Exploring effectiveness of psychotherapy options for sexually abused children and adolescents: A systematic review of randomized controlled trials

Abstract

Childhood sexual abuse (CSA) can have major implications for child mental health on the short-term, but also for developmental outcomes later in life, especially when left untreated. Yet, there is no consensus about best practices in psychotherapy for child and adolescent CSA-victims. In this study, we therefore systematically reviewed existing literature on the effectiveness of different types of psychotherapy, as well as specific treatment components, for improving CSA-victims’ mental-health outcomes. We searched databases (PsycINFO, PubMed, Scopus, Web of Science) for randomized controlled trials (RCTs) examining effectiveness of psychotherapy for child or adolescent victims of CSA. This search yielded 32 RCTs testing effectiveness of cognitive behavioral therapy (with and without adaptation to CSA), trauma-focused cognitive behavioral therapy, group therapy, prolonged-exposure treatment, eye movement desensitization and reprocessing, and play therapy. For each type of psychotherapy, some studies demonstrated evidence for its effectiveness in improving CSA-victims’ mental health, but other studies did not. We also found some evidence that certain therapy approaches might be specifically effective for specific groups of clients, i.e., TF-CBT for highly vulnerable and traumatized clients, group therapy for girls, and briefer approaches for younger children. Regarding treatment components, trauma narration and pharmacotherapy appeared to enhance effectiveness of psychotherapy. A thorough comparison between studies was difficult, because control-groups and measured outcomes differed greatly. Therefore, the field needs more rigorous large-scale RCTs, with long-term follow-up and more uniformity in outcome measures, investigating the effectiveness of specific treatment components, to be able to draw evidence-based conclusions about best practices for CSA-victims.