Aug. 5, 2003 -- Exposure to violence is a common part of life for many children in America, especially those living in poor, crowded, urban areas. Children who witness or are victims of violence often develop symptoms of posttraumatic stress disorder (PTSD). But they can be helped, new research shows, by a classic treatment for posttraumatic stress disorder -- group therapy.
Sixth graders with violence-induced posttraumatic stress disorder showed significant decreases in PTSD symptoms after a 10-week intervention involving cognitive-behavioral group therapy. The research appears in the Aug. 6 issue of The Journal of the American Medical Association.
People with posttraumatic stress disorder can re-experience a traumatic event in the form of flashbacks, memories, or nightmares. They can also experience symptoms of numbness, sleep disturbances , depression, anxiety, irritability, and anger.
The middle school students who took part in a school-based intervention program reported being victims of roughly three violent events and witnessing an average of six such events within their communities. Social workers taught them ways to reduce their feelings of anxiety and sadness. Students also learned how to deal with negative thoughts, solve real-life problems, approach anxiety-provoking situations, and cope with violent events through talking, writing, and drawing.
In addition to the group sessions, the program included at least one individual session for each child, four group meetings for parents, and an educational presentation for teachers. Researchers at the nonprofit think tank, RAND Corporation, developed the program.
"This program is administered by people already working in the schools," study author Bradley D. Stein, MD, PhD, tells WebMD. "It doesn't take years of special training."
Roughly half of the students recruited for the program received immediate group counseling and the other half were observed for three months without treatment. When the students were evaluated, 86% of the students who went through the program had fewer posttraumatic stress symptoms and 67% had fewer symptoms of depression. More than three-fourths of parents reported that their child was functioning better than they were before intervention.
After the second group participated in the same 10-session program, they also showed improvements similar to those seen in the first group. The improvements continued long after the program was completed.
While community violence can occur anywhere, the prevalence of such violence in America's poor, urban communities is startling. According to statistics from the National Center for Children Exposed to Violence:
- Nine out of 10 high school kids surveyed in an urban community in Miami reported having witnessed community violence, and 44% said they had been victims of violent crime.
- 88% of children living in an urban neighborhood in Richmond, Va., reported having heard gunfire near their home, and 25% reported witnessing someone being killed.
- 39% of middle school kids living in a poor, urban neighborhood in New Haven, Conn., witnessed someone being shot during the preceding year.
"Living in certain communities in America has been compared to living in a war zone, and I don't think that is much of an exaggeration," clinical psychologist Albert D. Farrell, PhD, tells WebMD.
A professor of psychology at Virginia Commonwealth University, Farrell has studied the impact of exposure to violence on high-risk children and adolescents for years. He says it is clear that kids who witness or are victims of violent events are more likely to exhibit violent or aggressive behaviors themselves. They are also more likely to abuse drugs and act out in other ways.
Steven Berkowitz, MD, of the Yale Child Study Center, agrees that intervention is key to helping children cope.
"One of the clearest pathways to delinquency and criminal behavior is early chronic exposure to violence and victimization," he tells WebMD. "One way of dealing with feeling helpless is to become aggressive. Intervention helps children gain some sense of control and perspective on the violence in their lives."