To The Editor: In their randomized controlled
trial of school-based CBT, Dr Stein and colleagues1 excluded
children "with symptoms of PTSD . . . that they were not willing to discuss
in a group." The scientific and ethical value of this restriction, however,
has not always been appreciated in international psychosocial relief efforts.
Group interventions for children traumatized by civil wars and genocide in
the developing world have used methods similar to the approach of Stein et
al, emphasizing exposure to trauma memories through imagination and artistic
expression.2 However, children uncomfortable
with emotional self-disclosure have been included and sometimes pressed to
participate actively.2 Perhaps not surprisingly,
uncontrolled trials of these interventions found that a substantial proportion
of children experienced symptom exacerbation, rather than alleviation.3
Neugebauer R. School-Based Interventions for Children Exposed to ViolenceSchool-Based Interventions for Children Exposed to Violence. JAMA. 2003;290(19):2541. doi:10.1001/jama.290.19.2541-a
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