PTSD therapy side effects remain rare among children and adolescents, analysis finds

Psychological interventions are effective in treating post-traumatic stress disorder (PTSD) in children and adolescents. But can they also have unwanted side effects? To answer this question, an international research team led by Dr. Thole H. Hoppen and professor Nexhmedin Morina from the Institute of Psychology at the University of Münster conducted the first meta-analysis of its kind, which has been published in the Journal of Child Psychology and Psychiatry.

The researchers came to a clear conclusion: unwanted side effects of psychotherapy, specifically in the treatment of PTSD in children and adolescents, are rare. “By analyzing numerous studies, we were able to show that most children and adolescents did not discontinue therapy prematurely, and they were not exposed to an increased risk of side effects,” explains Hoppen, the study’s lead author.

Less than 0.01% of children and adolescents with PTSD reported symptom deterioration after the end of treatment. The occurrence of adverse events during psychological treatments was also very rare (0.29% of patients).

In collaboration with working groups from the University of Freiburg and the British universities King’s College London and the University of East Anglia in Norwich, the researchers evaluated 71 studies that dealt with possible risks of psychotherapeutic treatment. This approach was new.

While there is always information on possible risks and side effects of medications such as psychotropic drugs, potential adverse effects of psychotherapy have long been neglected in research. “Although the effectiveness of psychological treatments for PTSD is well established, their safety profile remains understudied,” reports Morina, the study’s senior author.

Despite growing research attention, no meta-analysis had systematically summarized the available studies. By conducting a broad search of health databases, the researchers were able to draw on published data from more than 5,600 children and adolescents.

They investigated potential negative side effects of psychotherapeutic treatment. These included discontinuing treatment, significant deterioration of the disorder after the end of treatment, and other unwanted consequences such as increased suicidal tendencies during the treatment phase or worsening of a comorbid (i.e., simultaneously experienced) condition such as depression.

“The rates of unwanted side effects are negligible and not significantly more frequent than in control groups. The results are encouraging for clinical practice,” Hoppen states. This was especially true for so-called trauma-focused cognitive behavioral therapy, in which traumas (such as sexual violence, serious traffic accidents, war experiences, severe physical violence and injuries after catastrophic natural disasters) are openly discussed.

Trauma-focused methods in particular are often misunderstood as potentially harmful because people affected fear that direct confrontation with traumatic memories could worsen symptoms. As a result, some children and adolescents, as well as their parents, avoided psychotherapeutic treatment.

“This worry constitutes a significant barrier and may, among other things, contribute to the chronicity of the disorder,” Morina points out.

On the one hand, many affected individuals avoided trauma treatment because of such reservations. On the other hand, many less experienced therapists also expressed concerns that confronting traumatic memories might be harmful.

“Our findings should encourage those affected and their relatives to seek—and their therapists to offer—psychotherapeutic treatment, including trauma-focused treatments. Delaying or avoiding treatment for post-traumatic stress disorder can have negative consequences—especially in childhood and adolescence,” Hoppen stresses.

Who’s behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

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Alexander Pol

PhD nano-engineering from Delft University. Published researcher and journal reviewer. Brings scientific insight to content standards.

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