Cognitive Behavior Therapy in Educational Settings as a Method to Treat Child Refugees

Results

After six weeks in the Ehntholt et al. (2005) study, participants had lower anxiety levels and fewer behavioral difficulties (4). After treatment, there was no significant difference on the depression score, but the CBT group exhibited a significant improvement in the average SDQ score (9.20 before treatment; 5.40 after). The study concluded that the use of therapy groups had other positive results “of decreasing the children’s sense of hopelessness and loneliness, as well as normalizing their reactions” (4,p. 245). However, after a 2 month follow-up, a self-reported survey completed by participants did not detect further significant changes (4).

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Gormez et al. (2017) showed compelling evidence of improvement in emotional and trauma-related symptoms (5). Post-treatment anxiety scores of the participants were statistically lower than initial diagnostic scores (40.38% versus 53.28% ), indicating that participants exhibited fewer symptoms found in anxiety-related disorders post treatment. According to the initial SDQ, 90.6% of participants showed symptoms of behavior difficulties, with an average score of 18.77, compared to 56.3% post-intervention, with an average score of 16.81 (5). After a school year in the study conducted by Fazel et al. (2009), the participants had lower SDQ scores, from the baseline average of 12.3 to a post-intervention average of 10.6 (2).

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Discussion

The three studies used CBT interventions within educational settings in different ways with different results. The first study conveyed the most drastic change of the SDQ averages in the shortest amount of time (43). The first and second interventions produced results better or on par with the third study in a shorter amount of time (2,4,5). Perhaps the reason for this is the fact that CBT therapy sessions were conducted in groups, normalizing the trauma and reactions to trauma and creating a supportive cohort within the community of the school (4,5). However, in the third study, students received one-on-one assistance and did not form a peer support system (2). One limitation to this conclusion is that since the educators were also the facilitators for CBT, they might have been biased in scoring students on the SDQ.

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Since most refugee children spend large amounts of time in educational settings, training teachers in CBT can benefit vulnerable children (2). Teachers have existing knowledge and hands-on experience with their students and thus and are better able to screen and identify refugee children in need of mental health care (2). It was noted in the third study that using mental health professionals took strain off of educators (2). However, the results showed that one-on-one therapy was less successful in lowering the SDQ scores than group therapy conducted by a teacher. In addition, one-on-one therapy is less accessible due to the lack of mental health professionals, especially those fluent in the children’s native language, and the large demand for assistance. Perhaps a more sustainable solution is the training of educators to use CBT techniques. The first study found that, once trained, teachers were able to implement CBT techniques and were well-suited to group therapy (4). Likewise, the second study found that using a school-based, teacher-led psychological intervention was a sustainable way to improve symptoms of PTSD amongst refugee children (5).

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In cases where parents may be afraid of the stigma of mental health care, the school-based intervention can provide a non-stigmatizing, convenient-access opportunity (4). “School-based health services offered an alternative to traditional clinic-based services for meeting the needs of minority children” (2, p. 298).

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In the future, more direct research is needed to compare the efficacy of group CBT and one-on-one CBT in educational settings. It would also be interesting to compare the efficacy of using mental health professionals versus trained educators in CBT. CBT in school settings is a promising means to assist refugee children suffering from symptoms of trauma, anxiety and emotional disturbances.

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