Dismantling Psychological Interventions for Youth with Complex Trauma: A Systematic Review and Component Network Meta-Analysis
In brief
Exposure was the only therapy component linked to lower youth PTSD symptoms
A review of 48 studies involving 6,017 young people found that several trauma-focused treatments reduced PTSD symptoms, but exposure was the only individual component with a significant effect. The analysis also identified combinations involving affective skills and, for depression, parental involvement; whether these combinations work as well in routine care remains unknown.
- Journal
- Psychotherapy and psychosomatics (Q1)
- Published
- 10 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yu Li, Junkai Feng, Wanyan Hu, Zhuo Zeng, Qian Pan, Jun Wang, et al.
- PMID
- 42858309
- DOI
- 10.1159/pps/aemag009
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 12 October 2026): Component NMA of trauma therapies for youth
Abstract
INTRODUCTION: Complex trauma-related posttraumatic stress disorder (PTSD) and comorbidities pose a significant mental health burden in children. However, the comparative effectiveness of psychological interventions and shared therapeutic components remains unclear. METHODS: We conducted a systematic review, network, and component network meta-analysis of randomized controlled trials of psychological interventions for children and adolescents with complex trauma. PubMed, Embase, Web of Science, PsycINFO, and Cochrane Library were searched up to September 2024. PTSD was the primary outcome; retention and comorbid symptoms (depression, anxiety, dissociation, externalizing problems) were secondary outcomes. RESULTS: Forty-eight studies (6,017 participants) were included in this review. Multimodal group interventions (SMD -1.68, 95% confidence interval [CI] -3.04 to -0.32), phase-based trauma-focused cognitive behavioral therapy (TF-CBT) with parental involvement (-1.12, -1.53 to -0.70), TF-CBT (-1.06, -1.59 to -0.52), non-TF-CBT with parental involvement (-0.93, -1.70 to -0.17), eye movement desensitization and reprocessing (-0.85, -1.60 to -0.10), and phase-based TF-CBT (-0.79, -1.20 to -0.39) significantly reduced PTSD. Exposure emerged as the only significantly effective component for PTSD (-0.85, 95% credible interval [CrI] -1.60 to -0.06). Efficient component combinations included affective modulation with a therapeutic foundation of psychoeducation and nonspecific elements for PTSD (-0.97, 95% CrI -1.92 to -0.01) and exposure plus parental involvement with the same foundation for depression (-2.11, 95% CrI -4.06 to -0.20). CONCLUSION: Trauma-focused approaches were the most effective treatments for pediatric PTSD and emotional comorbidities related to complex trauma. A more cost-effective intervention approach may prioritize exposure techniques, incorporate affective modulation, and include parental involvement when feasible.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.