Psychological therapies for the treatment of post‐traumatic stress disorder in children and adolescents

Donna Gillies; Fiona Taylor; Carl Gray; Louise O'Brien; Natalie D'Abrew

doi:10.1002/14651858.CD006726.pub2

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Terapias psicológicas para el tratamiento del trastorno de estrés postraumático en niños y adolescentes

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Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents

Post-traumatic stress disorder, otherwise known as PTSD, is highly prevalent in children and adolescents who have experienced trauma. A new Cochrane Review in December 2012 looks at whether psychological therapies might help. One of the Australian author team, Donna Gillies from the Western Sydney and Nepean Blue Mountains Local Health Districts summarises their findings.

Figure 1

Study flow diagram.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 All psychological therapies versus control, Outcome 1 Improvement.

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Analysis 1.2

Comparison 1 All psychological therapies versus control, Outcome 2 PTSD total.

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Analysis 1.3

Comparison 1 All psychological therapies versus control, Outcome 3 Anxiety.

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Analysis 1.4

Comparison 1 All psychological therapies versus control, Outcome 4 Depression.

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Analysis 1.5

Comparison 1 All psychological therapies versus control, Outcome 5 Loss to follow‐up.

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Analysis 2.1

Comparison 2 CBT versus control, Outcome 1 Improvement.

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Analysis 2.2

Comparison 2 CBT versus control, Outcome 2 PTSD total.

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Analysis 2.3

Comparison 2 CBT versus control, Outcome 3 PTSD avoidance.

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Analysis 2.4

Comparison 2 CBT versus control, Outcome 4 PTSD hyperarousal.

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Analysis 2.5

Comparison 2 CBT versus control, Outcome 5 PTSD re‐experiencing.

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Analysis 2.6

Comparison 2 CBT versus control, Outcome 6 Anxiety.

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Analysis 2.7

Comparison 2 CBT versus control, Outcome 7 Depression.

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Analysis 2.8

Comparison 2 CBT versus control, Outcome 8 Loss to follow‐up.

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Analysis 3.1

Comparison 3 Narrative versus control, Outcome 1 Improvement.

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Analysis 3.2

Comparison 3 Narrative versus control, Outcome 2 PTSD total.

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Analysis 3.3

Comparison 3 Narrative versus control, Outcome 3 PTSD avoidance.

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Analysis 3.4

Comparison 3 Narrative versus control, Outcome 4 PTSD hyperarousal.

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Analysis 3.5

Comparison 3 Narrative versus control, Outcome 5 PTSD re‐experiencing.

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Analysis 3.6

Comparison 3 Narrative versus control, Outcome 6 Depression.

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Analysis 3.7

Comparison 3 Narrative versus control, Outcome 7 Loss to follow‐up.

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Analysis 4.1

Comparison 4 EMDR versus control, Outcome 1 PTSD.

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Analysis 4.2

Comparison 4 EMDR versus control, Outcome 2 PTSD avoidance.

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Analysis 4.3

Comparison 4 EMDR versus control, Outcome 3 PTSD hyperarousal.

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Analysis 4.4

Comparison 4 EMDR versus control, Outcome 4 PTSD re‐experiencing.

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Analysis 4.5

Comparison 4 EMDR versus control, Outcome 5 Anxiety.

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Analysis 4.6

Comparison 4 EMDR versus control, Outcome 6 Depression.

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Analysis 4.7

Comparison 4 EMDR versus control, Outcome 7 Loss to follow‐up.

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Analysis 5.1

Comparison 5 Other psychological therapies versus control, Outcome 1 PTSD total.

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Analysis 5.2

Comparison 5 Other psychological therapies versus control, Outcome 2 PTSD avoidance.

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Analysis 5.3

Comparison 5 Other psychological therapies versus control, Outcome 3 PTSD hyperarousal.

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Analysis 5.4

Comparison 5 Other psychological therapies versus control, Outcome 4 PTSD re‐experiencing.

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Analysis 5.5

Comparison 5 Other psychological therapies versus control, Outcome 5 Depression.

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Analysis 5.6

Comparison 5 Other psychological therapies versus control, Outcome 6 Loss to follow‐up.

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Analysis 6.1

Comparison 6 CBT versus supportive counselling, Outcome 1 Improvement.

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Analysis 6.2

Comparison 6 CBT versus supportive counselling, Outcome 2 PTSD avoidance.

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Analysis 6.3

Comparison 6 CBT versus supportive counselling, Outcome 3 PTSD hyperarousal.

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Analysis 6.4

Comparison 6 CBT versus supportive counselling, Outcome 4 PTSD re‐experiencing.

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Analysis 6.5

Comparison 6 CBT versus supportive counselling, Outcome 5 Anxiety state.

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Analysis 6.6

Comparison 6 CBT versus supportive counselling, Outcome 6 Anxiety trait.

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Analysis 6.7

Comparison 6 CBT versus supportive counselling, Outcome 7 Depression.

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Analysis 6.8

Comparison 6 CBT versus supportive counselling, Outcome 8 Behaviour.

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Analysis 6.9

Comparison 6 CBT versus supportive counselling, Outcome 9 Loss to follow‐up.

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Analysis 7.1

Comparison 7 Narrative versus supportive counselling, Outcome 1 Improvement.

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Analysis 7.2

Comparison 7 Narrative versus supportive counselling, Outcome 2 PTSD total.

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Analysis 7.3

Comparison 7 Narrative versus supportive counselling, Outcome 3 Depression.

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Analysis 7.4

Comparison 7 Narrative versus supportive counselling, Outcome 4 Loss to follow‐up.

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Analysis 8.1

Comparison 8 Narrative versus meditation/relaxation, Outcome 1 Improvement.

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Analysis 8.2

Comparison 8 Narrative versus meditation/relaxation, Outcome 2 PTSD total.

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Analysis 8.3

Comparison 8 Narrative versus meditation/relaxation, Outcome 3 Loss to follow‐up.

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Analysis 9.1

Comparison 9 Exposure versus interpersonal therapy, Outcome 1 Improvement.

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Analysis 9.2

Comparison 9 Exposure versus interpersonal therapy, Outcome 2 PTSD total.

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Analysis 9.3

Comparison 9 Exposure versus interpersonal therapy, Outcome 3 Depression.

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Analysis 9.4

Comparison 9 Exposure versus interpersonal therapy, Outcome 4 Loss to follow‐up.

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Analysis 10.1

Comparison 10 Sensitivity analysis: types of therapy, Outcome 1 Improvement.

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Analysis 10.2

Comparison 10 Sensitivity analysis: types of therapy, Outcome 2 PTSD total.

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Analysis 11.1

Comparison 11 Sensitivity analysis: types of trauma, Outcome 1 Improvement.

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Analysis 11.2

Comparison 11 Sensitivity analysis: types of trauma, Outcome 2 PTSD total.

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Analysis 12.1

Comparison 12 Sensitivity analysis: allocation concealment, Outcome 1 PTSD total.

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Analysis 13.1

Comparison 13 Sensitivity analysis: blinding, Outcome 1 Improvement.

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Analysis 13.2

Comparison 13 Sensitivity analysis: blinding, Outcome 2 PTSD total.

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Analysis 14.1

Comparison 14 Sensitivity analysis: skewed and non‐skewed data, Outcome 1 PTSD total.

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Analysis 15.1

Comparison 15 ITT analysis, Outcome 1 Improvement.

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Comparison 1. All psychological therapies versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Short‐term	2	49	Odds Ratio (M‐H, Random, 95% CI)	8.64 [2.01, 37.14]
1.2 Medium‐term	2	50	Odds Ratio (M‐H, Random, 95% CI)	9.46 [2.46, 36.32]
1.3 Long‐term	1	53	Odds Ratio (M‐H, Random, 95% CI)	1.84 [0.60, 5.65]
2 PTSD total Show forest plot	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term	6	241	Std. Mean Difference (IV, Random, 95% CI)	‐1.05 [‐1.52, ‐0.58]
2.2 Medium‐term	3	115	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐0.97, ‐0.18]
2.3 Long‐term	1	53	Std. Mean Difference (IV, Random, 95% CI)	‐0.44 [‐0.98, 0.11]
3 Anxiety Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Short‐term	3	91	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [1.00, ‐0.13]
3.2 Medium‐term	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐0.63 [‐1.34, 0.08]
4 Depression Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Short‐term	5	156	Std. Mean Difference (IV, Random, 95% CI)	‐0.74 [‐1.11, ‐0.36]
4.2 Medium‐term	3	110	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.36, 0.40]
4.3 Long‐term	1	53	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.52, 0.56]
5 Loss to follow‐up Show forest plot	7		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Short‐term	5	208	Odds Ratio (M‐H, Random, 95% CI)	1.59 [0.56, 4.49]
5.2 Medium‐term	3	116	Odds Ratio (M‐H, Random, 95% CI)	1.54 [0.47, 5.04]
5.3 Long‐term	1	57	Odds Ratio (M‐H, Random, 95% CI)	10.06 [0.52, 196.10]

Comparison 1. All psychological therapies versus control

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Comparison 2. CBT versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Short‐term	2	49	Odds Ratio (M‐H, Random, 95% CI)	8.64 [2.01, 37.14]
1.2 Medium‐term	1	25	Odds Ratio (M‐H, Random, 95% CI)	8.00 [1.21, 52.69]
2 PTSD total Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term	3	98	Std. Mean Difference (IV, Random, 95% CI)	‐1.34 [‐1.79, ‐0.89]
2.2 Medium‐term	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐0.73 [‐1.44, ‐0.01]
3 PTSD avoidance Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 PTSD hyperarousal Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 PTSD re‐experiencing Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 Anxiety Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.1 Short‐term	2	59	Std. Mean Difference (IV, Random, 95% CI)	‐0.66 [‐1.33, 0.01]
6.2 Medium‐term	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐0.63 [‐1.34, 0.08]
7 Depression Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

7.1 Short‐term	3	98	Std. Mean Difference (IV, Random, 95% CI)	‐0.80 [‐1.47, ‐0.13]
7.2 Medium‐term	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐0.19 [‐0.88, 0.51]
8 Loss to follow‐up Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

8.1 Short‐term	2		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. CBT versus control

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Comparison 3. Narrative versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Long‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 PTSD total Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Medium‐term	2	79	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.23, 0.09]
2.2 Long‐term	1	53	Std. Mean Difference (IV, Random, 95% CI)	‐0.44 [‐0.98, 0.11]
3 PTSD avoidance Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 PTSD hyperarousal Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 PTSD re‐experiencing Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

6.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7 Loss to follow‐up Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

7.1 Medium‐term	2	83	Odds Ratio (M‐H, Random, 95% CI)	5.13 [0.56, 47.28]
7.2 Long‐term	1	57	Odds Ratio (M‐H, Random, 95% CI)	10.06 [0.52, 196.10]

Comparison 3. Narrative versus control

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Comparison 4. EMDR versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PTSD Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Short‐term	2	65	Std. Mean Difference (IV, Random, 95% CI)	‐0.61 [‐1.96, 0.74]
2 PTSD avoidance Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 PTSD hyperarousal Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 PTSD re‐experiencing Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 Anxiety Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

6.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7 Loss to follow‐up Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

7.1 Short‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. EMDR versus control

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Comparison 5. Other psychological therapies versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PTSD total Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 PTSD avoidance Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

2.1 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3 PTSD hyperarousal Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

3.1 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4 PTSD re‐experiencing Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.1 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 Loss to follow‐up Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Short‐term	2	115	Odds Ratio (M‐H, Random, 95% CI)	1.38 [0.35, 5.52]
6.2 Medium‐term	1	33	Odds Ratio (M‐H, Random, 95% CI)	0.95 [0.23, 3.88]

Comparison 5. Other psychological therapies versus control

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Comparison 6. CBT versus supportive counselling

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Short‐term	2	208	Odds Ratio (M‐H, Random, 95% CI)	3.18 [1.76, 5.74]
2 PTSD avoidance Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 PTSD hyperarousal Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 PTSD re‐experiencing Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 Anxiety state Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

5.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6 Anxiety trait Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

6.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
6.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

7.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
8 Behaviour Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

8.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
8.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
8.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
9 Loss to follow‐up Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

9.1 Short‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.2 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9.3 Long‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. CBT versus supportive counselling

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Comparison 7. Narrative versus supportive counselling

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Long‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 PTSD total Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 Loss to follow‐up Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.1 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 Long‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 7. Narrative versus supportive counselling

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Comparison 8. Narrative versus meditation/relaxation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Short‐term	1	31	Odds Ratio (M‐H, Random, 95% CI)	1.5 [0.32, 7.14]
1.2 Medium‐term	2	76	Odds Ratio (M‐H, Random, 95% CI)	1.09 [0.41, 2.88]
2 PTSD total Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.73, 0.70]
2.2 Medium‐term	2	76	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.39, 0.51]
3 Loss to follow‐up Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Short‐term	1	31	Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Medium‐term	2	78	Odds Ratio (M‐H, Random, 95% CI)	0.29 [0.03, 2.89]

Comparison 8. Narrative versus meditation/relaxation

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Comparison 9. Exposure versus interpersonal therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Short‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 PTSD total Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 Depression Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Short‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.2 Medium‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3.3 Long‐term	1		Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 Loss to follow‐up Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.1 Short‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.2 Medium‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.3 Long‐term	1		Odds Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 9. Exposure versus interpersonal therapy

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Comparison 10. Sensitivity analysis: types of therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 CBT	2	49	Odds Ratio (M‐H, Random, 95% CI)	8.64 [2.01, 37.14]
1.2 Narrative	2	78	Odds Ratio (M‐H, Random, 95% CI)	3.82 [0.67, 21.80]
2 PTSD total Show forest plot	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 CBT	3	98	Std. Mean Difference (IV, Random, 95% CI)	‐1.34 [‐1.79, ‐0.89]
2.2 Narrative	2	79	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.23, 0.09]
2.3 EMDR	2	65	Std. Mean Difference (IV, Random, 95% CI)	‐0.61 [‐1.96, 0.74]
2.4 Other psychological therapies	1	78	Std. Mean Difference (IV, Random, 95% CI)	‐1.12 [‐1.60, ‐0.64]

Comparison 10. Sensitivity analysis: types of therapy

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Comparison 11. Sensitivity analysis: types of trauma

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Sexual abuse	1	25	Odds Ratio (M‐H, Random, 95% CI)	6.0 [0.93, 38.63]
1.2 Civil/social violence	2	78	Odds Ratio (M‐H, Random, 95% CI)	3.82 [0.67, 21.80]
1.3 Physical trauma	1	24	Odds Ratio (M‐H, Random, 95% CI)	15.40 [1.47, 160.97]
2 PTSD total Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Sexual abuse	1	36	Std. Mean Difference (IV, Random, 95% CI)	‐1.05 [‐1.79, ‐0.31]
2.2 Civil/social violence	3	157	Std. Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.35, ‐0.24]
2.3 Physical trauma	2	62	Std. Mean Difference (IV, Random, 95% CI)	‐1.51 [‐2.08, ‐0.94]
2.4 Natural disaster	1	32	Std. Mean Difference (IV, Random, 95% CI)	‐1.31 [‐2.08, ‐0.54]

Comparison 11. Sensitivity analysis: types of trauma

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Comparison 12. Sensitivity analysis: allocation concealment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PTSD total Show forest plot	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Low risk	1	78	Std. Mean Difference (IV, Random, 95% CI)	‐1.12 [‐1.60, ‐0.64]
1.2 Unclear risk	7	242	Std. Mean Difference (IV, Random, 95% CI)	‐0.90 [‐1.38, ‐0.43]

Comparison 12. Sensitivity analysis: allocation concealment

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Comparison 13. Sensitivity analysis: blinding

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Low risk	2	49	Odds Ratio (M‐H, Random, 95% CI)	12.76 [2.89, 56.44]
1.2 Unclear risk	1	53	Odds Ratio (M‐H, Random, 95% CI)	1.84 [0.60, 5.65]
1.3 High risk	1	25	Odds Ratio (M‐H, Random, 95% CI)	6.0 [0.93, 38.63]
2 PTSD total Show forest plot	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Low risk	4	114	Std. Mean Difference (IV, Random, 95% CI)	‐0.91 [‐1.65, ‐0.16]
2.2 Unclear risk	4	206	Std. Mean Difference (IV, Random, 95% CI)	‐0.96 [‐1.47, ‐0.46]

Comparison 13. Sensitivity analysis: blinding

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Comparison 14. Sensitivity analysis: skewed and non‐skewed data

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PTSD total Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Non‐skewed	4	206	Std. Mean Difference (IV, Random, 95% CI)	‐0.96 [‐1.47, ‐0.46]
1.2 Skewed	3	90	Std. Mean Difference (IV, Random, 95% CI)	‐0.73 [‐1.59, 0.14]

Comparison 14. Sensitivity analysis: skewed and non‐skewed data

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Comparison 15. ITT analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Best‐case	3	116	Odds Ratio (M‐H, Random, 95% CI)	5.79 [1.66, 20.12]
1.2 Worst‐case	3	116	Odds Ratio (M‐H, Random, 95% CI)	2.02 [0.74, 5.50]

Comparison 15. ITT analysis

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Terapias psicológicas para el tratamiento del trastorno de estrés postraumático en niños y adolescentes

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Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents

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