Task Force Finds Cognitive Behavioral Therapy Effective for Children and Adolescents Exposed to Trauma

Evaluation Focuses on Behavioral and Psychological Interventions

October 29, 2008 • Science Update

Individual and group cognitive behavioral therapy (CBT) were the only interventions found effective in an evaluation of seven commonly-used approaches to reduce the psychological harm to youth who experience trauma.

Evidence for the five other interventions evaluated—play therapy, art therapy, psychodynamic therapy, pharmacologic therapy, and psychological debriefing—was found insufficient to judge effectiveness. The evaluation is one of a series of reviews of community health interventions carried out by the Task Force on Community Preventive Services, an independent, nonfederal group convened by the U.S. Department of Health and Human Services. Task Force recommendations based on the reviews are incorporated in the Guide to Community Preventive Services , which summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease.

The number of children and adolescents in the U.S. exposed to trauma each year is substantial. National survey data from 2002 to 2003 on children ages 12 to 17 indicate that one in eight children experienced a form of child maltreatment, such as abuse or neglect; one in 12 experienced sexual victimization; and one in three witnessed or indirectly experienced violence or victimization, including rioting, assault, and theft. The psychological harm that can result from exposure of children to trauma includes post-traumatic stress disorder, anxiety, depression and thoughts of suicide, risk-taking and aggressive behavior, and substance abuse.

The Task Force evaluated seven interventions commonly used in medical and mental health responses for children in the wake of public health disasters or trauma. Six of the interventions are used in children with psychological symptoms: individual and group cognitive-behavioral therapy, play therapy, art therapy, psychodynamic therapy, and pharmacologic therapy. The seventh, psychological debriefing, is typically used before screening for symptoms.

The review concluded that, for both individual and group CBT, there was strong evidence, demonstrated in published studies, that the use of these interventions in children exposed to trauma reduced overall psychological harm. With the five other interventions, there were too few studies of each that met the standard set for Community Guide reviews. Assessment of studies was based on such features as prospective vs. retrospective data collection, whether there was a control group, and the degree of follow-up. Eleven studies of individual CBT and ten studies of group CBT met criteria for use in the review, in contrast to one or two studies for each of the remaining interventions.

Subject matter experts on the team conducting the evaluation included current and former NIMH scientists Eve Mościcki, Sc.D., M.P.H., LeShawndra Price, Ph.D., and Farris Tuma, Sc.D. The review authors point out that health practitioners are using interventions lacking evidence of effectiveness, and failing to use interventions whose effectiveness has been demonstrated. Based on this review, the Task Force recommends the use of individual and group CBT to prevent psychological harm in children and adolescents with symptoms as a result of exposure to trauma.

References
Task Force on Community Preventive Services. Recommendations to reduce psychological harm from traumatic events among children and adolescents. American Journal of Preventive Medicine. 2008 Sep;35(3):314-316.
Wethington, H.R. et al. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. American Journal of Preventive Medicine. 2008 Sep;35(3):287-313.

About The Community Guide

The Guide to Community Preventive Services  serves to filter scientific literature that can often be inconsistent, uneven in quality, and inaccessible. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in the rigorous and systematic scientific reviews of published studies conducted by the review teams of the Community Guide.

About the Interventions Reviewed

• Cognitive Behavioral Therapy CBT includes strategies such as revisiting the traumatic event by discussion or imagery, stress management or relaxation techniques, and rethinking counterproductive trauma-related thoughts and associations.
• Play Therapy Play in various forms is used to allow a child to express thoughts and experiences and gain understanding in a non-threatening way.
• Art Therapy Artistic self expression is used as an avenue for processing and resolving traumatic memories.
• Psychodynamic TherapyPsychodynamic therapy is a form of individual psychotherapy that may last for many months; it is aimed at helping a person release unconscious thoughts and understand the impact of past experience, like trauma, on his or her current life.
• Pharmacologic Therapy Medications are used in an effort to relieve symptoms following exposure to trauma.
• Psychological Debriefing Psychological debriefing takes place within one to three days of trauma exposure, before any screening for symptoms. The goal is to aid recovery by providing those exposed to trauma with the opportunity to discuss and process the event with others who have shared it.