The Impact of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) on Post-Traumatic Stress Disorder: A Meta-Analysis

Background: An estimated two-thirds of youth in the United States have experienced at least one traumatic event (McLaughlin et al., 2013; SAMHSA, 2023). The commonality of childhood trauma, specifically in the United States, is significant and correlated to many negative physical, social, and mental health outcomes (Finklehor, 2020; Cross et al., 2017; Lewis et al., 2010). Several evidence-based interventions have been developed to address the effects of trauma in adolescents. One such intervention is Cognitive Behavioral Intervention for Trauma in Schools (CBITS). CBITS is a school-based, 10-session group-based intervention, with each session lasting about 45-60 minutes. CBITS includes cognitive-behavioral techniques like relaxation training, cognitive restructuring, social problem-solving, trauma narrative development, and exposure therapy (Pfeiffer et al., 2024). The aim of this study was to explore CBITS and its effectiveness on reducing PTSD symptoms, as well as understand its application to different settings and populations. To date, no systematic review or meta-analysis has solely focused on the effectiveness of CBITS.

Methods: Following PRISMA guidelines, a systematic search of electronic databases was conducted to identify relevant studies in Fall 2024. A total of 28 studies met inclusion criteria. Of these, seven studies were randomized controlled trials (RCTs), and 21 were intervention-only studies.

Result: The majority of the samples were made up of minoritized individuals and female youth, and took place in a school setting, followed by after school programs, residential facilities, and juvenile justice settings. Most of the facilitators were school mental health clinicians or clinicians, social workers, or psychologists more generally. Several studies adapted the original CBITS model. The analysis of RCTs showed a moderate overall effect size of 0.91 (95% CI: 0.41, 1.06) based on a random-effects model, highlighting the positive impact of CBITS on reducing PTSD symptoms. Individual effect sizes (Hedge’s g) ranged widely, from -0.37 to 0.83, reflecting the diverse contexts of these studies. Intervention-only studies also demonstrated positive results, with an overall effect size of 0.68 (95% CI: 0.47, 0.89). The effect sizes for these studies ranged from 0.15 (95% CI: 0.03, 0.27) to 1.21 (95% CI: 0.98, 1.44), with stronger outcomes observed in studies that adhered closely to the CBITS protocol or targeted populations with significant trauma exposure. Subgroup analyses provided additional insights into the effectiveness of CBITS. Interventions targeting younger participants produced larger effect sizes, with a pooled value of 0.98 (95% CI: 0.62, 1.34), compared to 0.65 (95% CI: 0.32, 0.98) for older adolescents. Similarly, studies focused on high-risk populations reported higher effect sizes (1.02; 95% CI: 0.78, 1.26) than those conducted with general student populations (0.57; 95% CI: 0.29, 0.85).

Conclusion: This meta-analysis underscores CBITS’ effectiveness as an evidence-based intervention for reducing PTSD symptoms in school-aged children and adolescents. Its adaptability across study designs and populations highlights its potential as a scalable solution to address trauma in school environments. Implications for practice and research will be discussed.