Nonpharmacological treatments of Post-Traumatic Stress Disorder (PTSD) among children and adolescents: A scoping review

Abstract

Post-traumatic stress disorder (PTSD) is a worldwide public health burden leading to severe impairment. PTSD has a particularly high occurrence among children exposed to potentially traumatic events. Our study aimed to establish the current state of the literature regarding nonpharmacological treatments studied to date to reduce post-traumatic stress symptoms (PTSS) in children and adolescents. We conducted the search on three databases: PubMed, Web of Sciences, and Embase, using the following MeSH Terms; stress disorders, post-traumatic, and psychological treatment. We refined the search by applying filters to document type, languages, and age. Initially, 4570 articles were identified, of which 60 met our inclusion criteria and were included in the review. We included studies that focused on children and adolescents with PTSD following a traumatic event that occurred at least three months prior to being assigned to non-pharmacological treatment. Exclusion criteria included case studies, meta-analyses, literature reviews, and grief-focused therapies. Additionally, trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR), already well-established as standard treatments, were excluded. Studies were also omitted if PTSD was not formally diagnosed or if the primary outcome measured was unrelated to PTSS. Most treatments relied on psychoeducation, support, coping skills, and trauma narratives using different strategies. We found large studies on combined therapies, prolonged exposure therapy, and school-based therapies–especially with collective traumatic events. For collective traumatic events, our study exposed a preponderant utilization of group therapies. Most studies reported that the therapies tested were efficient. The level of evidence for each therapy was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, revealing noteworthy findings, particularly for prolonged exposure therapy. Our study emphasizes treatments that should be further examined in larger studies, and the specificities of psychotherapeutic treatment according to the type of traumatic event, single or collective. Based on our findings, we developed a therapeutic algorithm that can serve as a guideline for managing PTSD in children and adolescents.