Violence Prevention: Individual Cognitive-Behavioral Therapy to Reduce Psychological Harm for Traumatic Events Among Children and Adolescents
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends individual cognitive-behavioral therapy (CBT) for symptomatic youth who have been exposed to traumatic events based on strong evidence of effectiveness in reducing psychological harm.
The CPSTF has related findings for group CBT (recommended).
The full CPSTF Finding and Rationale Statement and supporting documents for Violence Prevention: Individual Cognitive-Behavioral Therapy to Reduce Psychological Harm for Traumatic Events Among Children and Adolescents are available in The Community Guide Collection on CDC Stacks.
Intervention
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 and intentional or unintentional. 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.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 11 studies (search period through March 2007).
Study Characteristics
- Number of individual CBT sessions ranged from 2 to 20
- Study populations included children and adolescents of varying ages and geographic locations who developed symptoms following traumatic exposures (e.g., physical abuse, sexual abuse)
- Five studies included parents in some treatment sessions
- Youth were predominantly white or black
- Studies conducted in U.S. (9 studies), Australia (1), and The Netherlands (1)
- Studies excluded children who were too disruptive or seriously suicidal
Summary of Results
Eleven studies qualified for the review.
- Summary effect measures indicated CBT intervention group had higher reduction in rate of psychological harm than comparison group
- Summary effects for PTSD and anxiety were statistically significant; those for internalizing behavior, externalizing behavior, and depression were not (primarily due to differences in number of studies reporting each outcome)
- Studies assessed effects on traumatized children and adolescents of varying ages, geographic locations, and for varied traumas such as physical abuse and sexual abuse
Summary of Economic Evidence
An economic review did not find studies specific to this review.
However, evidence from two studies that evaluated a CBT intervention for children and adolescents with depression (not necessarily related to traumatic exposure), found CBT had potential to be cost effective based on commonly used threshold values.
Applicability
Findings likely applicable to children and adolescents who have developed symptoms following traumatic exposures (e.g., anxiety, PTSD, depression, and externalizing and internalizing symptoms). Because studies excluded children who were too disruptive or seriously suicidal, applicability to this subgroup is unknown.
Evidence Gaps
The following outlines evidence gaps from these reviews on reducing psychological harms from traumatic events: Individual CBT; Group CBT.
- Identification of robust predictors of transient and enduring symptoms following traumatic events would allow for better screening of exposed children and adolescents and more efficient allocation of treatment resources.
- The optimal timing of cognitive behavioral therapy (CBT) intervention following the exposure and the onset of symptoms is important to assess.
- It would be useful to stratify the outcomes of CBT treatment by the severity of patient PTSD symptoms and history. For example, it would be useful to know whether children and adolescents with multiple traumatic exposures require more intensive or longer treatment.
- One study with long term follow-up indicates that it may take a year after the end of the intervention for benefits to appear. This outcome should be replicated. If confirmed, it suggests that follow-up periods of less than one year are not adequate and may erroneously indicate intervention ineffectiveness.
- The cost effectiveness and differential cost effectiveness of individual and group CBT among children and adolescents should be explored.
- The effectiveness of individual and group CBT among minority populations, especially in communities in which violence is prevalent, should be further explored.
- Adaptations of CBT involving the recruitment, training, deployment, and supervision of nonprofessionals should be evaluated, and their applicability to low-income countries should also be explored.
Implementation Considerations and Resources
Benefits of individual CBT reported in literature include decreased shame, improved trust, and enhanced emotional strength and parenting ability of the caretaking parent. Effects of CBT on participating parents may be a mediator of effects on children.
No potential harms of individual CBT were noted.
Standardized individual CBT requires relatively intensive efforts by providers. Specific training is necessary for those delivering this type of therapy.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.