Reducing Psychological Harm from Traumatic Events Among Children and Adolescents: Art Therapy, Pharmacological Therapy, Play Therapy, Psychodynamic Therapy, and Psychological Debriefing

The Community Guide conducted systematic reviews of five interventions commonly used to reduce psychological harm from traumatic events among children and adolescents: play therapy, art therapy, psychological debriefing, psychodynamic therapy, pharmacological therapies.

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 & Findings

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of the following interventions to treat symptomatic youth who have been exposed to traumatic events:

• Art therapy (based on too few studies)
  • Task Force Finding
• Pharmacological therapy (based on too few studies, with short-term outcomes)
  • Task Force Finding
• Play therapy (there was substantial variability in the interventions evaluated and among outcomes assessed)
  • Task Force Finding
• Psychodynamic therapy (based on too few studies)
  • Task Force Finding
• Psychological debriefing (effects were not significant and showed potential for harm)
  • Task Force Finding

About the Interventions

• Play therapy connects concrete experience and abstract thought while allowing the child to safely express experiences, thoughts, feelings, and desires that might be more threatening if addressed directly.
• Proponents of art therapy argue that trauma is stored in the memory as an image; therefore, expressive art techniques are an effective method for processing and resolving traumatic issues. 
• Psychological debriefing, also known as critical incident stress management, is a group meeting offered 24–72 hours after a traumatic event, prior to the assessment of symptoms, for the purpose of integrating profound personal experiences on both cognitive and emotional levels—intended to prevent the development of adverse reactions.
• Psychodynamic therapy seeks to allow the traumatized individual to release unconscious thoughts and emotions and to integrate the traumatic event into his/her understanding of life and self-concept.
• Pharmacological therapies for symptomatic youth are administered on the assumption that exposure to trauma causes neurochemical disruptions in mechanisms controlling arousal, fear, memory, and other aspects of emotional processing, and that medications can correct these disruptions. 

Results from the Systematic Reviews

• In three qualifying studies of play therapy, researchers found substantial heterogeneity in the interventions and outcomes examined.
• Available studies provide insufficient evidence to determine the effectiveness of art therapy, psychodynamic therapy, pharmacological therapy, and psychological debriefing in reducing psychological harm in symptomatic children and adolescents who have been exposed to trauma.
• Harms reported in some reviews of psychological debriefing among adults indicate a need for caution in research and application of this intervention to children and adolescents.

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

• Analytic framework [PDF - 267KB]
• Research gaps
• Summary evidence table [PDF - 132KB]
• Included studies
• Search strategy

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. [PDF - 605KB] 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. [PDF - 58KB] Am J Prev Med 2008;35(3):314-6.

More Community Guide publications about Violence Prevention Focused on Children and Youth

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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 among children and adolescents from traumatic events: art therapy, pharmacological therapy, play therapy, psychodynamic therapy, and psychological debriefing. www.thecommunityguide.org/violence/traumaticevents/othertherapy.html. Last updated: MM/DD/YYYY.

Review completed: June 2006