Enhancing the mental health of children, students, and adolescents with trauma and PTSD through TF-CBT

Document Type : Review


Educational Psychology, Faculty of education, University of Johannesburg, South Africa


Background: Sub-Saharan African (SSA) countries have witnessed tremendous and devastating traumatic events that adversely affect all individuals, regardless of age. Nevertheless, little is known about the use of psychological therapy in the treatment of traumatised individuals suffering from post-traumatic stress disorder (PTSD).
Objectives: This study examined the efficacy of trauma-focused cognitive behavioural therapy (TF-CBT) in enhancing the mental health of children and adolescents with trauma and PTSD in SSA countries.
Methods: This study employed a scoping review lens in strict adherence to Joanna Briggs Institute (JBI) guidelines. An extensive study was conducted in the Google Scholar, Scopus, PubMed, and PsyInfo databases. The search results showed that 284 related articles were retrieved from these databases based on formulated search terms. Seventy-seven articles were screened. At the end of the screening, 16 articles were included for review.
Results: This review revealed that TF-CBT enhanced children's mental health through a substantial reduction in symptoms of trauma and PTSD. Furthermore, TF-CBT enhanced students' mental health through a significant reduction of anxiety and PTSD symptoms. Furthermore, TF-CBT significantly improved adolescents' mental health by significantly reducing their symptoms of PTSD, depression, stress, and anxiety, moderated by a history of sexual abuse and primary caregiver involvement. In light of the findings of this study, more studies are needed in some sub-Saharan nations that are vulnerable to traumatic events. In addition, since TF-CBT is proven efficient in enhancing the mental health of individuals irrespective of age in SSA, the World Health Organisation should recommend it for treating individuals with trauma and PTSD.
Conclusion: TF-CBT is an effective psychological therapy that improves the mental health of children, students, and adolescents living in the SSA. It has been demonstrated that the use of TF-CBT enhances the mental health of individuals, regardless of their age. However, researchers at the SSA have not fully used this promising psychological therapy to improve the mental health of children and adolescents with trauma and PTSD.


  1. Perfect MM, Turley MR, Carlson JS, Yohanna J, Saint Gilles MP. School-Related Outcomes of Traumatic Event Exposure and Traumatic Stress Symptoms in Students: A Systematic Review of Research from 1990 to 2015. School Ment Health 2016; 8: 7-43. doi:10.1007/s12310-016-9175-2
  2. National Center for PTSD. Understanding PTSD and Aging. 2023; : 1-16.
  3. Li W, Cheng P, Liu Z, Ma C, Liu B, Zheng W, et al. Post-traumatic stress disorder and traumatic events in China: a nationally representative cross-sectional epidemiological study. Psychiatry Res 2023; 326: 115282. doi:10.1016/j.psychres.2023.115282 PMid:37290364
  4. Alisic E, Zalta AK, Van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, et al. Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry 2014; 204: 335-340. doi:10.1192/bjp.bp.113.131227 PMid:24785767
  5. Miedema SS, Stamatakis C, Tracy A, Hegle J, Kamagate MF, McOwen J, et al. Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa. Child Abuse Negl 2023; : 106494. doi:10.1016/j.chiabu.2023.106494 PMid:37806930
  6. Swain KD, Pillay BJ, Kliewer W. Traumatic stress and psychological functioning in a South African adolescent community sample. South Afr J Psychiatry 2017; 23: 1-6. doi:10.4102/sajpsychiatry.v23i0.1008 PMid:30263182 PMCid:PMC6138196
  7. Seedat S, Nyamai C, Njenga F, Vythilingum B, Stein DJ. Trauma exposure and post-traumatic stress symptoms in urban African schools: Survey in Cape Town and Nairobi. Br J Psychiatry 2004; 184: 169-175. doi:10.1192/bjp.184.2.169 PMid:14754831
  8. McLean CP, Rosenbach SB, Capaldi S, Foa EB. Social and academic functioning in adolescents with child sexual abuse-related PTSD. Child Abuse Negl 2013; 37: 675-678. doi:10.1016/j.chiabu.2013.03.010 PMid:23623621 PMCid:PMC3740087
  9. Finkelhor D, Shattuck A, Turner HA, Hamby SL. Trends in Children's Exposure to Violence, 2003 to 2011. JAMA Pediatr 2014; 168: 540-546. doi:10.1001/jamapediatrics.2013.5296 PMid:24781431
  10. Kataoka S, Langley A, Wong M, Baweja S, Stein B. Responding to Students with PTSD in Schools. Child Adolesc Psychiatr Clin N Am 2012; 21: 119-x. doi:10.1016/j.chc.2011.08.009 PMid:22137816 PMCid:PMC3287974
  11. Baghi I, Mousavi M, Malekshahi A, Mobayen M. Evaluation of the diagnostic value of FAST in patients with multiple trauma referring to a trauma center in northern Iran. Novel Clin Med 2022;1(3):135-42. doi: 10.22034/ncm.2022.336374.1033
  12. Wendel EL. Assessing teacher attitudes related to trauma-informed care in three urban high schools. 2018. doi:10.26153/tsw/1068
  13. Tomaszek K, Muchacka-Cymerman A. Student Burnout and PTSD Symptoms: The Role of Existential Anxiety and Academic Fears on Students during the COVID 19 Pandemic. Depress Res Treat 2022; 2022: e6979310. doi:10.1155/2022/6979310 PMid:35096425 PMCid:PMC8796705
  14. West SD, Day AG, Somers CL, Baroni BA. Student perspectives on how trauma experiences manifest in the classroom: Engaging court-involved youth in the development of a trauma-informed teaching curriculum. Child Youth Serv Rev 2014; 38: 58-65. doi:10.1016/j.childyouth.2014.01.013
  15. Tang W, Hu T, Hu B, Jin C, Wang G, Xie C, Chen S, Xu J. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord 2020; 274: 1-7. doi:10.1016/j.jad.2020.05.009 PMid:32405111 PMCid:PMC7217769
  16. Allen B, Johnson JC. Utilization and Implementation of Trauma-Focused Cognitive-Behavioral Therapy for the Treatment of Maltreated Children. Child Maltreat 2012; 17: 80-85. doi:10.1177/1077559511418220 PMid:21875905
  17. Olowe NE, Kehinde-Dada OV, Adeolu T. Trauma-Focused Cognitive Behavioral Therapy: An Effective Treatment Approach for Victimized Girl-Child in an Era of Global Turbulence. International Conference on Education, Science and Technology (ICEST 2022). ICEST 2022 Conference Proceedings Trauma-Focused-Cognitive-Behavioral-Therapy-An-Effective-Treatment-Approach-for-Victimized-Girl-Child-in-an-Era-of-Global-Turbulence.pdf (researchgate.net)
  18. Cohen JA, Mannarino AP. Trauma-focused Cognitive Behavior Therapy for Traumatized Children and Families. Child Adolesc Psychiatr Clin 2015; 24: 557-570. doi:10.1016/j.chc.2015.02.005 PMid:26092739 PMCid:PMC4476061
  19. Hanson RF, Jobe-Shields L. Trauma-focused cognitive-behavioral therapy for children and adolescents. In: APA handbook of trauma psychology: Trauma practice, Vol. 2. Washington, DC, US: American Psychological Association, 2017: 389-410. doi:10.1037/0000020-018
  20. Thielemann JFB, Kasparik B, König J, Unterhitzenberger J, Rosner R. Stability of Treatment Effects and Caregiver-Reported Outcomes: A meta-Analysis of Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents. Child Maltreat 2023; 10775595231167383. doi:10.1177/10775595231167383 PMid:36959760
  21. Bennett RS, Denne M, McGuire R, Hiller RM. A Systematic Review of Controlled-Trials for PTSD in Maltreated Children and Adolescents. Child Maltreat 2021; 26: 325-343. doi:10.1177/1077559520961176 PMid:33016112
  22. Bormann JE, Thorp SR, Smith E, Glickman M, Beck D, Plumb D, et al. Individual Treatment of Posttraumatic Stress Disorder Using Mantram Repetition: A Randomized Clinical Trial. Am J Psychiatry 2018; 175: 979-988. doi:10.1176/appi.ajp.2018.17060611 PMid:29921143
  23. Hultmann O, Broberg AG, Axberg U. A randomized controlled study of trauma focused cognitive behavioural therapy compared to enhanced treatment as usual with patients in child mental health care traumatized from family violence. Child Youth Serv Rev 2023; 144: 106716. doi:10.1016/j.childyouth.2022.106716
  24. McGuire A, Steele RG, Singh MN. Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children. Clin Child Fam Psychol Rev 2021; 24: 20-37. doi:10.1007/s10567-020-00334-0 PMid:33428071
  25. Chipalo E. Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review. J Child Adolesc Trauma 2021; 14: 545-558. doi:10.1007/s40653-021-00370-0 PMid:34790283 PMCid:PMC8586102
  26. Thielemann JFB, Kasparik B, König J, Unterhitzenberger J, Rosner R. A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child Abuse Negl 2022; 134: 105899. doi:10.1016/j.chiabu.2022.105899 PMid:36155943
  27. Thomas FC, Puente-Duran S, Mutschler C, Monson CM. Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review. Child Adolesc Ment Health 2022; 27: 146-160. doi:10.1111/camh.12435 PMid:33216426
  28. Tricco AC, Lillies E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation | Annals of Internal Medicine. 2018. Available from: https://www.acpjournals.org/doi/10.7326/M18-0850 doi:10.7326/M18-0850 PMid:30178033
  29. Murray LK, Skavenski S, Kane JC, Mayeya J, Dorsey S, Cohen JA, Michalopoulos LTM, Imasiku M, Bolton PA. Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia. JAMA Pediatr 2015; 169: 761-769. doi:10.1001/jamapediatrics.2015.0580 PMid:26111066 PMCid:PMC9067900
  30. Dorsey S, Lucid L, Martin P, King KM, O'Donnell K, Murray LK, et al. Effectiveness of Task-Shifted Trauma-Focused Cognitive Behavioral Therapy for Children Who Experienced Parental Death and Posttraumatic Stress in Kenya and Tanzania: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77: 464-473. doi:10.1001/jamapsychiatry.2019.4475 PMid:31968059 PMCid:PMC6990668
  31. Kane JC, Figge C, Paniagua-Avila A, Michaels-Strasser S, Akiba C, Mwenge M, et al. Effectiveness of trauma-focused cognitive behavioral therapy compared to psychosocial counseling in reducing HIV risk behaviors, substance use, and mental health problems among orphans and vulnerable children in Zambia: a community-based randomized controlled trial. AIDS Behav (e-pub ahead of print 9 October 2023 doi:10.1007/s10461-023-04179-w PMid:37812272
  32. Edeh NI, Ugwoke EO, Anaele EN, Madusaba BM, Naboth-Odums A, Isiwu EA, et al. Supporting business educators and students against COVID-19 trauma using trauma-focused cognitive behavioral therapy. Medicine (Baltimore) 2022; 101: e29133. doi:10.1097/MD.0000000000029133 PMid:35446296 PMCid:PMC9276341
  33. Kaminer D, Simmons C, Seedat S, Skavenski S, Murray L, Kidd M, et al. Effectiveness of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents: a randomized controlled trial. Eur J Psychotraumatology 2023; 14: 2181602. doi:10.1080/20008066.2023.2181602 PMid:37052081 PMCid:PMC10013405
  34. Jibrin AY, Adamu H, Adisa SA. Effect of trauma-focused cognitive behavioural therapy on kidnapping anxiety among secondary school students in Zaria Metropolis, Kaduna State Nigeria. Journal of Professional Counselling 2022; 5: 168-175. 
  35. O'Callaghan P, McMullen J, Shannon C, Rafferty H. Comparing a trauma focused and non trauma focused intervention with war affected Congolese youth: a preliminary randomised trial. Interv J Ment Health Psychosoc Support Confl Affect Areas 2015; 13: 28. doi:10.1097/WTF.0000000000000054
  36. O'Callaghan P, McMullen J, Shannon C, Rafferty H, Black A. A Randomized Controlled Trial of Trauma-Focused Cognitive Behavioral Therapy for Sexually Exploited, War-Affected Congolese Girls. J Am Acad Child Adolesc Psychiatry 2013; 52: 359-369. doi:10.1016/j.jaac.2013.01.013 PMid:23582867
  37. O'Donnell K, Dorsey S, Gong W, Ostermann J, Whetten R, Cohen JA, et al. Treating Maladaptive Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group-Based Trauma-Focused Cognitive-Behavioral Therapy. J Trauma Stress 2014; 27: 664-671. doi:10.1002/jts.21970 PMid:25418514 PMCid:PMC4591025
  38. Unterhitzenberger J, Rosner R. Case report: manualized trauma-focused cognitive behavioral therapy with an unaccompanied refugee minor girl. Eur J Psychotraumatology 2016; 7: 29246. doi:10.3402/ejpt.v7.29246 PMid:26781638 PMCid:PMC4716550
  39. Kane JC, Murray LK, Cohen J, Dorsey S, Skavenski van Wyk S, Galloway Henderson J, et al. Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia. J Child Psychol Psychiatry 2016; 57: 1194-1202. doi:10.1111/jcpp.12623 PMid:27647052 PMCid:PMC5031361
  40. McMullen J, O'Callaghan P, Shannon C, Black A, Eakin J. Group trauma-focused cognitive-behavioural therapy with former child soldiers and other war-affected boys in the DR Congo: a randomised controlled trial. J Child Psychol Psychiatry 2013; 54: 1231-1241. doi:10.1111/jcpp.12094 PMid:23738530
  41. Murray LK, Skavenski S, Michalopoulos LM, Bolton PA, Bass JK, Familiar I, et al. Counselor and client perspectives of Trauma-focused Cognitive Behavioral Therapy for children in Zambia: a qualitative study. J Clin Child Adolesc Psychol Off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div 53 2014; 43: 902-914. doi:10.1080/15374416.2013.859079 PMid:24400677 PMCid:PMC4087094
  42. Murray LK, Familiar I, Skavenski S, Jere E, Cohen J, Imasiku M, et al. An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. Child Abuse Negl 2013; 37: 1175-1185. doi:10.1016/j.chiabu.2013.04.017 PMid:23768939 PMCid:PMC3823750
  43. Dorsey S, Akiba CF, Triplett NS, Lucid L, Carroll HA, Benjamin KS, et al. Consumer perspectives on acceptability of trauma-focused cognitive behavioral therapy in Tanzania and Kenya: A mixed methods study. Implement Res Pract 2022; 3: 26334895221109963. doi:10.1177/26334895221109963 PMid:37091080 PMCid:PMC9924250
  44. Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, et al. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLOS Med 2020; 17: e1003090. doi:10.1371/journal.pmed.1003090 PMid:32413027 PMCid:PMC7228043
  45. Conway M. Trauma-Focused Cognitive Behavior Therapy with Children and Adolescents: A Systematic Review. Soc Work Master's Clin Res Pap (e-pub ahead of print 2016).
  46. Spiegel JA, Graziano PA, Arcia E, Cox SK, Ayala M, Carnero NA, O'Mara NL, Sundari Foundation. Addressing Mental Health and Trauma-Related Needs of Sheltered Children and Families with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). Adm Policy Ment Health Ment Health Serv Res 2022; 49: 881-898. doi:10.1007/s10488-022-01207-0 PMid:35867261 PMCid:PMC9393136
  47. Herrenkohl TI, Hong S, Verbrugge B. Trauma-Informed Programs Based in Schools: Linking Concepts to Practices and Assessing the Evidence. Am J Community Psychol 2019; 64: 373-388. doi:10.1002/ajcp.12362 PMid:31355976
  48. Brown EJ, Cohen JA, Mannarino AP. Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers. J Affect Disord 2020; 277: 39-45. doi:10.1016/j.jad.2020.07.123 PMid:32791391
  49. Márquez YI, Deblinger E, Dovi AT. The Value of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in Addressing the Therapeutic Needs of Trafficked Youth: A Case Study. Cogn Behav Pract 2020; 27: 253-269. doi:10.1016/j.cbpra.2019.10.001
  50. Peters W, Rice S, Cohen J, Murray L, Schley C, Alvarez-Jimenez M, Bendall S. Trauma-focused cognitive-behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth. Psychol Trauma Theory Res Pract Policy 2021; 13: 313-321. doi:10.1037/tra0001016 PMid:33661675