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November 19, 2003

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

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

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