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Violence Prevention: Group Cognitive-Behavioral Therapy to Reduce Psychological Harm for Traumatic Events Among Children and Adolescents


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 10 studies (search period through March 2007). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to violence prevention.

Summary of Results

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.

Summary of Economic Evidence

  • An economic review of this intervention did not find any 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 a traumatic exposure), found CBT had the potential to be cost effective based on commonly used threshold values (Haby et al. 2004; Lynch et al. 2005).


Findings of this review are 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 had severe mental health problems, the applicability to this subgroup is unknown.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps from these reviews on reducing psychological harms from traumatic events: Individual CBT; Group CBT; Play Therapy; Art Therapy; Psychodynamic Therapy; Pharmacological Therapy; Psychological Debriefing.

  • 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.

Study Characteristics

  • The studies reviewed assessed the effects of group CBT on traumatized children and adolescents of varying ages, geographic locations, and traumatic exposures.
  • Index trauma varied and included community violence and war, volcanic eruptions, sexual abuse, suicide of a family member, and juvenile cancer and treatment.
  • Most children in these studies were exposed to multiple traumas.
  • The number of group CBT sessions generally ranges from 8 to 12.
  • Some studies excluded children who were too disruptive (per mental health clinician) or had severe mental health problems (e.g., psychotic disorders, severe developmental delays, or behaviors that were dangerous to themselves or others).