A Holistic Approach to Childhood Trauma: Assessing the Role of Adlerian Therapy in Post-Hospitalisation Recovery
Abstract
Background/Aim: The psychological well-being of children recovering from gastrointestinal illnesses, such as diarrhoea, is of paramount importance, particularly regarding trauma experienced during hospitalisation. This study addresses a significant gap in the literature by evaluating the efficacy of Adlerian therapy in mitigating post-hospitalisation psychological trauma among preschool children compared to play therapy.
Methods: A quasi-experimental design with a control group was employed, involving 60 children aged 6-10 years hospitalised for severe diarrhoea. Participants were equally divided into intervention (Adlerian therapy) and control (play therapy) groups, receiving therapy over four weeks. Each session, lasting 90 to 120 minutes, focused on establishing a therapeutic alliance and addressing individual emotional dynamics utilising interactive methods, such as hand puppets and storybooks. Trauma levels were assessed using the Child and Adolescent Trauma Screen (CATS) at multiple time points.
Results: Initial analyses revealed no significant differences in CATS scores between the groups (p = 0.452). However, the Adlerian therapy group exhibited a significant reduction in trauma symptoms, with a mean CATS score decline from 22.5 (SD = 5.2) to 15.0 (SD = 4.5), compared to a decrease in the control group from 23.1 (SD = 5.4) to 21.5 (SD = 5.2). The calculated effect size for the intervention group was Cohen's d = 1.47. Further analysis of domain-specific scores from the CATS revealed that the most pronounced improvements were in the areas of re-experiencing (Cohen's d = 1.84), negative alterations in cognition and mood (Cohen's d = 1.89) and arousal and reactivity (Cohen's d = 1.82) every week.
Conclusion: Adlerian therapy effectively alleviated psychological trauma in preschool children following gastrointestinal illness. This approach is recommended for integration into clinical practice, emphasising the importance of tailored psychological interventions to support the mental health of children recovering from hospitalisation.
References
World Health Organization. Diarrhoeal disease. 2024 [Internet]. [Cited: 2-Nov-2024]. Available at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
Debebe S, Kloos H, Assefa A. Diarrheal prevalence and associated risk factors among under-five children attending Robe Didea General Hospital, Arsi Robe Town, Oromia Regional State, Ethiopia: a cross-sectional study. Alexandria J Med. 2024;60(1):65-75. doi: 10.1080/20905068.2024.2327870.
Arifin H, Rakhmawati W, Kurniawati Y, Pradipta RO, Efendi F, Gusmaniarti G, et al. Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey. J Pediatr Nurs. 2022 Sep-Oct;66:e37-e45. doi: 10.1016/j.pedn.2022.06.005.
Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov. 2023;22(5):387-409. doi: 10.1038/s41573-023-00670-0.
GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023 Jul 15;402(10397):203-234. doi: 10.1016/S0140-6736(23)01301-6.
Hasan MJ, Suman M. Early hospitalization reduces the length-of-hospital stay and antibiotic use in children with moderate diarrhea: a study in Bangladesh. J Pediatr Rev 2021;9(1):71-80. doi: 10.32598/jpr.9.1.916.1.
Geoffrion S, Goncalves J, Robichaud I, Sader J, Giguère CÉ, Fortin M, et al. Systematic review and meta-analysis on acute stress disorder: rates following different types of traumatic events. Trauma Violence Abuse. 2022 Jan;23(1):213-223. doi: 10.1177/1524838020933844.
Brewin CR, Field AP. Meta-analysis shows trauma memories in posttraumatic stress disorder lack coherence: a response to Taylor et al. (2022). Clin Psychol Sci. 2024;12(5):1027-33. doi: 10.1177/21677026241240456.
Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022 Jan;27(1):281-95. doi: 10.1038/s41380-021-01161-7.
Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A Systematic review of mental health disorders of children in foster care. Trauma Violence Abuse. 2022;23(1):255-64. doi: 10.1177/1524838020941197.
Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, et al. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry. 2019 Dec;6(12):1039-53. doi: 10.1016/S2215-0366(19)30406-7.
Cedeno R, Torrico TJ. Adlerian Therapy. In: StatPearls. StatPearls Publishing; 2024. [Internet]. [Cited: 2-Nov-2024]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK599518/.
Devlin JM, Birkey J, Smith J. Contemporary Adlerian family counseling. Family J. 2024;32(2):263-8. doi:10.1177/10664807231215431.
Kamsari F, Ghadami M, Keshavarzafshar H, Ahghar G. Comprehensive the effects of Adlerian group counseling and reality therapy grouping on well-being in students of middle school in Tehran city. JPsychol Sci. 2021;20(101):691-700.
McCarty DL, Christian DD. Using an adventure therapy activity to assess the adlerian lifestyle. J Creat Mental Health. 2020;15(3):393-404. doi:10.1080/15401383.2019.1697405.
Schuyler EJ, Rasmussen P. Adlerian family therapy. In: Lebow J, Chambers A, Breunlin DC, eds. Encyclopedia of couple and family therapy. Berlin: Springer International Publishing; 2017:1-5. doi: 10.1007/978-3-319-15877-8_577-1.
Rennick JE, Knox AM, Treherne SC, Dryden-Palmer K, Stremler R, Chambers CT, et al. Family members' perceptions of their psychological responses one year following pediatric intensive care unit (PICU) hospitalization: qualitative findings from the caring intensively study. Front Pediatr. 2021 Sep 7;9:724155. doi: 10.3389/fped.2021.724155.
Daughtrey HR, Ruiz MO, Felix N, Saynina O, Sanders LM, Anand KJS. Incidence of mental health conditions following pediatric hospital admissions: analysis of a national database. Front Pediatr. 2024;12:1344870. doi:10.3389/fped.2024.1344870.
Parotto M, Gyöngyösi M, Howe K, Myatra SN, Ranzani O, Shankar-Hari M, et al. Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations. Lancet Respir Med. 2023 Aug;11(8):739-754. doi: 10.1016/S2213-2600(23)00239-4.
Hale ME, Pinkman K, Quinoy AM, Schoffner KR. Identifying mental health outcomes and evidence-based psychological interventions for supporting pediatric gunshot wound patients: A systematic review and proposed conceptual model. BMC Pediatrics. 2024;24(1):397. doi: 10.1186/s12887-024-04878-w.
Triantafyllidis A, Alexiadis A, Votis K, Tzovaras D. Social robot interventions for child healthcare: A systematic review of the literature. Computer Methods Progr Biomed Update. 2023;3:100108. doi: 10.1016/j.cmpbup.2023.100108.
Delvecchio E, Salcuni S, Lis A, Germani A, Di Riso D. Hospitalized children: anxiety, coping strategies, and pretend play. Front Public Health. 2019;7. doi: 10.3389/fpubh.2019.00250.
Correale C, Borgi M, Collacchi B, Falamesca C, Gentile S, Vigevano F, et al. Improving the emotional distress and the experience of hospitalization in children and adolescent patients through animal assisted interventions: a systematic review. Front Psychol. 2022 Mar 4;13:840107. doi: 10.3389/fpsyg.2022.840107.
Gjærde LK, Hybschmann J, Dybdal D, Topperzer MK, Schrøder MA, Gibson JL, et al. Play interventions for paediatric patients in hospital: a scoping review. BMJ Open. 2021 Jul 26;11(7):e051957. doi: 10.1136/bmjopen-2021-051957.
Espenes K, Tørmoen AJ, Rognstad K, Nilsen KH, Waaler PM, Wentzel-Larsen T, et al. Effect of psychosocial interventions on children and youth emotion regulation: a meta-analysis. Adm Policy Ment Health. 2024 May 8. doi: 10.1007/s10488-024-01373-3.
Trimboli C, Parsons L, Fleay C, Parsons D, Buchanan A. A systematic review and meta-analysis of psychosocial interventions for 6–12-year-old children who have been forcibly displaced. SSM - Mental Health. 2021;1:100028. doi: 10.1016/j.ssmmh.2021.100028.
Tzouvara V, Kupdere P, Wilson K, Matthews L, Simpson A, Foye U. Adverse childhood experiences, mental health, and social functioning: A scoping review of the literature. Child Abuse Neglect. 2023;139:106092. doi: 10.1016/j.chiabu.2023.106092.
Antoniou G, Lambourg E, Steele JD, Colvin LA. The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis. Brit J Anaesth. 2023;130(6):729-46. doi: 10.1016/j.bja.2023.03.008.
Hornor G, Davis C, Sherfield J, Wilkinson K. Trauma-informed care: essential elements for pediatric health care. J Pediatric Health Care. 2019;33(2):214-21. doi: 10.1016/j.pedhc.2018.09.009.
An J, Zhu X, Shi Z, An J. A serial mediating effect of perceived family support on psychological well-being. BMC Public Health. 2024;24(1):940. doi:10.1186/s12889-024-18476-z.
Furlong M, McGuinness C, Mulligan CM, McGarr SL, McGilloway S. Family talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness: a randomised controlled trial and cost analysis. Front Psychiatry. 2024;15. doi: 10.3389/fpsyt.2024.1287378.
Fakhrou AA, Adawi TR, Ghareeb SA, Elsherbiny AM, AlFalasi MM. Role of family in supporting children with mental disorders in Qatar. Heliyon. 2023;9(8):e18914. doi: 10.1016/j.heliyon.2023.e18914.
Satyanarayana VA, Das A, Shah A. Psychotherapy for families with adolescent children: clinical practice guidelines. J Ind Assoc Child Adolesc Mental Health. 2024;20(2):127-35. doi: 10.1177/09731342241237074.
Bailin A, Cho E, Sternberg A, Evans SC, Hollinsaid NL, Bearmanet SK, al. Principle-Guided Psychotherapy for Children and Adolescents (FIRST): study protocol for a randomized controlled effectiveness trial in outpatient clinics. Trials 2023;24: 682. doi: 10.1186/s13063-023-07717-y.
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