Systematic review shows cognitive-behavioural interventions for sexual abuse not conclusively effective

Date Published: 
12/27/2007
Source: 

Macdonald, G.M., Higgins, J.P.T., & Ramchandani, P. (2006). Cognitivebehavioural interventions for children who have been sexually abused. Campbell Collaboration Systematic Review. Retrieved online at www.campbellcollaboration.org.

Reviewed by: 
Delphine Collin-Vézina
Summary: 

This systematic review assessed the efficacy of cognitive-behavioural therapeutic approaches in treating the sequelae of sexual abuse in youth under age 18. Studies were included in the analysis if a) the participants were children or adolescents up to 18 who had experienced sexual abuse; b) behavioural or cognitive-behavioural intervention techniques were used; c) outcomes were assessed using valid psychometric instruments related to child psychological functioning, child behaviour problems, future offending behaviours, and/or parental skills and knowledge; and d) the participants were randomly or quasi-randomly assigned to the experimental or control groups, with control group participants being given an existing treatment or no treatment. Interventions may or may not have included parents.

Two independent reviewers selected ten studies through this rigorous method of creening. Overall, a total of 847 children participated. There were no language restrictions. All but one of the studies were conducted in United States.

Meta-analyses showed that although cognitive-behavioural therapeutic approaches had a positive effect on diminishing some sequelae of child sexual abuse, such as depression, anxiety, and post-traumatic stress disorder, most of the results were not statistically significant at the 95% confidence level. For some domains, such as the child sexualized behavior problems, the conclusions drawn by studies were conflicting. The reviewers highlighted the need for more carefully conducted research. For instance, a few studies were conducted using only 10 to 20 participants assigned in each group, which limited their statistical power.

The reviewers also advocated for more rigour in the analysis and reporting processes of trials. For example, some researchers did not clarify the cut-off points they chose to assess clinical levels of symptoms experienced by participants.

In summary, this systematic review does not support cognitive-behavioural approaches as being the treatment of choice for reducing the sequelae of sexual abuse, even though some positive effects have been shown that merit further attention.

Methodological notes: 

This Campbell/Cochrane Systematic Review followed a prescribed and transparent method of retrieving, appraising and synthesizing empirical studies relevant to the research question. This study was vetted by both experts in the field of practice and by experts specializing in data synthesis methodologies. Systematic reviews of existing literature are increasingly being used to harness existing research evidence while addressing many of the biases inherent in narrative reviews.

Systematic reviews differ from narrative reviews because they are more rigorous in information retrieval strategies; they follow an explicit and transparent criteria for appraising the quality of existing research evidence; they attempt to identify and control for different types of bias in existing studies; and they have explicit ways of establishing the comparability (or incomparability) of different studies. These steps increase the scientific merit of combining studies to establish a cumulative effect of what the existing evidence is telling us about the research question. In reviewing systematic reviews, it is important to consider both the overall effects and the effects based on sub-analyses, as systematic reviews can provide rich details about the complexity of trying to apply this new knowledge to a practice and/or policy context.