School-based Cognitive-Behavioural Therapy Group Intervention for Refugee Children who have Experienced War-related Trauma
Abstract
This study evaluated the effectiveness of a school-based group intervention designed for children who have experienced trauma. Twenty-six children (aged 11-15 years) who were refugees or asylum-seekers from war-affected countries participated. The manual-based intervention consisted of cognitive-behavioural therapy (CBT) techniques and was implemented within secondary schools. The treatment group ( n = 15) received six sessions of group CBT over a 6-week period, while the control group ( n = 11) were placed on a waiting list for 6 weeks and then invited to enter treatment. Children in the CBT group showed statistically significant, but clinically modest improvements following the intervention, with decreases in overall severity of post-traumatic stress symptoms. Significant improvements were also found in overall behavioural difficulties and emotional symptoms. Children in the waiting list control group did not show any improvements over the same period. However, follow-up data, which were only available for a small subset of eight children, suggest that gains in the CBT group were not maintained at 2-month follow-up.
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Group CBT appeared to result in a significant decrease in overall PTSD symptoms severity and intrusive PTSD symptoms.
“Group CBT appeared to result in a significant decrease in overall PTSD symptoms severity and intrusive PTSD symptoms.”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [63]
These improvements were not maintained at 2-month follow-up.
“Unfortunately, these improvements were not maintained at 2-month follow-up [63].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [63]
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 [63]
Unaccompanied minors also appeared to improve with regards to behavior and emotional difficulties.
“UM also appeared to improve with regards to behavior and emotional difficulties [63].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [63]
Only seven studies (38.9%) included follow-up assessments in their study designs, limiting the evidence regarding long-term benefits of the interventions.
“In addition, only seven studies (38.9%) included follow-up assessments in their study designs limiting the evidence regarding long-term benefits of the interventions [60, 61, 63, 67, 68, 73, 78].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [63]
Excluding unaccompanied minors who do not speak the language of the host country prevents a great number of them from receiving support.
“Additionally, excluding UM who do not speak the language of the host country, also prevents a great number of UM from receiving support [63, 69, 70, 73, 75].”
From Examining cognitive behavioral therapy interventions for unaccompanied minors: a systematic review and qualitative research synthesis. (2025) · cites this paper as [63]
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Pfeiffer, E., & Goldbeck, L. (2017) · Journal of Traumatic Stress · doi:10.1002/jts.22218 · Cited by 56 · see citing works
Moderators of Treatment Effectiveness for War-Affected Youth With Depression in Northern Uganda
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“The use of interpersonal psychotherapy [8], trauma/grief-focused therapy [9], cognitive behavioral therapy [10], narrative exposure therapy [11], recreational and connectivity activities [12], and school-based interventions [13] have all demonstrated partial efficacy in controlled studies among war-affected population…”
Ooi, C. S., Rooney, R. M., Roberts, C. M., Kane, R. T., Wright, B. R., & Chatzisarantis, N. L. D. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01641 · Cited by 57 · see citing works
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“Two studies using CBT reported medium and large effects on PTSD compared to untreated controls (SMD= 0.88, Ehntholt et al., 2005; SMD = 0.37 in the group of girls, Tol et al., 2012; see Table 1).”
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“From these studies, only one intervention [27] appeared to be effective compared to a control condition in reducing PTSD symptoms in refugee minors.”
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Cognitive Behavioral Therapy for Symptoms of Trauma and Traumatic Grief in Refugee Youth
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“A different CBT model [53] was used by Ehntholt and colleagues [54] in a controlled study with 26 refugee youth in a school, compared with wait-list control.”
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“Family risk and protective factors include quality of attachment, family cohesion, separation, role change, paternal unemployment and parental psychological health (Betancourt and Williams 2008; Ehntholt et al. 2005; National Child Traumatic Stress Network 2003; Thomas and Lau 2002).”
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Trauma, Burnout, and Resilience of Syrian Primary Teachers Working in a War Zone
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“The role of teachers as support systems for children in traumatic environments has been highlighted in school intervention studies (Alisic et al., 2012; Berger et al., 2007; Ehntholt et al., 2005).”
BackgroundNarratives of healing: A case study of a young Liberian refugee settled in Australia
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Resmi İlkokullara Devam Eden Suriyeli Mülteci Öğrencilerin Eğitim Sorunları
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“PTSS outcomes were reported for nine CBT treatment groups (Allison & Ferreira, 2017; Ehntholt et al., 2005; ElKhani et al., 2018; Gormez et al., 2017; Kataoka et al., 2003; Ooi et al., 2016; Pfeiffer et al., 2018; Pfeiffer & Goldbeck, 2017; Sarkadi et al., 2018).”
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Developing mental health social work for asylum seekers: A proposed model for practice
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Impact of resilience enhancing programs on youth surviving the Beslan school siege
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“Previous literature on school-based interventions for non-environmental traumatic events suggests that the use of a waitlist control group provides a feasible method for analysis [41-43].”
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Cognitive Behaviour Therapies and their implications for applied educational psychology practice
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“Though an emerging evidence base is appearing, with positive outcomes for children seen in school settings by an educational psychologist using CBT (Squires, 2001 ), these are not always sustained for all children (Ehntholt, Smith, & Yule, 2005 ; Luk et al, 2001 ).”
BackgroundKing, D., & Said, G. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000260 · Cited by 31 · see citing works
“…have been shown to be effective in reducing PTSD and functional impairment and in increasing hope, coping and social support in low-resource settings (Purgato et al., 2018) and in middle- and high-income countries (Ehntholt et al., 2005; Fazel and Betancourt, 2017; Sarkadi et al., 2018).”
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- Authors
- Ehntholt, K. A., Smith, P. A., & Yule, W.
- Affiliations
- Maudsley Hospital (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Venue
- Clinical Child Psychology and Psychiatry
- Publisher
- SAGE Publications
- Published
- 2005-04
- Volume
- 10
- Issue
- 2
- Pages
- 235-250
- ISSN
- 1359-1045 (ISSN-L)
- 1461-7021
- OpenAlex
- W2070171994
- Cited by
- 298
- References
- 24
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 10 · 2023: 12 · 2022: 17 · 2021: 13 · 2020: 76 · 2019: 23 · 2018: 12 · 2017: 17 · 2016: 14 · 2015: 12 · 2014: 5 · 2013: 17 · 2012: 9
- FWCI
- 6.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Child Psychology and Psychiatry (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- cognitive behavioral therapy, group intervention, refugee children, asylum seekers, war trauma, posttraumatic stress symptoms, school-based intervention, high school students, emotional symptoms, behavioral problems, maintenance therapy, waitlist control
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