Skip to main content
SpringerLink
Log in

Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review

  • Evidence Based Intervention
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

In 2019, more than 25.9 million children under 18 were displaced due to unending political conflicts. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) has a high level of empirical evidence to support its efficacy in processing trauma and behavioral problems in non-refugee children. Yet, little is known about its long-term effectiveness in refugee children. This study conducted a systematic review that assessed the evidence of the effectiveness of TF-CBT in reducing trauma symptoms among refugee children under 18 years of age. A systematic review was conducted from peer-reviewed literature databases (12 databases): PsycINFO, PubMed, Scopus, Google Scholar, ProQuest Dissertations and Theses (PQDT), Cochrane Library, MEDLINE, PROSPERO, EBSCOHost, Campbell Collaboration Library of Systematic Reviews, Social Sciences Index, and grey literature sources published from 1990 to 2019. The search yielded 1650 articles, and 4 peer reviewed studies were identified that met inclusion criteria and yielded a sample size of 64 refugee children from 21 different countries. All 4 studies provided evidence that supported TF-CBT’s effectiveness in decreasing trauma symptoms and sustainment during the follow-up assessment among refugee children participants. Despite TF-CBT effectiveness for trauma symptoms treatment, there is still limited evidence to suggest that TF-CBT is effective for all refugee children due to the pilot nature of the studies, and its underutilization in traumatized refugee children from different cultural backgrounds. Future studies should conduct more TF-CBT interventions with diverse refugee children to provide more empirical support for its effectiveness with that population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

A-DES:

Adolescent Dissociative Experiences Scale

CAPS-CA:

Clinician Administered PTSD Scale for Children and Adolescents

CASP:

Critical Appraisal Skills Program

CATS:

Child and Adolescent Trauma Screen

CBT:

Cognitive Behavioral Therapy

CCPT:

Client Centered Play Therapy

DSM-IV:

Diagnostic and statistical manual of mental disorders, 4th edition

DIMDCA:

The Diagnostic Interview for Mental Disorders in Childhood and Adolescence

KIDNET:

Narrative Exposure Therapy for Children

MFQ:

The Mood and Feelings Questionnaire

PDS:

Posttraumatic Diagnostic Scale

PHQ-15:

The Patient Health Questionnaire Physical Symptoms

PROPS:

Parent Report of Posttraumatic Symptoms

PTSD:

Posttraumatic stress disorder

PTSS:

Post Traumatic Stress Symptoms

RCT:

Randomized Control Trials

SCARED:

Screen for Child Anxiety Related Disorders

SDQ:

Strengths and Difficulties Questionnaire

SCD:

Single Case Design

TF-CBT:

Trauma-Focused Cognitive Behavioral Therapy

TS:

Trauma Symptoms

UCLA-PTSD:

The University of California Los Angeles PTSD Reaction Index

UPS:

Uncontrolled Pilot study

References

  • Alayarain, A. (2017). Children of refugees: Torture, human rights, and psychological consequences. E-Book.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

  • Anani, G. (2013). Dimension of gender-based violence against Syrian refugees in Lebonaon. Syria Crisis http://www.fmreview.org/sites/fmr/files/FMRdownloads/en/detention/detention/anani.pdf.

  • Bass, J., Bearup, L., Bolton, P., Murray, L., & Skavenski, S. (2011). Implementing trauma-focused cognitive behavioral therapy (TF-CBT) among formerly trafficked-sexually abused girls in Cambodia: A feasibility study. John Hopkins Bloomberg School of Public Health.

  • Bogdanski, S., & Chang, B. C. (2005). Collecting grey literature: An annotated bibliography, with examples from the sciences and technology. Science & Technology Libraries, 25(3), 35–70.

    Article  Google Scholar 

  • Bohnacker, I., & Goldbeck, L. (2017). Family-based trauma-focused cognitive behavioral therapy with three siblings of a refugee family. Praxis der Kinderpsychologie und Kinderpsychiatrie, 66(8), 614–628.

    Article  Google Scholar 

  • Boland, A., Cherry, M.G., & Dickson, R. (2017). Doing a systematic review (2nd edition). SAGE.

  • Bridging Refugee Youth and Children’s Services (2020). Retrieved from https://brycs.org

  • Campbell and Cochrane Collaboration. (2018). Better evidence for the better world. Retived from campbellcollaboration.org.

  • Campbell Collaboration (2019). What is a systematic Review? Retrieved from https://www.campbellcollaboration.org/what-is-a-systematic-review.html

  • Carrion, V. G., & Wong, S. S. (2012). Can traumatic stress alter the brain? Understanding the implications of early trauma on brain development and learning. Journal of Adolescent Health, 51, S23–S28.

    Article  Google Scholar 

  • Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34, 748–757.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2013). Adverse Childhood Experiences Study: Prevalence of individual adverse childhood experiences. Retrieved from http://www.cdc.gov/ace/prevalence.htm

  • Cochrane Community (2018). Promising and registering new Cochrane Review. Retrieved from https://community.cochrane.org/review-production/production-resources/proposing-and-registering-new-cochrane-reviews

  • Cohen, J. A., & Mannarino, A. P. (2015). Trauma-focused cognitive behavioral therapy for traumatized children and families. Child and Adolescent Psychiatric Clinics of North America, 24(3), 557–570.

    Article  Google Scholar 

  • Cohen, J. A., & Mannarino, A. P. (2008). Trauma‐focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158–162.

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. Guildford Press.

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. The Guilford Press.

  • Critical Appraisal Skills Programme-CASP (2018). Retrieved from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf.

  • Eberle-Sejari, R., Nocon, A., & Rosner, R. (2015). Zur Wirksamkeit von psychotherapeutischen Interventionen bei jungen Flüchtlingen und Binnenvertriebenen mit posttraumatischen Symptomen – Ein systematischer review (translation of title: Efficacy of psychotherapeutic interventions for young refugees and internally displaced persons – A systematic review). Kindh Entwickl, 24, 156–169.

    Article  Google Scholar 

  • Ehntholt, K. A., & Yule, W. (2006). (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 47, 1197–1210.

    Article  Google Scholar 

  • Folkes, C. E. (2002). Thought field therapy and trauma recovery. International Journal Emergency on Mental Health, 4(22), 99–103.

    Google Scholar 

  • Gadeberg, A. K., Montgomery, E., Frederiksen, H. W., & Norredam, M. (2017). Assessing trauma and mental health in refugee children and youth: a systematic review of validated screening and measurement tools. European Journal of Public Health, 27(3), 439–446.

    Article  Google Scholar 

  • Gerger, H., Munder, T., & Barth, J. (2014). Specific and nonspecific psychological interventions for PTSD symptoms: A meta-analysis with problem complexity as a moderator. Journal of Clinical Psychology, 70, 601–615.

    Article  Google Scholar 

  • Goenjian, A. K., Karayan, I., Pynoos, R. S., Minassian, D., Najarian, L. M., Steinberg, A. M., & Fairbanks, L. A. (1997). Outcome of psychotherapy among early adolescents after trauma. The American Journal of Psychiatry, 154, 536–542.

    Article  Google Scholar 

  • González-Prendes, A. (2012). Cognitive-behavioral therapy and social work values: a critical analysis. Journal of Social Work Values & Ethics, 9(2), 2.

    Google Scholar 

  • Grand Challenges for Social Work. (2018). University of Maryland, School of Social Work. Retrieved from https://grandchallengesforsocialwork.org/news/.

  • Hilado, A., & Lundy, M. (2018). Models for practice with immigrants and refugees: Collaboration, cultural awareness and integrative theory. Sage.

  • Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. C., Hukkelberg, S. S., Indregard, T., Stormyren, S. D., & Wentzel-Larsen, T. (2014). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child and Adolescent, 43, 356–369.

    Article  Google Scholar 

  • Kalt, A., Hossain, M., Kiss, L., & Zimmerman, C. (2013). Asylum seekers, violence and health: A systematic review of research in high-income host countries. American Journal of Public Health, 103(3), e30–e42.

    Article  Google Scholar 

  • Kamerman, S. B., & Gatenio-Gabel, S. (2014). Social work and child well-being. In A. Ben-Arieh, F. Casas, I. Frønes, & J. Korbin (Eds.), Handbook of child well-being. Springer. https://doi.org/10.1007/978-90-481-9063-8_22.

  • Kinzie, J. D., Cheng, K., Tsai, J., & Riley, C. (2006). Traumatized refugee children: The case for individualized diagnosis and treatment. Journal of Nervous and Mental Disease, 194, 534–537.

    Article  Google Scholar 

  • Lang, J. M., Ford, J. D., & Fitzgerald, M. M. (2010). An algorithm for determining use of trauma-focused cognitive-behavioral therapy. Psychotherapy Theory Research, 47, 554–569.

    Article  Google Scholar 

  • Lely, J., Smid, G. E., Jongedijk, R. A., W Knipscheer, J., & Kleber, R. J. (2019). The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. European journal of psychotraumatology, 10(1), 1550344. https://doi.org/10.1080/20008198.2018.1550344.

  • Lustig, S., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., & Saxe, G. N. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36.

    Article  Google Scholar 

  • Marcos, L. R. (1979). Effects of interpreter on evaluation of psychopathology in non-English speaking patients. American Journal of Psychiatry, 136(2), 171–174.

    Article  Google Scholar 

  • Marshall, E. A., Butler, K., Roche, T., Cumming, J., & Taknint, J. T. (2016). Refugee youth: A review of mental health counselling issues and practices. Canadian Psychology, 57(4), 308–319.

    Article  Google Scholar 

  • Millard, L. A., & Flach, P. A. (2016). Higgins JP. Machine learning to assist risk-of-bias assessments in systematic reviews. International Journal of Epidemiology, 45(1), 266–277.

    Article  Google Scholar 

  • Murray, L. K., Cohen, J. A., Ellis, B. H., & Mannarino, A. (2008). Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth. Child and Adolescent Psychiatric Clinic, 17, 585–604.

    Article  Google Scholar 

  • Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., et al. (2013). Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in Lusaka, Zambia: a randomized clinical trial. JAMA Pediatrics, 169, 761–769.

    Article  Google Scholar 

  • Murray, L.K., Skavenski, S., Kane, J.C., Mayeya, J., Dorsey, S., Cohen, J.A., Michalapoulos, L.T., Imasiku, M., & Bolton, PA. (2015). Effectiveness of Trauma-Focused Cognitive Bheavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia: A Randomized Clinical Trial. JAMA Pediatr 169(8):761–9.

  • Murray, L. K., & Skavenski, S. A. (2012). International settings. In J. A. Cohen, A. P. Mannarino, & E. Deblinger (Eds.), Trauma-focused CBT for children and adolescents: treatment applications (pp. 225–252). Guilford Press.

  • National Association of Social Workers. (2005). Retrieved from https://www.socialworkers.org/Events/Celebrations/NASW-50th-Anniversary.

  • National Child Stress Network Refugee Task Force [NCTSNRTTF]. (2005). Mental health interventions for refugee children in resettlement. White paper II. Retrieved from https://www.nctsn.org/what-is-child-trauma/trauma-types/refugee-trauma

  • National Child Traumatic Stress Network. (2012). Trauma-Focused Cognitive Behavioral Therapy. Retrieved from https://www.nctsn.org/interventions/trauma-focused-cognitive-behavioral-therapy

  • Nocon, A., Eberle-Sejari, R., Unterhitzenberger, J., & Rosner, R. (2017). The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: Systematic review and meta-analysis. European Journal of Psychotraumatology, 8, 1–15.

    Article  Google Scholar 

  • Palic, S., & Elklit, A. (2011). Psychosocial treatment of posttraumatic stress disorder in adult refugees: A systematic review of prospective treatment outcome studies and a critique. Journal of Affective Disorders, 131(1), 8–23.

    Article  Google Scholar 

  • Rubin, A., & Babbie, E. R. (2016). Empowerment series: Research methods for social work. Cengage Learning.

  • Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012). Treatment for childhood refugee trauma: A randomized controlled trial. International Journal of Play Therapy, 21, 57–73.

    Article  Google Scholar 

  • Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 37, 156–183.

    Article  Google Scholar 

  • TF-CBT National Ceritification Program. (2019). TF-CBT Certification Criteria. Retrieved from https://www.tfcbt.org/tf-cbt-certification-criteria/.

  • Thomsona, C., Vidgen, A., & Roberts, N. P. (2018). Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. Clinical Psychology Review, 63, 66–79.

    Article  Google Scholar 

  • Trauma and Community Resilience Center. (2020). Boston Children’s Hospital. Retrieved from https://www.childrenshospital.org/centers-and-services/programs/o-_-z/trauma-and-community-resilience-center.

  • Tyrer, R. A., & Fazel, M. (2014). School and community-based interventions for refugee and asylum seeking children: A systematic review. PLoS One, 9(2), e89359.

    Article  Google Scholar 

  • U.S Citizenship and Immigration Services. (2008). Definition of refugee from immigration and nationality act. Retrieved from https://www.uscis.gov

  • United Nations High Commission for Refugees. (2019). Retrieved from https://www.unhcr.org/en-us/figures-at-a-glance.html

  • Unterhitzenberger, J., Eberle-Sejari, R., Rassenhofer, M., Sukale, T., Rosner, R., & Goldbeck, L. (2015). Trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: A case series. BMC Psychiatry, 15, 260.

    Article  Google Scholar 

  • Unterhitzenberger, J., & Rosner, R. (2016). Case report: Manualized trauma-focused cognitive behavioral therapy with an unaccompanied refugee minor girl. European Journal of Psychotraumatology, 7, 29246.

    Article  Google Scholar 

  • Unterhitzenberger, J., Wintersol, S., Lang, M., Konig, J., & Rosner, R. (2019). Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: A pilot study. Child and Adolescent Psychiatry and Mental Health, 13, 22.

    Article  Google Scholar 

  • Vasserman, D. S. (2019). Thinking, moving, and feeling: A proposed movement and behavioral intervention for refugee children with trauma (Order No. 10812711) [Doctoral Dissertation, William James College]. ProQuest Dissertations and Theses Global.

  • Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. Lancet, 379, 1641–1652.

    Article  Google Scholar 

  • Women’s Refugee Commission. (2020). Creating a Better World for Refugees. Retrieved from https://www.womensrefugeecommission.org.

  • World Health Organization. (2018). Mental health promotion and mental health care in refugees and migrants. Copenhagen: WHO Regional Office for Europe; 2018 (Technical guidance on refugee and migrant health). Retrieved from https://www.euro.who.int/__data/assets/pdf_file/0004/386563/mental-health-eng

  • Yasinski, C., Hayes, A. M., Ready, C. B., Cummings, J. A., Berman, I. S., McCauley, T., Webb, C., & Deblinger, E. (2016). In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT). Journal of Consulting and Clinical Psychology, 84(12), 1066–1077.

    Article  Google Scholar 

  • Young Center for Immigrant Children’s Rights. (2020). Child Advocate Program. Retrieved from https://www.theyoungcenter.org/child-advocate-program-young-c

Download references

Author information

Authors and Affiliations

  1. School of Social Work, The University of Alabama, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL, 35401, USA

    Edson Chipalo

Authors
  1. Edson Chipalo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edson Chipalo.

Ethics declarations

Conflict of Interest

There are no conflicts of interest in this systematic review.

Informed Consent

No informed consent needs to be obtained.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supporting Information

Table 1

Summary of the Included studies. Table 2 TF-CBT PRACTICE (XLSX 15 kb)

Figure 1

PRISMA Flow Diagram to show the process of Study (XLSX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chipalo, E. Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review. Journ Child Adol Trauma 14, 545–558 (2021). https://doi.org/10.1007/s40653-021-00370-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-021-00370-0

Keywords

Search

Navigation