The comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents. A network meta-analysis with implications for practice in Colombia

Abstract

Sexually abused children and young people are at high risk of a range of adverse consequences, including post-traumatic stress disorder, externalising and internalising problems, and sexualised behaviour. In addressing these, counsellors, therapists and clinicians typically choose from a range of psychotherapeutic approaches, including psychodynamic, cognitive behavioural, systemic, and humanistic therapies.
Systematic reviews, rigorously conducted, are now an established method for assessing whether an intervention is better than no intervention, whether one intervention is better than another, and what the relative effects might be of a range of interventions. The latter approach – known as network meta-analysis - makes use of methodological advances to enable researchers to combine data from direct (head-to-head) comparisons and indirect comparisons in which not all interventions will have been assessed in studies directly assessing one against the other.
Interested on researching what is known globally about the effectiveness of different psychotherapies to address the psychological impairments derived from sexual abuse and to contrast this evidence with practice in Colombia, I conducted a study comprising two components: i) a systematic review with network meta-analysis to assess the relative effectiveness of different psychotherapies to mitigate the psychological consequences of sexual abuse in children and young people; and ii) an electronic survey of Colombian practitioners to explore the psychotherapeutic interventions they use to treat the psychological consequences of sexual abuse, the factors influencing their choice of interventions and the extent to which the results of the global evidence are aligned or not with the Colombian practice.
Although the results of the systematic review were imprecise, small and uncertain, the evidence suggests that, relative to the other psychological interventions explored, child centred therapy (delivered to child and carer) and cognitive behavioural therapy (delivered to the child) might reduce posttraumatic stress disorder symptoms at post‐treatment. The results from the electronic survey suggest that most of the Colombian clinicians who responded the survey identified cognitive behavioural therapy as the therapy that most endorsed as empirically supported and the therapy they were most likely to use to treat abused children. It was also a therapy that most had received training in, and which most would like further training in. Neither the age, years of experience, practice setting, level of education, or theoretical orientation of the clinicians, or their attitudes towards the use of evidence-based practice, were associated with the treatments they used with sexually abused children.
The findings point towards a need to expand and improve the quality of research on what works in treating the psychological consequences of child sexual abuse, particularly outside of North America, where most studies have been conducted to date. They also suggest that there is benefit in exploring other variables or factors that influence the clinicians’ decisions on treatment and, in a country where 85% of the cases of sexual abuse are against children and adolescents aged 0 to 18 years old, mobilizing Colombian decision makers, practitioners, and trainers to put research evidence at the centre of their agendas the treatment of the psychological consequences of child sexual abuse.

Date of Award	23 Jan 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Geraldine M Macdonald (Supervisor) & William Turner (Supervisor)