Victimización Sexual en la Infancia e Intervención Basada en la Evidencia:

La Terapia Cognitivo-Conductual Focalizada en el Trauma

Palabras clave: intervención basada en la evidencia, terapia cognitivo-conductual, terapia del trauma, victimización sexual infantil, victimología del desarrollo

Resumen

La victimización sexual infantil es un grave problema que afecta a uno de cada cinco niños y niñas de nuestro país y que requiere de una intervención temprana y eficaz, que permita superar las graves consecuencias que sus víctimas manifiestan. La Terapia Cognitivo-Conductual Focalizada en el Trauma (TF-CBT) es el modelo de intervención que reúne una mayor cantidad de evidencia en cuanto a su efectividad. Con un mínimo de 8 y un máximo de 25 sesiones de 50 minutos, en las que se trabaja con la víctima de entre 3 y 18 años y sus cuidadores, se ofrece psicoeducación sobre la experiencia de victimización, se tratan habilidades parentales que pueden haberse visto afectadas por la situación, técnicas de relajación que permitan reducir la hiperactivación del sistema de afrontamiento al estrés, identificación y expresión emocional, el triángulo entre pensamientos, emociones y conductas, la narrativa del trauma y el procesamiento cognitivo de los pensamientos distorsionados, la exposición a situaciones o lugares angustiantes, así como estrategias para mejorar la seguridad en el futuro. Es necesario que los profesionales de nuestro país se puedan formar en este modelo y confirmar sus positivos resultados en el tratamiento de víctimas de abuso sexual infantil en España.

Biografía del autor/a

Bárbara Kanter, Grup de Recerca en Victimització Infantil i Adolescent (GReVIA), Universitat de Barcelona. España

Psicóloga general sanitaria e investigadora del Grupo de Investigación en Victimización Infantil y Adolescente de la Universidad de Barcelona. España

Citas

Achenbach, T. M. y Rescola, L. A. (2001). Manual of the Achenbach system of empirically based assessment school-age forms & profiles. Burlington, VT: Aseba.

American Psychological Association, Presidential Task Force On Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285. https://doi.org/10.1037/0003-066X.61.4.271

Beck, A. T., Steer, R. A. y Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J. y McKenzie Neer, S. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child & Adolescent Psychiatry, 36(4), 545-553. https://doi.org/10.1097/00004583-199704000-00018

Cary, C. E. y McMillen, J. C. (2012). The data behind the dissemination: a systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748-757. https://doi.org/10.1016/j.childyouth.2012.01.003

Cisler, J. M., Sigel, B. A., Kramer, T. L., Smitherman, K., Pemberton, J. y Kilts, C. D. (2015). Amygdala response predict trajectory of symptoms reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD. Journal of Psychiatric Research, 71, 33-40. https://doi.org/10.1016/j.jpsychires.2015.09.011

Cohen, J. A. (2003). Treating acute posttraumatic reactions in children and adolescents. Society of Biological Psychiatry, 53(9), 827-833. https://doi.org/10.1016/S0006-3223(02)01868-1

Cohen, J. A., Berliner, L. y Mannarino, A. P. (2010). Trauma-Focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34(4), 215-224. https://doi.org/10.1016/j.chiabu.2009.12.003

Cohen, J. A., Deblinger, E. y Mannarino, A. P. (2004a). Trauma-Focused Cognitive-Behavioral Therapy for sexually abused children. Psychiatric Times, 21, 1-5.

Cohen, J. A., Deblinger, E., Mannarino, A. P. y Steer, R. A. (2004b). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. American Academy of Child and Adolescent Psychiatry, 43(4), 393-402. https://doi.org/10.1097/00004583-200404000-00005

Cohen, J. A., Mannarino, A. P. y Deblinger, E. (2012). Trauma-Focused CBT for children and adolescents: Treatment applications. Nueva York, NY: The Guilford Press.

Cohen, J. A., Mannarino, A. P. y Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed). Nueva York, NY: The Guilford Press.

Cohen, J. A., Mannarino, A. P., Kliethermes, M. y Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36(6), 528-541. https://doi.org/10.1016/j.chiabu.2012.03.007

Cohen, J. A., Mannarino, A. P. y Knudsen, K. (2005). Treating sexually abused children: 1-year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135-145. https://doi.org/10.1016/j.chiabu.2004.12.005

Cohen, J. A., Mannarino, A. P y Murray, L. K. (2011). Trauma-focused CBT for youth who experience ongoing traumas. Child Abuse & Neglect, 35(8), 637-646. https://doi.org/10.1016/j.chiabu.2011.05.002

Cohen, J. A., Mannarino, A. P., Perel, J. M. y Staron, V. (2007). A pilot randomized controlled trial of combined Trauma-Focused CBT and sertraline for childhood PTSD symptoms. American Academy of Child and Adolescent Psychiatry, 46(7), 811-819. https://doi.org/10.1097/chi.0b013e3180547105

Cuevas, C. A., Finkelhor, D., Clifford, C. y Ormrod, R. K. (2010). Psychological distress as a risk factor for re-victimization in children. Child Abuse & Neglect, 34(4), 235-243. https://doi.org/10.1016/j.chiabu.2009.07.004

Cyr, M., Frappier, J. Y., Hébert, M., Tourigny, M., McDuff, P. y Turcotte, M. E. (2018). Impact of child sexual abuse disclosure on the health of nonoffending parents: A longitudinal perspective. Journal of Child Custody, 15(2), 147-167. https://doi.org/10.1080/15379418.2018.1460649

de Arellano, M. A., Lyman, D. R., Jobe-Shileds, L., George, P., Dougherty, R. H., Daniels, A. S., … Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive behavioral therapy for children and adolescents: Assessing the evidence. Psychiatric Services, 65(5), 591-602. https://doi.org/10.1176/appi.ps.201300255

de Jong, R., Alink, L., Bijleveld, C., Finkenaauer, C. y Hendriks, J. (2015). Transition to adulthood of child sexual abuse victims. Aggression and Violent Behavior, 24, 175-187. https://doi.org/10.1016/j.avb.2015.04.012

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K. y Steer, R. A. (2011). Trauma-Focused Cognitive Behavioral Therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28(1), 67-75. https://doi.org/10.1002/da.20744

Deblinger, E., Mannarino, A. P., Cohen, J. A. y Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal American Academy of Child and Adolescent Psychiatry, 45(12), 1474-1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb

Deblinger, E., Pollio, E., Runyon, M. K. y Steer, R. A. (2017). Improvements in personal resiliency among youth who have completed trauma-focused cognitive behavioral therapy: A preliminary examination. Child Abuse & Neglect, 65, 132-139. https://doi.org/10.1016/j.chiabu.2016.12.014

Fergusson, D. M., McLeod, G. F. H. y Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect, 37(9), 664-674. https://doi.org/10.1016/j.chiabu.2013.03.013

Finkelhor, D. y Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55(4), 1-13. https://doi.org/10.1111/j.1939-0025.1985.tb02703.x

Finkelhor, D., Ormrod, R. K. y Turner, H. A. (2007). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31(1), 7-26. https://doi.org/10.1016/j.chiabu.2006.06.008

Friedrich, W. N., Grambsch, P., Damon, L., Hewitt, S. K., Koverola, C., Lang, R. A., … Broughton, D. (1992). Child Sexual Behavior Inventory: Normative and clinical comparisons. Psychological Assessment, 4(3), 303-331. https://doi.org/10.1037/1040-3590.4.3.303

Godbout, N., Briere, J., Sabourin, S. y Lussier, Y. (2014). Child sexual abuse and subsequent relational and personal functioning: The role of parental support. Child Abuse & Neglect, 38(2), 317-325. https://doi.org/10.1016/j.chiabu.2013.10.001

Griffin, J. L. y Wozniak, J. (2019). Trauma-Focused Cognitive Behavioral Therapy. En V. G. Carrión (Ed.), Assessing and treating youth exposed to traumatic stress (pp. 185-205). Washington, DC: American Psychiatric Association Publishing.

Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., … Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children – present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of American Academy of Child & Adolescent Psychiatry, 36(7), 980-988. https://doi.org/10.1097/00004583-199707000-00021

King, N. J., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., … Ollendick, T. H. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal American Academy of Child and Adolescent Psychiatry, 39(11), 1347-1355. https://doi.org/10.1097/00004583-200011000-00008

Kovacs, M. (1992). Children’s Depression Inventory. Nueva York, NY: Multi-Health System.

Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of reviews. Clinical Psychology Review, 29, 647-657. https://doi.org/10.1016/j.cpr.2009.08.003

Mannarino, A. P., Cohen, J. A. y Berman, S. R. (1994). The Children’s Attributions and Perceptions Scale: A new measure of sexual abuse-related factors. Journal of Clinical Child Psychology, 23(2), 204-211. https://doi.org/10.1207/s15374424jccp2302_9

Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K. y Steer, R. A. (2012). Trauma-Focused Cognitive-Behavioral Therapy for children: Sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17(3), 231-241. https://doi.org/10.1177/1077559512451787

Pereda, N. (2009). Consecuencias psicológicas iniciales del abuso sexual infantil. Papeles del Psicólogo, 30(2), 3-13. Recuperado de: http://www.papelesdelpsicologo.es/pdf/1702.pdf

Pereda, N. (2010). Consecuencias psicológicas a largo plazo del abuso sexual infantil. Papeles del Psicólogo, 31(2), 191-201. Recuperado de: http://www.papelesdelpsicologo.es/pdf/1846.pdf

Pereda, N. (2016). ¿Uno de cada cinco?: victimización sexual infantil en España. Papeles del Psicólogo, 37(2), 3-13. Recuperado de: http://www.papelesdelpsicologo.es/pdf/2697.pdf

Pereda, N., Abad, J., Guilera, G. y Arch, M. (2015). Victimización sexual autorreportada en adolescentes españoles comunitarios y en colectivos de riesgo. Gaceta Sanitaria, 29(5), 328-334. https://doi.org/10.1016/j.gaceta.2015.05.003

Pereda, N. y Sicilia, L. (2017). Reacciones sociales ante la revelación de abuso sexual infantil y malestar psicológico en mujeres víctimas. Psychosocial Intervention, 26(3), 131-138. https://doi.org/10.1016/j.psi.2017.02.002

Sánchez-Meca, J., Rosa-Alcázar, A. I. y López-Soler, C. (2011). The psychological treatment of sexual abuse in children and adolescents: A meta-analysis. International Journal of Clinical and Health Psychology, 11(1), 67-93. Recuperado de: http://www.aepc.es/ijchp/articulos.php?coid=English&id=371

Saywitz, K. J., Mannarino, A. P., Berliner, L. y Cohen, J. A. (2000). Treatment for sexually abused children and adolescents. American Psychologist, 55(9), 1040-1049. https://doi.org/10.1037/0003-066X.55.9.1040

Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H. y Aluwahlia, S. (1983). A Children Global Assessment Scale (CGAS). Archives of General Psychiatry, 40(11), 1228-1231. https://doi.org/10.1001/archpsyc.1983.01790100074010

Spielberger, C. D. y Edwards, C. D. (1973). STAIC preliminary manual for the State-Trait Anxiety Inventory for Children (“How I feel questionnaire”). Palo Alto, CA: Consulting Psychologists Press.

Steine, I. M., Winje, D., Christoffer Skogen, J., Krystal, J. H., Marita Milde, A., Bjorvatn, B., … Pallesen, S. (2017). Posttraumatic symptom profiles among adult survivors of childhood sexual abuse: A longitudinal study. Child Abuse & Neglect, 67, 280-293. https://doi.org/10.1016/j.chiabu.2017.03.002

Vizard, E. (2013). Practitioner Review: The victims and juvenile perpetrators of child sexual abuse-assessment and intervention. Journal of Child Psychology and Psychiatry, 54(5), 503-515. https://doi.org/10.1111/jcpp.12047

Wamser-Nanney, R. (2017). Maternal support following childhood sexual abuse: Links to parent-reported children’s outcomes. Child Abuse & Neglect, 67, 44-53. https://doi.org/10.1016/j.chiabu.2017.02.023

Weiner, D. A., Scheinder, A. y Lyons, J. A. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31(11), 1199-1205. https://doi.org/10.1016/j.childyouth.2009.08.013

Publicado
2020-03-01
Cómo citar
Kanter, B., & Pereda, N. (2020). Victimización Sexual en la Infancia e Intervención Basada en la Evidencia:. Revista De Psicoterapia, 31(115), 197-212. https://doi.org/10.33898/rdp.v31i115.313
Sección
Open Access: Artículos de temática libre