Child sexual abuse is a widespread social problem, which can cause a range of mental health conditions including fear, anxiety, post-traumatic stress disorder, behavioural problems, inappropriate sexual behaviour and an increased risk of psychological problems in adulthood.
Cognitive behavioural therapy is often used to help children (and their non-offending parent) to manage the conditions that arise as a result of the abuse. As is sometimes the case with mental health treatments, high quality evidence has never been available to support this treatment choice. Indeed, the Cochrane review first published in 2006 that looked at cognitive-behavioural approaches for children who have been sexually abused did not find any reliable studies to confirm the potential of CBT.
The Cochrane Developmental, Psychosocial and Learning Problems Group have now updated their systematic review on the subject, so mental health professionals and other professionals working with abused children will be interested to read the pooled findings of the latest research.
The review authors conducted the usual water-tight Cochrane search, looking for randomised or quasi-randomised controlled trials of CBT including children and adolescents (up to 18 years old) who had experienced being sexually abused, compared with treatment as usual, with or without placebo control. Treatment as usual was almost always supportive, unstructured psychotherapy.
The primary outcomes of interest were depression, post-traumatic stress disorder, anxiety and child behaviour problems.
They found 10 trials (including a total of 847 participants) to include in the review, but were disappointed by the quality of the studies. Trial reporting was generally poor and all studies were judged ‘high risk of bias’ in relation to the blinding of outcome assessors or personnel.
Here’s what they found:
- CBT may have a positive impact on the conditions caused by child sexual abuse, but the results were not statistically significant
- The strongest results were found for CBT as a treatment for post-traumatic stress disorder and anxiety, but the treatment effects were regarded as ‘moderate’ at best
The reviewers concluded:
The conclusions of this updated review remain the same as those when it was first published. The review confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the evidence base and the need for more carefully conducted and better reported trials.
Macdonald G, Higgins JPT, Ramchandani P, Valentine JC, Bronger LP, Klein P, O’Daniel R, Pickering M, Rademaker B, Richardson G, Taylor M. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001930. DOI: 10.1002/14651858.CD001930.pub3.