How to effectively cope with children's psychological trauma? The feasibility and effectiveness of cognitive behavioral approach to trauma in the intervention of Chinese children with posttraumatic stress disorders



All kinds of psychological diseases induced by traumatic events are prominent problems faced by children in their growth, which bring a heavy burden to families and society. According to the survey, nearly 100 million (47.06%) children in primary and secondary schools in China have experienced at least one traumatic event. The death of close relatives (42.62%), community violence (31.71%), domestic violence (22.20%) and major diseases (11.75%) account for a high proportion, which are the main inducing factors of psychological diseases. Due to the lack of a mature value system, mode of thinking and psychological model, traumatic experiences may easily cause serious damages to children's minds. Among them, as a typical psychological trauma response, posttraumatic stress disorders (PTSD) affect 23.0% of the children who have experienced natural disasters (such as earthquakes and floods), 11.5% - 20.7% of the children who have experienced major health emergencies (such as COVID-19), and 6.7% - 12.7% of all children. The high prevalence rate, high recurrence rate and high disability rate of psychological trauma have brought a heavy burden to families and society. The prolonged course and high cost of disease treatment further reduce the accessibility of children's health services, posing a great challenge to mental health care. It has become an important part of the prevention and treatment of children's mental diseases in China how to increase the accessibility of children's mental health services and effectively alleviate children's psychological trauma.

In order to alleviate the contradiction between supply and demand in the field of children's psychological trauma in China, the team of the Behavioral Health Research Center of SSDPP has developed a Chinese program of trauma-focused cognitive behavioral therapy (TF-CBT) after repeated explorations and practices, aiming at enabling children to acquire psychological immunity, develop resistance in disasters or adversity, and gain the power of growth. The program includes group service for seven times and case service for two or three times (about 50 minutes per time), which is suitable for professionals such as psychological consultants, school teachers and social workers, as well as non-professional persons to use in multiple scenarios such as schools, communities and institutions.

From 2018 to 2019, the research group carried out a small-scale pilot randomized controlled trial in two primary schools in Henan Province to test the feasibility and effect of TF-CBT among Chinese children. In the trial, 87 children with all or part PTSD were randomly divided into the intervention group and the control group. The TF-CBT provided by the center was used for the intervention group (n=45) in the last two months, while the control group (n=42) received the school’s routine psychological services over the same period, mainly including a series of psychological education and psychological counseling services provided by the psychological teachers. By comparing the mental health status of the two groups of children at baseline, after treatment, and three months after treatment, we found that the TF-CBT group intervention program can be successfully implemented in the schools of China and can effectively alleviate children's psychological trauma.

In the implementation of the project, the children had a high willingness to participate. Among the 100 eligible children, 87% were willing to get involved. The participation rate of children in the intervention group was also high, and the attendance rate of each activity was about 93.33%. After the activity, the children in the intervention group gave a high evaluation to the TF-CBT program. 81.82% of the children said they were "very satisfied" and 15.91% were "relatively satisfied". These results indicate that Chinese children are relatively satisfied with the TF-CBT intervention, so the program has a high feasibility in Chinese schools.

In terms of intervention effect, the TF-CBT program can significantly reduce the severity of PTSD. As shown in Figure 1, in the post test stage, the average score of the intervention group was lower than that of the control group (mean score [variance], 21.90 [15.89] vs 28.59 [16.69]; p<0.05). During the three-month follow-up after the intervention, no significant difference was found between the intervention group and the control group (21.30 [17.91] vs 21.97 [16.94]; p=0.98). In addition, the TF-CBT program can significantly reduce the severity of anxiety symptoms. In the post test stage, the average score of the intervention group was lower than that of the control group (17.87 [4.17] vs. 19.99 [4.44]; p<0.05). During the three-month follow-up after the intervention, no significant difference was found between the intervention group and the control group (18.42 [4.78] vs 20.09 [4.97]; p=0.12). Although the depression symptoms were reduced, no significant difference was found.

Figure 1  Treatment effect of primary outcome (PTSD) and secondary outcome (depression and anxiety) in intervention group and control group at baseline, posttreatment and 3-month follow-up

The above research results were published on September 8, 2022 in the international journal Psychological Trauma: Theory, Research, Practice, and Policy (Li et al., 2022). Professor Qu Zhiyong of SSDPP at Beijing Normal University is the corresponding author of this article.

Research results:

Li, J., Li, J., Yuan, L., Zhou, Y., Zhang, W., & Qu, Z. (2022). The acceptability, feasibility and preliminary effectiveness of group cognitive behavioral therapy for Chinese children with posttraumatic stress disorder: a pilot randomized controlled trial (Online ahead of print). Psychological Trauma: Theory Research Practice and Policy. https://doi.org/10.1037/tra0001324