of the PTSD-RI-5 was supported through confirmatory factor analysis in this sample. In conclusion, a DSM-5 version of the PTSD-RI-5 can be regarded as an adequate instrument for clinical and research purposes in Japan.

Long-term psychological consequences among adolescent survivors of the Wenchuan earthquake in China: A cross-sectional survey six years after the disaster.

BACKGROUND: Most epidemiological studies on adolescent survivors' mental health have been conducted within 2 years after the disaster. Longer-term psychological consequences remain unclear. This study explored psychological symptoms in secondary school students who were living in Sichuan province 6 years after the Wenchuan earthquake. METHODS: A secondary data analysis was performed on data from a final survey of survivors conducted 6 years after the Wenchuan earthquake as part of the five-year mental health and psychosocial support project. A total of 2641 participants were divided into three groups, according to the level of traumatic experience exposure during the earthquake (0, 1, and 2 or more). ANCOVA was used to compare the mean scores of the Symptom Checklist-90 (SCL-90) among the three groups, adjusting for covariates such as age, gender, ethnicity, having a sibling, parents' divorce, and socio-economic status. Logistic regression analysis was used to identify relationships between the traumatic experiences and suicidality after the disaster. RESULTS: Having two or more kinds of traumatic experiences was associated with higher psychological symptom scores on the SCL-90 (Cohen's d=0.23-0.33) and suicidal ideation (OR 1.98, 95% CIs:1.35-2.89) and attempts (OR 3.32, 95% CIs:1.65-6.68), as compared with having no traumatic experience. LIMITATIONS: Causality cannot be inferred from this cross-sectional survey, and results may not generalize to other populations due to convenience sampling. CONCLUSIONS: Severely traumatized adolescent survivors of the earthquake may suffer from psychological symptoms even 6 years after the disaster. Long-term psychological support will be needed for these individuals.

Feasibility of trauma-focused cognitive behavioral therapy for traumatized children in Japan: a Pilot Study.

BACKGROUND: Trauma-focused cognitive behavioral therapy is used to treat children who have experienced traumatic events and suffer from trauma-related disorders. Its effectiveness has been demonstrated in several randomized controlled studies. However, most of these studies have been performed in the United States, with few studies conducted in Asian countries. Therefore, we aimed to evaluate the feasibility of trauma-focused cognitive behavioral therapy in children who have experienced traumatic events and who suffer from trauma-related disorders in Japan. FINDINGS: Thirty-five traumatized children (mean age = 10.9 years; range = 3-17 years; 74.3% girls) who received trauma-focused cognitive behavioral therapy were included. The effectiveness of the program was evaluated in each case using the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for DSM-IV for trauma-related symptoms and the Children's Global Assessment Scale for social functioning. Pre- and post-treatment outcome measures were analyzed using two-tailed paired t tests. The results for 35 participants indicate that post-traumatic stress symptoms were significantly improved following therapy [t(35) = 8.27; p < 0.01], whereas the assessment of social functioning supported the effectiveness of the program [t(35) = -14.68; p < 0.01]. The pre- to post-treatment effect sizes (Glass's delta) were 1.24 for the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index and 1.96 for the Children's Global Assessment Scale. CONCLUSIONS: Our findings indicate that trauma-focused cognitive behavioral therapy is feasible for treating traumatized children of an Asian population. We discuss the implications of this result for clinical practice and future research.