A preview of the efficiency of systemic family therapy in treatment of children with posttraumatic stress disorder developed after car accident

Abstract

Background/Aim. Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. Methods. The sample of this clinical observational study included 7-sixth grade pupiles - 5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed - one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. Results. Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Conclusion. Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.Uvod/Cilj. Traumatski stres obuhvata fizicke i emocionalne reakcije na dogadjaje opasne po zivot koje remete fizicki i psiholoski integritet dece, kao i njihovih roditelja ili staratelja. Saobracajne nezgode predstavljaju glavni uzrok posttraumatskog stresnog poremecaja (posttraumatic stress disorder - PTSD) kod dece. Cilj rada bio je da se prikaze klinicka efikasnost sistemske porodicne terapije (systemic family therapy - SFT) kod dece sa PTSD, traumatizovane u saobracajnoj nezgodi u istovetnim okolnostima. Zeleli smo da naglasimo i znacaj reagovanja porodice na akutnu traumatizaciju dece, kao i znacaj specificnih porodicnih faktora na mogucu retraumatizaciju dece. Metode. Uzorak je sacinjavalo sedam ucenika VI razreda osnovne skole, pet decaka i dve devojcice, uzrasta 13 godina. Svi ucenici bili su ucesnici saobracajne nezgode sa jednim smrtnim ishodom. Formirane su dve grupe: jednu grupu cinilo je troje dece, koja su zajedno sa porodicama bila ukljucena u osam sesija SFT, a drugu grupu cinilo je cetvoro dece koja su lecena antidepresivom sertralinom tokom tri meseca. Rezultati. Dva meseca nakon saobracajne nezgode, pre zapocinjanja terapije, sva deca iz istrazivanja bila su clanovi rigidno umrezenih porodica. Tri meseca nakon primenjene terapije, ocenjivanjem rezultata primenjenih terapijskih pristupa, klinicki, ali i testovno, uoceno je da je stepen adaptibilnosti porodica ukljucenih u SFT bio visi u poredjenju sa porodicama dece ukljucenih u farmakoterapijsko lecenje. Zakljucak. Sistemska porodicna terapija pokazala se efikasnom u lecenju i prevenciji retraumatizacije dece sa PTSD, traumatizovane u saobracajnoj nezgodi. Rizik od retraumatizacije bio je manji ukljucenjem dece i roditelja u SFT nego sto je to bio slucaj sa decom ciji roditelji nisu bili ukljuceni u porodicnu terapiju. Smatramo da promena funkcionisanja porodicnih sistema nije bila slucajna i da je zavisila od primenjene terapije i povecanja nivoa porodicne adaptabilnosti kao moguceg glavnog faktora rizika od retraumatizacije.