Cognitive Model of the Maintenance and Treatment of Post-traumatic Stress Disorder Applied to Children and Adolescents
Abstract
The diagnosis of post-traumatic stress disorder (PTSD) has recently been established as a useful construct in children and adolescents, and is also now held to be a helpful framework when describing symptoms in refugees or survivors of war. This article reviews existing models of PTSD and existing evidence for treatment efficacy in both adults and children, and leads on to discuss the application of the Ehlers and Clark (2000) cognitive model to work with children and adolescents. The difference between techniques such as exposure and cognitive restructuring is examined. Two vignettes illustrate the practical details of working with young refugees with PTSD, including both exposure and cognitive restructuring in different phases of therapy, the importance of a collaborative formulation, and the importance of parental support during treatment as well as cultural and language factors specific to refugees.
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In a case study, after sixteen sessions of individual CBT, the unaccompanied minor had moved from a severe PTSD score to minor symptoms, although this was not considered a clinically significant reduction.
“In a case study, the author reported that after sixteen sessions of individual CBT, the UM had moved from a severe PTSD score to minor symptoms although this was not considered a clinically significant reduction [64].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [64]
Three studies (16.7%) examined CBT in unaccompanied minors.
“Three studies (16.7%) examined CBT in UM [63–65].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [64]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2022) · doi:10.1176/appi.books.9780890425787 · Cited by 23,476 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Posttraumatic Stress Disorder in the National Comorbidity Survey
Kessler, R. C. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950240066012 · Cited by 10,379 · see citing works
(1975) · Medical Entomology and Zoology · Cited by 7,245 · see citing works
A cognitive model of posttraumatic stress disorder
Ehlers, A., & Clark, D. M. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00123-0 · Cited by 6,147 · see citing works
Cognitive Therapy and the Emotional Disorders
Ince, L. P. (1977) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1977.31.4.633 · Cited by 2,889 · see citing works
Trauma and Posttraumatic Stress Disorder in the Community: The 1996 Detroit Area Survey of Trauma
Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.7.626 · Cited by 2,407 · see citing works
A dual representation theory of posttraumatic stress disorder.
Brewin, C. R., Dalgleish, T., & Joseph, S. (1996) · Psychological Review · doi:10.1037/0033-295x.103.4.670 · Cited by 1,696 · see citing works
Freeman, A. M. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n1112 · Cited by 1,667 · see citing works
Review of Child and Adolescent Refugee Mental Health
Lustig, S. L., Kia‐Keating, M., Grant-Knight, W., Geltman, P. L., Ellis, H., Kinzie, J. D., Keane, T. M., & Saxe, G. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200401000-00012 · Cited by 790 · see citing works
A Mental Health Intervention for Schoolchildren Exposed to Violence: A Randomized Controlled Trial
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003) · JAMA · doi:10.1001/jama.290.5.603 · Cited by 751 · cited 3× · see citing works
“Several studies have more recently shown that the majority of young people exposed to violence display symptoms of PTSD, and a substantial minority develop clinically significant PTSD (Stein et al., 2003).”
BackgroundMethodInfluentialBritish Journal of Clinical Psychology
(2010) · British Journal of Clinical Psychology · doi:10.1111/(issn)2044-8260 · Cited by 702 · see citing works
The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category
Summerfield, D. A. (2001) · BMJ · doi:10.1136/bmj.322.7278.95 · Cited by 689 · see citing works
(2010) · PsycEXTRA Dataset · doi:10.1037/e673052010-001 · Cited by 475 · see citing works
Dunmore, E., Clark, D. M., & Ehlers, A. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00181-8 · Cited by 472 · see citing works
Ursano, R. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.10.1805-a · Cited by 462 · see citing works
(1989) · Medical Entomology and Zoology · Cited by 451 · see citing works
Outcome of psychotherapy among early adolescents after trauma
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.4.536 · Cited by 381 · cited 1× · see citing works
“…young people who had PTSD as a result of exposure to a disaster includes that by Chemtob, Nakashima, and Carlson (2002) examining adolescents with PTSD 2–3 years following exposure to a disaster, and that by Goenjian et al. (1997) in which CBT for PTSD began 1.5 years after exposure to a disaster.”
BackgroundInfluentialEhlers, A., Mayou, R., & Bryant, B. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00126-7 · Cited by 335 · see citing works
March, J. S., Amaya-Jackson, L. M., Murray, M. C., & Schulte, A. C. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199806000-00008 · Cited by 329 · see citing works
Efficacy of Treatments for Posttraumatic Stress Disorder
Solomon, S. D. (1992) · JAMA · doi:10.1001/jama.1992.03490050081031 · Cited by 301 · see citing works
Chemtob, C. M., Nakashima, J., & Carlson, J. G. (2002) · Journal of Clinical Psychology · doi:10.1002/jclp.1131 · Cited by 301 · cited 1× · see citing works
“Research on young people who had PTSD as a result of exposure to a disaster includes that by Chemtob, Nakashima, and Carlson (2002) examining adolescents with PTSD 2–3 years following exposure to a disaster, and that by Goenjian et al. (1997) in which CBT for PTSD began 1.5 years after exposure to…”
BackgroundInfluentialKendall, P. C. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.61.2.235 · Cited by 259 · see citing works
Effects of War Trauma on Cambodian Refugee Adolescents' Functional Health and Mental Health Status
Mollica, R. F., Poole, C., Son, L., Murray, C. C., & Tor, S. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199708000-00017 · Cited by 230 · see citing works
Mind over mood: A cognitive therapy treatment manual for clients.
Greenberger, D., & Padesky, C. A. (1995) · Cited by 221 · see citing works
Does PTSD Transcend Cultural Barriers? A Study From the Khmer Adolescent Refugee Project
Sack, W. H., Seeley, J. R., & Clarke, G. N. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199701000-00017 · Cited by 152 · see citing works
Psychologically Distressed Refugee Children in the United Kingdom
Hodes, M. (2000) · Child and Adolescent Mental Health · doi:10.1111/1475-3588.00286 · Cited by 140 · see citing works
Henderson, D., Hargreaves, I. R., Gregory, S., & Williams, J. M. G. (2002) · British Journal of Clinical Psychology · doi:10.1348/014466502163921 · Cited by 129 · see citing works
Anxiety states: Panic and generalized anxiety.
Clark, D. M. (1989) · Cited by 115 · see citing works
Psychologically Distressed Refugee Children in the United Kingdom
Hodes, M. (2000) · Child Psychology and Psychiatry Review · doi:10.1017/s136064170000215x · Cited by 112 · see citing works
The validity of posttraumatic stress disorder among vietnamese refugees
Fawzi, M. C. S., Pham, T., Lin, L.-E., Nguyen, T. V., Ngo, D. T., Murphy, E., & Mollica, R. F. (1997) · Journal of Traumatic Stress · doi:10.1023/a:1024812514796 · Cited by 102 · see citing works
Posttraumatic Stress Disorder in Children and Adolescents
Keppel‐Benson, J. M., & Ollendick, T. H. (1993) · Issues in clinical child psychology · doi:10.1007/978-1-4757-4766-9_3 · Cited by 94 · see citing works
Handbook of Interventions that Work with Children and Adolescents
(2004) · Wiley eBooks · doi:10.1002/9780470753385 · Cited by 89 · see citing works
Treating acute posttraumatic reactions in children and adolescents
Cohen, J. A. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01868-1 · Cited by 86 · see citing works
Treating psychic trauma in children: A preliminary discussion
Terr, L. C. (1989) · Journal of Traumatic Stress · doi:10.1002/jts.2490020103 · Cited by 84 · see citing works
Clark, D. M. (1989) · Oxford University Press eBooks · doi:10.1093/med:psych/9780192615879.003.0003 · Cited by 75 · see citing works
Treating psychological symptoms in sexually abused children
Ramchandani, P., & Jones, D. P. H. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.183.6.484 · Cited by 72 · see citing works
Stallard, P. N. (2003) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465803003084 · Cited by 51 · see citing works
Abrahams, S., & Udwin, O. (2000) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104500005003008 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ehntholt, K. A., & Yule, W. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01638.x · Cited by 497 · see citing works
Gillies, D., Taylor, F., Gray, C., O'Brien, L., & D'Abrew, N. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006726.pub2 · Cited by 239 · see citing works
Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought
Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-Miller, A. (2010) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0061-4 · Cited by 169 · see citing works
Preventive interventions among children exposed to trauma of armed conflict: a literature review
Peltonen, K., & Punamäki, R. (2010) · Aggressive Behavior · doi:10.1002/ab.20334 · Cited by 159 · see citing works
Gillies, D. M., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2013) · Evidence-Based Child Health A Cochrane Review Journal · doi:10.1002/ebch.1916 · Cited by 157 · see citing works
Tol, W. A., Stavrou, V., Greene, M. C., Mergenthaler, C., van Ommeren, M., & García Moreno, C. (2013) · Conflict and Health · doi:10.1186/1752-1505-7-16 · Cited by 137 · see citing works
Stallard, P. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.09.005 · Cited by 104 · see citing works
Mitra, R., & Hodes, M. (2019) · Child Care Health and Development · doi:10.1111/cch.12640 · Cited by 71 · see citing works
Demazure, G., Gaultier, S., & Pinsault, N. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1083-y · Cited by 55 · see citing works
Sonderegger, R., Rombouts, S., Ocen, B., & McKeever, R. S. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466510x511637 · Cited by 44 · see citing works
Os, E., Zijlstra, E. A., Knorth, E. J., Post, W. J., & Kalverboer, M. (2018) · Trauma Violence & Abuse · doi:10.1177/1524838018757748 · Cited by 39 · see citing works
Lawton, K., & Spencer, A. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01151-5 · Cited by 39 · see citing works
Post-traumatic stress disorder in childhood: Table 1
Tareen, A., Garralda, M. E., & Hodes, M. (2007) · Archives of Disease in Childhood Education & Practice · doi:10.1136/adc.2006.100305 · Cited by 35 · see citing works
Taylor, A., Radford, G., & Calia, C. (2022) · Child and Adolescent Mental Health · doi:10.1111/camh.12547 · Cited by 25 · see citing works
Tol, W. A., Stavrou, V., Greene, M. C., Mergenthaler, C., Garcia‐Moreno, C., & van Ommeren, M. (2013) · World Psychiatry · doi:10.1002/wps.20054 · Cited by 24 · see citing works
Bemak, F., & Chung, R. C. (2021) · The Counseling Psychologist · doi:10.1177/0011000020972182 · Cited by 23 · see citing works
Brief Family Therapy for Refugee Children
Björn, G. J., Bodén, C., Sydsjö, G., & Gustafsson, P. A. (2013) · The Family Journal · doi:10.1177/1066480713476830 · Cited by 18 · see citing works
Volpe, E. M., Quinn, C. R., Resch, K., Douglas, V., & Cerulli, C. (2016) · Journal of Family Violence · doi:10.1007/s10896-016-9818-y · Cited by 11 · see citing works
Gillies, D. M., O’Brien, L., Rogers, P., & Meekings, C. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006726 · Cited by 11 · see citing works
Morroni, D., Konstantinou, P., Gkleka, C., Kassianos, A. P., & Karekla, M. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02500-z · Cited by 8 · see citing works
“In a case study, the author reported that after sixteen sessions of individual CBT, the UM had moved from a severe PTSD score to minor symp - toms although this was not considered a clinically signifi - cant reduction [64 ].”
Interviewing Asylum-Seeking Children: A Scoping Review of Research to Inform Best Practices
Chilliak, S., Musacchio, S., Montreuil, T. C., & Williams, S. (2024) · Trauma Violence & Abuse · doi:10.1177/15248380241260014 · Cited by 8 · see citing works
Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review
Moutsou, I., Georgaca, E., & Varaklis, T. (2023) · Healthcare · doi:10.3390/healthcare11060918 · Cited by 7 · see citing works
When is counselling indicated after a major traumatic life event?
Black, D., & Tufnell, G. (2006) · Current Paediatrics · doi:10.1016/j.cupe.2006.08.010 · Cited by 6 · see citing works
Cognitive Behavioral Models of Phobias and Pervasive Anxiety
Pilecki, B. C., & McKay, D. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7784-7_4 · Cited by 5 · see citing works
Raval, H. (2006) · Mental Health in Family Medicine · Cited by 4 · see citing works
Ooi, C. S. (2013) · Figshare · Cited by 4 · see citing works
Besic, J., & McBrien, J. L. (2012) · ISRN Education · doi:10.5402/2012/830938 · Cited by 3 · see citing works
Treatment Options for Young People and Refugees with Post-Traumatic Stress Disorder II
Hodes, M., & Diaz-Caneja, A. (2007) · Palgrave Macmillan UK eBooks · doi:10.1057/9780230625808_2 · Cited by 2 · see citing works
Refugee Children and Families : Psychological Health, Brief Family Intervention and Ethical Aspects
Björn, G. J. (2013) · Cited by 1 · see citing works
Improving mental health and wellbeing in recently-arrived refugee families and children
Tsoupas, J. (2012) · RMIT Research Repository (RMIT University Library) · doi:10.25439/rmt.27351276 · Cited by 1 · see citing works
Exploring the development of critical incident response teams
Lockhart, C. F., & Woods, K. A. (2016) · International Journal of School & Educational Psychology · doi:10.1080/21683603.2016.1234987
Hendriks, E. E. (2014) · SUNScholar (Stellenbosch University)
Jebarajakirthy, C. (2015) · Swinburne figshare (Swinburne University of Technology) · doi:10.25916/sut.26290369
Ismail, A. D. (2019) · University of the Western Cape Electronic Theses and Dissertations Repository (University of the Western Cape)
Cognitive Behavioral Models of Phobias and Pervasive Anxiety
McKay, D. (2022) · Springer eBooks · doi:10.1007/978-3-031-14080-8_4
Morroni, D., Charalambous, E., & Karekla, M. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100919
Terapeuters arbete med krigsrelaterat posttraumatiskt stressyndrom
Avdic, A. (2007) · DiVA (Mälardalen University College)
An exploration of therapeutic work with unaccompanied refugee young people
Staite, P. L. (2012) · UEL Research Repository (University of East London) · doi:10.15123/pub.3034
Acculturation and Culturally Adapted CBT for Refugee Youth and Families—A Systematic Review
Calia, C., & Afara, S. M. (2026) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-026-00947-7
- Authors
- Vickers, B.
- Affiliations
- Adolescent Assertive Outreach Team, London, UK,
- Corresponding author
- Vickers, Bea
- Venue
- Clinical Child Psychology and Psychiatry
- Publisher
- SAGE Publications
- Published
- 2005-04
- Volume
- 10
- Issue
- 2
- Pages
- 217-234
- ISSN
- 1359-1045 (ISSN-L)
- 1461-7021
- OpenAlex
- W2045481808
- Cited by
- 41
- References
- 41
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 6 · 2012: 4
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Child Psychology and Psychiatry (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, children and adolescents, cognitive restructuring, exposure therapy, refugee children, war survivors, parental support, treatment efficacy
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