CDC COMMUNITY GUIDE: Reducing Psychological Harm from Traumatic Events: Cognitive-Behavioral Therapy for Children and Adolescents (Individual & 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.

The Task Force on Community Preventive Services 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.

Results from the Systematic Reviews:

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.