Areas for Improvement in Trauma Focused Care: Attending to Interpersonal and Social Outcomes for Youth
Phillips, A. R., Halligan, S. L., Bailey, M., Birkeland, M. S., Lavi, I., Meiser-Stedman, R., Oram, H., Robinson, S., Sharp, T. H., & Hiller, R. M. (2024). Systematic review and meta-analysis: Do best-evidenced trauma-focused interventions for children and young people with PTSD lead to changes in social and interpersonal domains? European Journal of Psychotraumatology, 15(1), 2415267.
Introduction
Phillips et al. (2024) examines the impacts of evidence-based trauma-focused interventions, namely Trauma-Focused Cognitive Behavioral Therapy (tf-CBT) and Eye Movement Desensitization and Reprocessing (EMDR), on the social domains of children and young people. The study addresses a critical question: whether these treatments can effectively improve social skills, support networks, and interpersonal relations in youth with PTSD.
Methods
Researchers conducted a comprehensive review across seven databases (e.g., Web of Science, PubMed), focusing on randomized controlled trials (RCTs) that compared tf-CBT or EMDR with control conditions. The meta-analysis considered RCTs involving participants aged 5 to 25 with PTSD, measuring outcomes related to social skills, perceptions of social support, relationship quality, and social cognitions.
A total of 17 studies met inclusion criteria (n = 2498 participants). Thirteen of these assessed social functioning using standardized questionnaires, while a narrative synthesis was conducted for six studies reporting on other social-related outcomes, such as perceived support and attachment quality.
Results
Results indicated a small, non-significant positive effect favoring tf-CBT and EMDR over Treatment as Usual or Active Control for improving social skills and functioning (g = .20, 95% CI [-0.03, 0.44], p = .09). The narrative synthesis highlighted four out of six studies with improved social outcomes in the treatment group, but findings varied. For example, tf-CBT showed positive effects on perceived social support and reductions in social cognitions related to mistrust. However, heterogeneity across studies suggested variability in effectiveness, potentially due to factors like the involvement of caregivers and socio-economic context.
Discussion
Phillips et al. (2024) suggest that trauma-focused interventions may offer some benefit for social and interpersonal domains, though the impact remains limited. The lack of a significant meta-analytic effect raises questions about whether these therapies adequately address the complex social challenges associated with PTSD in youth.
Authors suggest that, “it may be that trauma-focused therapies for PTSD need to be adapted in some circumstances, so that they address social and interpersonal deficits.”
The authors posit that therapeutic adaptations, such as increased caregiver involvement or peer-group formats, could enhance outcomes.
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