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Trauma-focused CBT effective among orphans, vulnerable children in low-, middle-income countries

Cognitive behavioral therapy that focused on trauma and stress-related symptoms was effective among orphans and vulnerable children in Lusaka, Zambia, according to a randomized clinical trial.

“There are 15.1 million youth orphaned by AIDS in sub-Saharan Africa, with numbers predicted to increase. Orphans and vulnerable children experience multiple traumatic experiences, including abuse and exploitation, premature parental death, HIV infection and stigma, poor health care, poverty, reduced social support, and abbreviated childhood and education,” study researcher Laura K. Murray, PhD, of Johns Hopkins Bloomberg School of Public Health, and colleagues wrote in JAMA Pediatrics. “Given the association of childhood trauma with skill deficits and unhealthy decision making, as well as with long-term negative health outcomes, early and effective mental health intervention is critical to the care of [orphans and vulnerable children].”

To determine if trauma-focused cognitive behavioral therapy (CBT) effectively addressed trauma and stress-related symptoms among orphans and vulnerable children in Lusaka, Zambia, researchers conducted a randomized trial from August 2012 to December 2013. Children aged 5 to 18 years who experienced at least one traumatic event and reported significant trauma-related symptoms were randomly assigned to receive 10 to 16 sessions of trauma-focused CBT (n = 131) or usual community services offered to orphans and vulnerable children (n = 126). Trauma and stress were measured at baseline and within 1 month of treatment completion or 4.5 months after baseline for children who received usual treatment.

At follow-up, trauma symptom scores among children who received trauma-focused CBT had a mean item change of –1.54 (95% CI, –1.81 to –1.27), an 81.9% reduction, compared with –0.37 (95% CI, –0.57 to –0.17), a 21.1% reduction, among children who received usual treatment.

For the functioning measure, mean change from baseline to follow-up was –0.76 (95% CI, –0.98 to –0.54), a reduction of 89.4% for children who received trauma-focused CBT and –0.54 (95% CI, –0.8 to –0.29), a reduction of 68.3% for children who received usual treatment.

Differences between treatment groups were statistically significant for both of these measures (P < .001), according to researchers.

“Evidence-based treatments, such as [trauma-focused] CBT, are commonly conceptualized as specialized services only needed by a small percentage of the population, with less specific interventions provided to larger numbers of children. However, research reveals that high numbers of [orphans and vulnerable children] present with psychological distress which represents a highly prevalent need for specific services,” Murray and colleagues wrote. “Further studies are needed to evaluate the effectiveness of widely funded psychosocial support interventions within [orphans and vulnerable children] programs relative to interventions such as the [trauma-focused] CBT for addressing mental health problems.” – by Amanda Oldt

Disclosure: Researchers reported no relevant financial disclosures.