Meta-analysis is a scientific term that refers to a structured review of a particular topic in the research literature. Meta-analyses look at a bunch of research studies that have been previously published, combine all their data (or look at all of their data in a systematic fashion), and come to some broad, general conclusions from the analysis.
Meta-analyses are helpful to researchers, clinicians and laypeople alike, because they help distill the entire research literature on a specific topic into an easily digested summary.
In this research update, we look at cognitive behavioral therapy (CBT) for childhood posttraumatic stress disorder (PTSD), effective treatments for depression in a mother surrounding the birth of her child, and a look at anxiety symptom prevention with cognitive-behavioral interventions.
The first meta-analysis (Kowalik et al., 2011) looks at the world of childhood post-traumatic stress disorder (PTSD). According to the researchers, there is no clear “gold standard treatment for childhood posttraumatic stress disorder (PTSD).”
An annotated bibliography and meta-analysis were used to examine the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL).
The efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.
In other words, cognitive behavioral therapy works for the treatment of childhood PTSD. It seemed to works best for anxiety and depression related to PTSD, rather than for symptoms like rule-breaking or aggression.
Next up, we have a look at perinatal depression. Perinatal depression encompasses a wide range of mood disorders that can affect a woman during pregnancy and after the birth of her child. It includes prenatal depression, the “baby blues,” postpartum depression and postpartum psychosis. Between 15 and 20 percent of all women experience some form of pregnancy related depression or anxiety.
Sockol et al. (2011) conducted a meta-analysis to determine the efficacy of pharmacologic and psychological interventions for treatment of perinatal depression.
The researchers found 27 research studies that looked at these kinds of treatments for perinatal depression, including open drug trials (n=9), quasi-randomized trials (n=2), and randomized controlled trials (n=16) assessing change from pretreatment to posttreatment or comparing these interventions to a control group.
What did they find?
There was significant improvement in depressive symptoms from pretreatment to posttreatment, with an uncontrolled overall effect size (Hedges’ g) of 1.61 after removal of outliers and correction for publication bias. Symptom levels at posttreatment were below cutoff levels indicative of clinically significant symptoms.
At posttreatment, intervention groups demonstrated significantly greater reductions in depressive symptoms compared to control groups, with an overall controlled effect size (Hedges’ g) of 0.65 after removal of outliers.
What was most effective? Well, the researchers found that individual psychotherapy was superior to group psychotherapy. In this meta-analysis, the researchers found that psychotherapy focused on interpersonal therapy interventions was more effective than interventions focused on cognitive-behavioral interventions.
Finally, we look at whether cognitive-behavioral therapy (CBT) helps in the prevention of anxiety symptoms. Zalta (2011) conducted a systematic review that identified 15 independent pretest-posttest randomized or quasi-randomized efficacy trials for analysis.
At posttest (the end of the research study), groups which had CBT treatment demonstrated significantly greater symptom reduction compared to control groups. (The researcher reported weighted mean effect sizes (Hedges’ g) of 0.25 for general anxiety, 0.24 for disorder-specific symptoms, and 0.22 for depression after the removal of outliers.)
But for some reason, the effects didn’t seem to last. They appeared to diminish over 6- and 12-month follow-up.
Further analyses indicated that individually administered media interventions were more effective than human-administered group interventions at preventing general anxiety and depression symptoms.
References
Kowalik J, Weller J, Venter J, Drachman D. (2011). Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: a review and meta-analysis. J Behav Ther Exp Psychiatry, 42, 405-13.
Sockol, L.E., Epperson, C.N., Barber, J.P. (2011). A meta-analysis of treatments for perinatal depression. Clin Psychol Rev, 31, 839-49. doi: 10.1016/j.cpr.2011.03.009.
Zalta, A.K. (2011). A meta-analysis of anxiety symptom prevention with cognitive-behavioral interventions. J Anxiety Disord, 25, 749-60.
3 comments
There are lot of research going on childhood PTSD in neuroscience.Recent research on mirror neutrons and empathy suggested that we can now track the real meaning of suffering from PTSD.Take example of Dostoevsky“s gambling mania,psychoanalyzing Freud came very near guilt feeling of Dostoevsky but unable to found out reason behind guilt feeling.Same is true about guilt feeling of Hitler and Van Gogh.
Hi,
Couple of things. I have only read a couple of studies where mother’s who have either lost or chose to terminate pregnancies suffered greater and more intense episodes of PPD and expressed feelings of inadequacy as a mother when they finally had a child. Likewise, children of emotionally or physically absent parents were more likely to feel inadequate. Proving this stuff to be the rule more then the exception would be useful for therapist trying to treat PPD. (It could also help a couple assess often unconsidered emotional risks of having a child.)
Second, the comment “But for some reason, the effects didn’t seem to last. They appeared to diminish over 6- and 12-month follow-up.” makes me wonder what environment the subjects returned to after treatment. A patient coming to you from an emotionally abusive and unsupportive family to any kind of therapy has a sustained dysfunction. The best analogy would be that the patient is the handkerchief in the middle of a tug of war rope. If you picture therapy as the obviously stronger pull on the rope, during the contest, therapy wins. However, after the therapist drops the rope and the unsupportive family is the only force, the handkerchief and easily is pulled back to where it was. How is this factor filtered out in determining the affect of therapy?
Well said, LOL. CBT is a crock of shit. I had PTSD from childhood abuse and CBT was the worst thing that happend to me when I went to find help. Well actually thats not true, it DID help me in an inverted way, how I finally came to discover what I needed and what worked, opposed to the CBT that was thrown at me. It was the lon, long route, that need not of been too long and too expensive
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