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Accessing Evidence
Charla Davis
Department of Social Work, Wayne State University
SW 7820: Research Methods in Social Work 1
Dr. Brian Moss
March 8, 2021
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1. Formulate a Question to Answer Practice Needs
A. Many adults are suffering from PTSD as a result of childhood sexual abuse (Price,
Hilsenroth, Petretic-Jackson, Bonge; 2001). My professional goal is to pursue interpersonal
practice, particularly with adults who have been deeply affected by this trauma. The trauma
induced PTSD in this group has been shown to be specifically damaging because of its
advanced symptom complexity. It can lead to “long-term, chronic symptoms” such as
“sexual dysfunction, anxiety, depression and suicidal ideation” that are not easily overcome
by ensuing coping behaviors from childhood. (Ehring, Welboren, Morina, Wicherts,
Freitag, Emmelkamp; 2014, Price et al., 2001). In fact, 3 studies within my research found
evidence that 46-71% of patients received by 3 individual psychiatric health centers
reported childhood sexual abuse (Price et al., 2001). As a result of this prevalence, I find
myself interested in knowing whether group interventions or individual interventions are
more effective as I consider my future impact within social work. I have always intended
to work with clients one on one but want to ensure that this method would work most
effectively with this population.
B. In order to find studies that address interventions for adults with PTSD, I constructed an
Evidenced Based Practice question using the PICO framework.
Problem: In adults with PTSD from childhood sexual abuse
Intervention: Is individual psychotherapy
Compared with group psychotherapy
Outcome: more effective at decreasing the severity of PTSD symptoms?
2. Search for the Evidence
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A. In order to find more information, I used the Wayne State Library resources. The key words
I used to search the database were “intervention childhood trauma adults sexual abuse.”
The addition of “sexual abuse” seemed to specify the results in a way that was unhelpful,
so I removed it and the broader search gave me a multidimensional meta-analysis of
Psychotherapy for PTSD. However, this meta-analysis was from 2005 and I wanted to use
one from within the current decade. Furthermore, while it had related articles in the
bibliography, I wanted a meta-analysis that was focused primarily on PTSD due to child
sexual abuse. I amended my search to “meta analysis sexual abuse intervention childhood
ptsd adults” and found the article Meta-analysis of psychological treatments for
posttraumatic stress disorder in adult survivors of childhood abuse within the library
resource (Ehring et al., 2014). This article was published by the Clinical Psychology
Review and evaluated “sixteen randomized control trials” to assess the effectiveness of
various methods. Within the studies cited, they were two articles that specifically centered
on group or individual psychotherapy in terms of their effectiveness: A Review of
Individual Psychotherapy Outcomes for Adult Survivors of Sexual Abuse and Stabilizing
group treatment for Complex Posttraumatic Stress Disorder related to childhood abuse
based on psycho-education and cognitive behavioral therapy.
B. Summarizing Evidence
1. A Review of Individual Psychotherapy Outcomes for Adult Survivors of Sexual Abuse
(Price et al., 2001)
i.
The focus of this review was to evaluate eight literary sources documenting the
effectiveness of individual psychotherapy on adults with PTSD as a result of
sexual abuse in childhood. As such, it assesses the effectiveness of cognitive-
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behavioral, experiential, psychodynamic and psychoeducational approaches to
individual therapy as presented within the literature. One of the 8 studies
examined used a mix approach of both individual and group CBT.
ii.
A systematic review of literature was utilized to assess the effectiveness of
individual psychotherapeutic interventions. The eligibility criteria for the
literature used was as follows:
The investigation had to report quantifiable pre- and postmeasures of
symptomatology; (2) research included studies using clinical samples; (3) the
study had to include outcome data on the effect of individual psychotherapy, as
opposed to group psychotherapy only; and (4) case studies were excluded unless
clear and systematic pretreatment and posttreatment evaluations were
conducted utilizing standardized assessment measures.
The review assessed the studies individually on the sample size, recruitment
method and adequate description of samples, reporting measures, and the fact
that not all of the studies were restricted to survivors of sexual abuse when
determining the overall positivity of the results. It also utilized Cohen’s d to
measure effect sizes.
iii.
The study found that individual psychotherapy can be effective with a weighted
mean of .98 and .80 for specific/interpersonal symptoms and trauma/global
symptoms respectively across all treatment approaches. This improvement was
related to a decreased severity of general PTSD symptoms, proposed particular
symptoms and causalities related to the particular sub group, and overall health
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& functioning. In the studies that measured the long term effects of the treatment,
they found that positive effects persisted over the course of at least 3 months.
iv.
This article relates to my practice question by examining the effectiveness of
various forms of individual psychotherapy on my specified group. Furthermore,
the variety of approaches evaluated allowed for me to compare the weighted
scores to that of the same approaches within group settings. However, I take the
findings here with a grain of salt due to the number of studies meeting the criteria
and specificity of the review as well as the questions brought up within the article
related to these studies’ individual rigor.
2. Stabilizing group treatment for Complex Posttraumatic Stress Disorder related to
childhood abuse based on psycho-education and cognitive behavioral therapy
(Dorrepaal, Thomaes, Smit, van Balkom, Dyck, Veltman, Draijer; 2010)
i.
The focus of this study is to test the effectiveness of Stabilizing Group Treatment
on Complex PTSD in adults who experienced and are still suffering the effects
of child abuse. The intervention is group based and utilizes CBT and
psychoeducation.
ii.
This study is qualitative in design. Fifty-five patients were referred to the study
and of the 36 who met the criteria and began treatment, only 34 were able to
complete it due to scheduling conflicts. The participants were rated by clinicians
pre, post and 6 months after the 20-week period for intervention.
iii.
The study concluded that the participants “improved on all PTSD symptom
clusters” in post with effect sizes above .80 and these improvements were
maintained after 6 months out of the intervention. This was not the case for
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dissociative symptoms. Even more positively, 78% of participants were not
exhibiting enough of the symptom dimensions to meet the criteria for Complex
PTSD.
iv.
This study relates to my EBP question and the preceding article by proving the
effectiveness of group-based psychotherapy on adults with PTSD from child
abuse. While it does not necessarily attribute to the onset of PTSD to child sexual
abuse, it did require that participants had PTSD and were sexually abused before
the age of 16. One of the petitions for future research put forward in Price’s
review was for more emphasis on the “long-term sequelae of child abuse” which
is emphasized in this study as the authors recognize the lack of research on
interventional efficacy for this subgroup (Price et al., 2001; Dorrepaal et al.,
2010). Furthermore, the use of CBT and psychoeducation interventions allows
me to draw a comparison to the finding in both articles. This article is also
helpful in that it prescribes the techniques and topics of study that were utilized
within the study to achieve the results, as well as links to the sources which most
contributed to each week of intervention, allowing more easily for replication in
my own future practice.
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References
Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J., & Emmelkamp, P. M. G.
(2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult
survivors of childhood abuse. Clinical Psychology Review, 34(8), 645–657.
https://doi.org/10.1016/j.cpr.2014.10.004
Dorrepaal, E., Thomaes, K., Smit, J. H., van Balkom, A. J. L. M., van Dyck, R., Veltman, D. J.,
& Draijer, N. (2010). Stabilizing group treatment for Complex posttraumatic stress
disorder related to childhood abuse based ON psycho-education and cognitive
BEHAVIORAL Therapy: A pilot study. Child Abuse & Neglect, 34(4), 284–288.
https://doi.org/10.1016/j.chiabu.2009.07.003
Price, J. L., Hilsenroth, M. J., Petretic-Jackson, P. A., & Bonge, D. (2001). A REVIEW OF
INDIVIDUAL PSYCHOTHERAPY OUTCOMES FOR ADULT SURVIVORS OF
CHILDHOOD SEXUAL ABUSE. Clinical Psychology Review, 21(7), 1095–1121.
https://doi.org/10.1016/s0272-7358(00)00086-6