Summary: Deblinger E, Steer RA, and Lippmann J. "Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms," Child Abuse and Neglect vol 23(12): 1371-1378. 1999.

This study examines the long-term behavioral outcomes of a group of children who had been treated for posttraumatic stress symptoms due to sexual abuse. Two years after the children-and their parents, in some cases-completed the original treatment, they were again assessed by researchers to see if the gains they had achieved lasted long after treatment was over.

In the original study, 100 children were randomly assigned to one of four types of treatment. Twenty-five children received cognitive-behavioral treatment one-on-one with a therapist. Twenty-five attended cognitive-behavioral therapy along with their mothers. Another group of twenty-five children were assigned to a treatment program that offered cognitive-behavioral treatment to their mothers, who were encouraged to use the techniques they had learned in treatment to help their children cope with the aftermath of abuse. A final group of twenty-five children were referred to therapists in their own communities for treatment.

One of the symptoms of posttraumatic stress disorder (PTSD) is the avoidance of reminders of trauma. When those reminders-events that may seem commonplace to others-crop up, trauma survivors can react strongly. Avoidance of trauma reminders and strong reactions to them can get in the way of trauma survivors' efforts to come to terms with what has happened to them. Gradual exposure to traumatic reminders is a central feature of the cognitive-behavioral treatment model. This means that, over the course of therapy, children are gradually exposed to aspects of the traumatic event and helped to overcome their extreme responses to them. Over time, with the help of therapists and caregivers, children can work instead on processing their feelings related to the trauma.

Children and their mothers were assessed three months, six months, and one year following the original treatment. Children who had received cognitive-behavioral therapy directly, either alone or with their mothers, had fewer symptoms of PTSD than those who were treated in the communities or whose mothers had gotten treatment alone. Mothers who had been treated, either alone or with their children, reported better parenting skills than mothers who had not been treated. These mothers also reported that their children's behavior was better and that they felt less depressed than the other mothers. At the two-year follow-up, reported in this article, those gains had been maintained for the most part. There had been some decline in parenting skills between the three-month follow-up and the one-year follow-up, but no further decline at two years.