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Reducing Psychological Harm from Traumatic Events Among Children and Adolescents: Cognitive-Behavioral Therapy (Individual and Group)

Cognitive-behavioral therapy (CBT) is used to reduce psychological harm among children and adolescents who have psychological symptoms resulting from exposure to traumatic events. Therapists administer CBT individually or in a group, and treatment may be accompanied by therapy sessions for or with parents.

A traumatic event is one in which a person experiences or witnesses actual or threatened death or serious injury, or a threat to the physical integrity of self or others. Trauma may take the form of single or repeated events that are natural or human-made (e.g., tsunami or bombing) and intentional or unintentional (e.g., rape versus car crashes or severe illness). Traumatic exposures may have only temporary effects or result in no apparent harm. However, traumatic exposures may result in psychological harm and lead to long term health consequences.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends individual cognitive-behavioral therapy (CBT) and group CBT for symptomatic youth who have been exposed to traumatic events based on strong evidence of effectiveness in reducing psychological harm.

About the Intervention

  • CBT is often administered by doctoral-level professionals or other clinicians with graduate degrees, such as social workers.
  • CBT for traumatized children combines the following:
    • Exposure techniques such as review of the past traumatic event
    • Learning of stress management/relaxation techniques
    • Correction of inaccurately remembered events
    • Reframing counterproductive perceptions of the trauma

Individual CBT

  • The number of individual CBT sessions ranged from 2 to 20.
  • The most common traumatic exposures were sexual abuse and physical abuse.

Group CBT

  • The number of group CBT sessions generally ranges from 8 to 12.

Results from the Systematic Review

Individual CBT

Eleven studies qualified for the systematic review.

  • The summary effect measures indicated that the CBT intervention group had a higher reduction in the rate of psychological harm than the comparison group.
  • Although summary effects were of similar magnitude for all of the outcomes assessed, those for PTSD and anxiety were statistically significant, whereas those for internalizing behavior, externalizing behavior, and depression were not (primarily due to differences in the number of studies reporting each outcome).
  • The reviewed studies assessed the effects of individual CBT on traumatized children and adolescents of varying ages, geographic locations, and for varied traumas, such as physical abuse and sexual abuse. Studies excluded children who were too disruptive or seriously suicidal.

Group CBT

Ten studies qualified for the systematic review.

  • Summary-effect measures for the ten studies were in the desired direction for all outcomes assessed—anxiety, depression, and PTSD.
  • Most children in these studies were exposed to multiple traumas, and group CBT effectively reduced psychological harm among these children.
  • Because of the small number of studies, it was difficult to determine whether the effectiveness of group CBT varied by principal trauma.
  • The reviewed studies assessed the effects of group CBT on traumatized children and adolescents of varying ages, geographic locations, and traumatic exposures, including sexual abuse, witnessing community violence, natural disasters, and bereavement for loss of a close family member. Some studies excluded children who were too disruptive or had severe mental health problems.

These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to the treatment of children and adolescents following a traumatic event.

Supporting Materials

Publications

W Wethington H, Hahn R, Fuqua-Whitley D et al. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Adobe PDF File [PDF - 605 kB] Am J Prev Med 2008;35(3):287-313.

Task Force on Community Preventive Services. Recommendations to reduce psychological harm from traumatic events among children and adolescents. Adobe PDF File [PDF - 58 kB] Am J Prev Med 2008;35(3):314-6.

Read other Community Guide publications about Violence Prevention in our library.

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Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing psychological harm from traumatic events: cognitive-behavioral therapy for children and adolescents (individual & group). www.thecommunityguide.org/violence/traumaticevents/behaviortherapy.html. Last updated: MM/DD/YYYY.

Review completed: June 2006