Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review

• Published in: Trauma, Violence, & Abuse Violence, & Abuse, 2024-10, Vol.25 (4), p.2672-2688
• Main Authors: Protić, Sonja, Wittmann, Lutz, Taubner, Svenja, Conejo-Cerón, Sonia, Ioannou, Yianna, Heinonen, Erkki, Saliba, Andrea, Moreno-Peral, Patricia, Volkert, Jana, Barkauskiene, Rasa, Julia Schmidt, Stefanie, Rangel Santos Henriques, Margarida Isabel, Pinheiro Mota, Catarina, Sales, Célia M.D., Røssberg, Jan Ivar, Adler, Asta, Giacomo, Dina Di, Mucha Vieira, Filipa, Drndarević, Nikola, Ulberg, Randi, Stepisnik Perdih, Tjasa, Mestre, Jose M.
• Format: Article
• Language: English
• Subjects: Adolescents; Age; Cognition; Emotional behavior; Gender; Mediators; Mental health; Psychotherapy; Systematic review; Teenagers; Trauma; Youth
• ISSN: 1524-8380; 1552-8324; 1552-8324
• DOI: 10.1177/15248380231223264

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10–19 years) and transition age youth (TAY) (20–29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients’ age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.