Child Characteristics, Neuromarkers, and Intervention Components Impacting Treatment Outcome: CCT, TF-CBT, TAU
Child Characteristics, Neuromarkers, and Intervention Components Impacting Treatment Outcome: A Randomized Controlled Trial of Cue-Centered Treatment (CCT), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), and Treatment as Usual (TAU)
This study is designed to examine three treatment conditions for traumatized youth: Cue-Centered Treatment (CCT), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), and Treatment as Usual (TAU) to determine which treatment works most effectively for which youth. The investigators would like to determine feasibility of training on the treatment interventions. In addition, this study aims to inform development of systems of care for chronically traumatized youth.
The investigators hope to determine whether 1) TF-CBT and CCT will have better outcomes than TAU, 2) Child characteristics predict better outcome in either TF-CBT or CCT and to identify which phases of treatment are most effective, and 3) Imaging findings will be predictors of improved outcome. This research is important because while there are many existing trauma interventions for youth, little is known about what is most essential in those interventions. This study will shed light on what components of treatment are most effective. Furthermore, there are minimal guidelines on how to select the most appropriate intervention for a particular child. This study will contribute to that knowledge by informing which interventions are suited best for which youth.
Study Overview
Status
Conditions
Detailed Description
The children will be referred from Stanford Youth Solutions and University of California, San Francisco. Caregivers will undergo a telephone screening according to the inclusion and exclusion criteria. Written consent for participation will be obtained from participants, parents and/or legal guardians. Participants will be randomly assigned to one of three treatment conditions: TF-CBT, CCT, or TAU. Assessments will be administered at 4 time points: 1) pre-treatment, 2) mid-therapy, 3) post-treatment, and 4) three month follow-up. A medical/developmental history form will be completed only pre-treatment. The UCLA PTSD Reaction Index (PTSD-RI) parent and child versions will be used to assess exposure to traumatic events and post-traumatic stress symptoms. Given that trauma has high comorbidity with depression and anxiety disorders these symptoms will be assessed using the Multidimensional Anxiety Scale for Children (MASC) and Children's Depression Inventory (CDI). Executive functioning will be assessed by both child and parent report using the Behavioral Rating Inventory of Executive Function (BRIEF).
In addition, functional near-infrared spectroscopy (fNIRs) will be conducted at each of these time points to assess tasks of working memory, response inhibition, and facial recognition. The investigators will be using the NIRScout which is a portable NIRS recording unit. NIRS technology uses specific wavelengths of light, introduced at the scalp, to enable the noninvasive measurement of changes in the relative ratios of deoxygenated hemoglobin (deoxy-Hb) and oxygenated hemoglobin (oxy-Hb) in the capillary beds during brain activity.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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Sacramento, California, United States, 95826
- Stanford Youth Solutions
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San Francisco, California, United States, 94110
- University of California, San Francisco
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Exposure to at least one traumatic event and endorsement of any trauma symptoms on the UCLA PTSD Reaction Index for DSM-V
- Ages 7-18
- Willingness to participate in therapy and fNIRs imaging
- Caregiver willing to participate in the study
- Perpetrator of the traumatic event is not living in the home with the child
Exclusion Criteria:
- Low cognitive functioning (IQ less than 70)
- Substance dependence as defined by DSM criteria
- Autism/Schizophrenia
- Clinically significant medical illness
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Cue-Centered Therapy (CCT)
Cue-Centered Therapy provides 15 sessions of treatment.
Focuses on developing skills in recognizing stress cues and coping skills.
Taught to self-soothe without the active involvement of a guardian.
Teaches emotional, cognitive, and physiological conditioning to deal with ongoing traumatic stress.
Will have a fNIR (NIRScout) scan at 4 time points throughout study (baseline, midpoint, end of treatment, and 3 month post-treatment)
|
Identify stress reactions and develop coping skills to deal with them independently.
Helps address ongoing traumatic stressors.
The device is a portable Functional Near-Infrared Spectroscopy (fNIRS) recording unit.
NIRS technology uses specific wavelengths of light, introduced at the scalp to enable the non-invasive measurement of changes in the relative ratios of deoxygenated hemoglobin (deoxy-Hb) and oxygenated hemoglobin (oxy-Hb) in the capillary beds during brain activity.
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|
Experimental: Trauma-Focused CBT (TF-CBT)
Trauma-Focused CBT provides 15 sessions of treatment.
Focuses on reframing subconscious thought and emotions with emotional and cognitive conditioning.
Uses the active involvement and support of guardians.
Addresses discrete traumatic incidents in the past.
Will have a fNIR (NIRScout) scan at 4 time points throughout study (baseline, midpoint, end of treatment, and 3 month post-treatment)
|
The device is a portable Functional Near-Infrared Spectroscopy (fNIRS) recording unit.
NIRS technology uses specific wavelengths of light, introduced at the scalp to enable the non-invasive measurement of changes in the relative ratios of deoxygenated hemoglobin (deoxy-Hb) and oxygenated hemoglobin (oxy-Hb) in the capillary beds during brain activity.
Identifies negative cognitive/emotional patterns and helps re-frame them.
Uses active support from guardians and focuses on emotional and cognitive conditioning.
Focuses on discrete past incidents.
|
|
Experimental: Treatment as Usual (TAU)
TAU is the current Standard treatment at Stanford Youth Solutions will serve as the control.
The treatment is known as flexible integrated services.
Will have a fNIR (NIRScout) scan at 4 time points throughout study (baseline, midpoint, end of treatment, and 3 month post-treatment)
|
The device is a portable Functional Near-Infrared Spectroscopy (fNIRS) recording unit.
NIRS technology uses specific wavelengths of light, introduced at the scalp to enable the non-invasive measurement of changes in the relative ratios of deoxygenated hemoglobin (deoxy-Hb) and oxygenated hemoglobin (oxy-Hb) in the capillary beds during brain activity.
The control group.
The standard treatment utilized at Stanford Youth Solutions
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change From Baseline in UCLA Posttraumatic Stress Disorder (PTSD) Reaction Index for DSM 5 (Child Self-report)
Time Frame: Baseline and month 3 (end of treatment)
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The UCLA PTSD Reaction Index for DSM 5 is a 31 item self-report measure with child and caregiver versions.
The total severity score ranging from 0-80 is obtained by summing the four symptom category sub-scales (criteria B, C, D, & E).
A higher score corresponds to greater PTSD severity.
The items map onto the DSM 5 criteria for PTSD as well as assessing for dissociative subtype.
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Baseline and month 3 (end of treatment)
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Change From Baseline in UCLA Posttraumatic Stress Disorder (PTSD) Reaction Index for DSM 5 (Parent Report)
Time Frame: Baseline and month 3 (end of treatment)
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The UCLA PTSD Reaction Index for DSM 5 is a 31 item self-report measure with child and caregiver versions.
Scores range from 0 to 80 (higher score indicates more sever PTSD symptoms).
The items map onto the DSM-V criteria for PTSD as well as assessing for dissociative subtype.
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Baseline and month 3 (end of treatment)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change From Baseline in Children's Depression Inventory (CDI 2)
Time Frame: Baseline and month 3 (end of treatment)
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The CDI 2 is a 28 item self-report measure that assesses depressive symptoms in the past two weeks.
Each item is scored from 0-2 and all items are summed to obtain the total score (total score range: 0-54; a score of 19 or higher is suggestive of clinical depression).
The survey contains questions related to negative mood, negative self-esteem, interpersonal problems, anhedonia, and ineffectiveness.
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Baseline and month 3 (end of treatment)
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Change From Baseline in Multidimensional Anxiety Scale for Children (MASC 2)
Time Frame: Baseline and month 3 (end of treatment)
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The MASC 2 is a 50 item self-report measure assessing anxiety in the following sub-scales: separation anxiety/phobias, social anxiety, generalized anxiety, OCD, physical symptoms and harm avoidance.
The total raw score is obtained by summing all the sub-scales.
Total raw scores range from 0-150 with higher scores indicative of more severe anxiety.
The raw score gets converted into a T-score interpreted as such: 45-55 average, 56-60 slightly above average, 61-65 above average, 66-70 much above average, and score of 70 or above is considered to be indicative of clinical anxiety.
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Baseline and month 3 (end of treatment)
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Change From Baseline in the Behavior Rating Inventory of Executive Function (BRIEF) (Parent Report)
Time Frame: Baseline to month 3 (end of treatment)
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The BRIEF is an 86 item measure that assesses impairment in executive function with symptoms rated on a likert scale of 1 "never", 2 "sometimes" or 3 "often".
There are 8 clinical sub-scales (Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor) and two validity scales (Inconsistency and Negativity).
A Global Executive Composite score is obtained by summing all 8 clinical sub-scales.
The Global Executive Composite ranges from 0-258 with higher scores indicating greater impairment in executive functions.
The Global Executive Composite gets converted to a T-score with T-scores of 65 or above considered in the clinical range.
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Baseline to month 3 (end of treatment)
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Victor G Carrion, M.D., Stanford University
- Study Director: Hilit Kletter, PhD, Stanford University
- Study Director: Flint Espil, PhD, Stanford Univeristy
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 36092
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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