CDC Concludes Common Treatments for Trauma Lack Empirical Support

A recent study by the Centers for Disease Control and Prevention, published in the American Journal of Preventive Medicine, is being touted as evidence that some common treatments for trauma lack empirical evidence of success in helping children and adolescents. The study, which reviewed a small percentage of the available literature, found evidence for the effectiveness of cognitive behavioral treatment, but not for six other kinds of therapy, including what may be the most widely used interventions—play and art therapy.

But the data may not be as convincing as the researchers, and especially the mainstream media, conclude. The literature review looked at only a dozen studies, and neglected to consider a good body of evidence that does lend support for play and art therapy with traumatized children. Some books written on the subject include Empirically Based Play Interventions for Children, edited by Linda A. Reddy, Tara M. Files-Hall, and Charles E. Schaefer (2005); Helping Abused and Traumatized Children, by Eliana Gil (2006); and Contemporary Play Therapy: Theory, Research, and Practice, edited by Charles E. Schaefer and Heidi Gerard Kaduson (2008).

The CDC study can be examined here.

Meanwhile, a collaborative effort between the Swedish Red Cross and a team of psychological researchers from Haugesund University College in Norway has produced a large, longitudinal study on the effect of mass trauma on both children and adults. More than 500 Swedes were interviewed over several years after surviving the Indonesian tsunami of Christmas 2004. Researchers hope that their results—which so far have revealed a “complex process of grief” in survivors—will pave the way for a better understanding of trauma.

© Copyright 2008 by Daniel Brezenoff, Licensed Clinical Social Worker. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Dr. Arthur Becker-Weidman

    September 14th, 2008 at 1:49 PM

    Dear Daniel,

    I appreciate the current update. One of the problems with the study is that they were doing research on children and adolescents who had experienced a discrete trauma, yet, about 78% of pediatric trauma victims in the US have experienced multiple trauma and only about 20% have experienced a discrete episode (See Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) ComplexTrauma in Children and Adolescents.White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force.National Center for ChildTraumatic Stress, Los Angeles, CA. and
    Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M.,
    Cloitre, M. et al. (2005) Complex trauma in children and
    adolescents. Psychiatric Annals, 35, 390–398.)

    Complex Trauma requires a multimodal approach to address the various domains of impairment. Certainly CBT can be one element and helpful, but it does not address the underlying trauma that must be revisited (See Briere, J. & Scott, C. (2006) Principles of Trauma Therapy. Sage, New York. for example). The various domains of impairment include attachment, biology, emotional regulation, dissociation, behavioral regulation, cognition, and self-concept. Dyadic Developmental Psychotherapy is an evidence-based effective treatment for children with disorders of attachment and complex trauma (see: Becker-Weidman, A. (2005) Dyadic developmental psychotherapy: the theory. In: Creating Capacity for Attachment (eds A. Becker-Weidman & D. Shell), pp. 7–43. Wood N Barnes, Oklahoma City, OK.
    Becker-Weidman, A. (2006a) Treatment for children with
    trauma-attachment disorders: Dyadic Developmental Psychotherapy.
    Child Adolescent SocialWork Journal, 23-#2, 147–171.
    Becker-Weidman, A. (2006b) Dyadic developmental psychotherapy:
    a multi-year follow-up. In: New Developments in Child Abuse Research (ed. S. Sturt), pp. 43–60. Nova Science Publishers, NewYork.
    Becker-Weidman, A. & Shell, D. (eds) (2005) Creating Capacity for Attachment. Wood N Barnes, Oklahoma City, OK.
    Becker-Weidman, A., & Hughes, D., Dyadic Developmental Psychotherapy: an evidence-based treatment for children with complex trauma and disorders of attachment. Child and Family Social Work 2008, 13, pp 329–337).

    Much research is based on very limited and proscribed conditions and often does not match what clinicians actually see in clinics and offices.

  • Karen

    September 15th, 2008 at 6:56 AM

    Why do therapists rely so heavily on play therapy in adolescents? Is this a way they feel children can communicate to them what they have experienced without having to address the real situation aloud?

  • daniel b

    September 15th, 2008 at 8:10 AM

    Karen, I would say play therapy is more often used with children under 12 years or so, not so much with adolescents. Play therapy is used with kids because their ability to think and speak in abstractions is limited, but unconscious content can come forth during play, which also builds rapport and creates an environment safe for self-exploration and thus for building self-esteem.

    Thank you for reading, and commenting!

  • Karen

    September 17th, 2008 at 8:27 AM

    So you would maintain that talk therapy is best for those starting around the adolescent and teenage years? How do you ever get members of this age group to trust you and to relay what is going on? That must be so tough!

  • Starla

    September 18th, 2008 at 3:05 PM

    I am interested in hearing from you too about this because I can barely get my teenage kids to communicate with me and I am their mother. It still amazes me that they would talk to complete strangers about their problems. maybe in some ways it is easier for them to open up to others because there is no fear of what they will think or fear of hurting their parents but I don’t know.

  • Sandy

    September 21st, 2008 at 12:59 PM

    You are right about that. I remember being a teen and always finding it easier to talk with just about anyone besides my parents. Maybe I thought they would judge me harshly- I don’t know. But I think it is great when they can find someone to talk to who can help them through whatever issues they may be facing. As for younger kids I think this would be even more difficult because I know there are times when they have no way to articulate what is going on inside of them and do not even know the right words to use to make someone else understand. That is why I am always so glad that there are teachers and therapists who really care about this age group and who can hopefully give them the coping mechanisms that they need to survive.

  • Megan

    September 22nd, 2008 at 12:54 AM

    talking the talk with teenagers, is easier said than done. My kid has this wall on his face when he knows I am about to talk to him anything on a heavier note. It’s almost like he’s closed the door on me. I see a closed door most of the time, I get mumbles for answers. I have an aching feeling he is nursing some kind of trauma.

  • Tobias

    July 7th, 2009 at 9:10 PM

    Interesting article. Were did you got all the information from? Did you type it yourself or you copy it from elsewhere?

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