Group Cognitive-Behavior Therapy and Supportive Art and Sport Interventions on Bam Earthquake Related Post Traumatic Stress Symptoms in Children: A Field Trial

By Mahmoudi-Gharaei, Javad; Mohammadi, Mohammad Reza et al. | Iranian Journal of Psychiatry, Summer 2009 | Go to article overview

Group Cognitive-Behavior Therapy and Supportive Art and Sport Interventions on Bam Earthquake Related Post Traumatic Stress Symptoms in Children: A Field Trial


Mahmoudi-Gharaei, Javad, Mohammadi, Mohammad Reza, Yasami, Mohammad Taghi, Josheghani, Narges, Naderi, Fatemeh, Iranian Journal of Psychiatry


Objective: The main objective of this study is to evaluate the effect of psychological therapies and art/sport supportive interventions separately, and in combination on post traumatic stress symptoms in children and compare them with a control group .

Methods: In a field trial, we evaluated the efficacy of group behavioral therapy, art and sport supportive interventions in Bam earthquake children survivors with PTSD symptoms and compared it with a control group. Before and after interventions we evaluated the PTSD symptoms using K-SADS-PL semi-structural interview for each group and compared them using appropriate statistical methods.

Results: The participants were 200 individuals who were randomized in four groups according to an intervention program including: Group behavioral therapy; Group behavioral therapy plus art and sport interventions; Art and sport interventions; and control group. During the interventions, 39 individuals were excluded. None of the participants had severed PTSD or other psychiatry disorders that needed pharmacological interventions. In interventional groups, the reduction of total PTSD symptoms and the symptoms of re-experience, avoidance and hyper arousal was not statistically significant. However, in the control group, the PTSD symptoms increased during the study which was statistically significant.

Conclusion: Group behavior therapy and supportive interventions (art and sport) may have preventive effects on PTSD symptoms.

Keywords: Art, Behavior therapy, Child, Earthquakes, Group Therapy, Post traumatic stress disorder, Sports

Iran J Psychiatry 2009; 4:85-91

Following natural disasters, most of survivors show significant clinical symptoms including anxiety, depressive and posttraumatic stress symptoms (1). Commonly, PTSD is the first reaction of survivors to the traumatic experience and is a predictor for longterm subsequent mental and physical health consequences (2). In two different studies on 430 and 586 survivors of the earthquake in Turkey in 1999, the occurrence of mental problems such as PTSD was directly associated with the severity of traumatic experience and also the distance from the trauma area (3, 4).

In a study in Taiwan, 21.7% of the 323 earthquake survivors had PTSD symptoms. Mousavi et al have shown that 45.1% of the adolescents exposed to Bam earthquake in Iran are affected by PTSD (5). However, the prevalence range of PTSD from natural disasters is children (6). The comorbidity with other psychiatric disorders may cause more disabilities especially in estimated to be from 2.5-33% in adults and 28-70% in children and adolescents. The most common comorbidity is major depressive disorder. In a study on 218 student survivors of the earthquake in Armenia, the severity of PTSD symptoms was associated with the severity of depressive symptoms (7). In another study on Bam earth quake survivors, PTSD was a predictor for major depressive and generalized anxiety disorders in adolescents (8).

Therefore, therapeutic interventions are essential to reduce the symptoms of PTSD severity and psychological morbidities after disasters. Pharmacological (9, 10) and nonpharmacological interventions including individual and group supportive psychotherapy and cognitive behavioral therapy are the most frequent therapeutic interventions in treatment of PTSD patients (11, 12 and 13). Smith et al have introduced a kind of short term group cognitive behavioral therapy for the treatment of PTSD (14). Yule and et al have documented the efficacy of this method in several studies including the girls' survivors of Jupiter ship accident and the children survivors of Athens 1999 earth quake (15).

Psychological debriefing is another group intervention for prevention of posttraumatic symptoms during 48 to 72 hours after traumatic events using methods such as emotional regulation, normalization of responses and training of normal psychological reactions to traumatic experience in a supportive manner (16 , 17).

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