Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms Among Traumatized Refugee Children between 5 to 18 Years Old?

Background and Purpose: As of 2019, United Nations High Commissioner for Refugees (UNHCR) reported about 25.9 million children below the age of 18 years displaced due to unending political conflicts, and 90% of them are under the age of seven years and present a wide range of trauma symptoms. Studies show that 20% of children and adolescents may have an identifiable and treatable mental health disorder. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) has a high level of empirical support in helping children to process their trauma and overcome emotional and behavioral problems associated with trauma symptoms.

This systematic review aimed to examine the effectiveness of TF-CBT in decreasing trauma symptoms for traumatized refugee children across the globe aged from 5 to 18 years.

Methods: We searched the following 12 databases: PsycINFO, PubMed, Scopus, Google Scholar, ProQuest Dissertations and Theses (PQDT), Cochrane Library, MEDLINE, Web of Science, PROSPERO, EBSCOHost, Campbell Collaboration Library of Systematic Reviews, and Social Sciences Index. The search terms included “refugee children,” “trauma symptoms,” “coping,” “resilience,” “effectiveness,” intervention,” “treatment,” and “Trauma-Focused Cognitive Behavioral Therapy.” The Critical Appraisal Skills Program (CASP) checklist was used to assess the quality and risk of bias in relevant studies.

Results: The search yielded 1650 articles, and 4 met the eligibility criteria along with high quality based on the CASP checklist. The total sample was 71 refugee children from 15 different countries. Three studies were conducted in Germany with TF-CBT as the only intervention, while one was in the United States and compared TF-CBT to Client-Centered Play Therapy (CCPT). Three studies used a randomized control group design, while one was a single case design.

All the studies showed a significant decrease in trauma symptoms along with sustainment during the follow-ups, although minimal to no caregiver support was involved. The results indicate that TF-CBT is effective not only among the non-refugee children but also among refugee children. However, there is limited evidence to suggest that TF-CBT is effective for all refugee children regardless of cultural background.

Conclusions and Implications: Despite the effectiveness of TF-CBT and high need for trauma symptom treatment, TF-CBT is underutilized among traumatized refugee children from different cultural backgrounds. More studies on TF-CBT should be conducted to provide more empirical support for refugee children. A culturally tailored approach, including translators who are trained with TF-CBT relevant terms and therapists who are trained on feelings triggered by cultural diversities and cultural differences in trauma symptom treatment, also should be implemented to enhance its effectiveness. Overall, TF-CBT does assist in treating trauma on the resettlement of refugee children into the host society.