CBITS: Cognitive Behavioral Interventions
for Trauma in Schools
By Jack Komer, 12/2021.
What is CBITS?
The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is a school-based intervention used with students in fifth-twelfth grade. It is an individual and group intervention designed to reduce symptoms of PTSD, depression, and behavioral problems and improve functioning, resilience, school grades and attendance, peer and parent support, and coping skills. This intervention is intended for students in grade 5-12 who have experienced or witnessed traumatic life events such as community and school violence, accidents and injuries, physical abuse or domestic violence, and natural or man-made disasters (Cognitive Behavioral Intervention for Trauma in Schools (Cognitive Behavioral Intervention for Trauma in Schools (CBITS)), 2021). CBITS is available in English, Spanish, and Arabic (CBITS, 2012).
Components of CBITS
The CBITS intervention lasts 10 weeks, with one hour-long student group session each week, typically with five to eight students.
During these sessions, cognitive behavioral skills and trauma-focused work is used to help reduce symptoms. Techniques used in this intervention include psycho-education regarding responses to trauma and the connections between thoughts and feelings, relaxation training, cognitive restructuring of negative thoughts, graded exposure to fear hierarchy and stress/trauma memory through creative activities, and social problem-solving training.
1-3 individual sessions with the students also occurs during this intervention that focus on gradual exposure to a traumatic event, which is then brought out in the group sessions using drawing or writing exercises (Youth.GOV, 2021).
CBITS also includes 2 parent sessions and a teacher session, in which psycho-education is provided and skills taught to their students are reviewed to reinforce those skills at home and in school (National Child Traumatic Stress Network, 2012)
Evidence of CBITS Effectiveness
Randomized controlled trials have found CBITS to be more effective than simply receiving usual care or waitlist services with multiple populations, including but not limited to improving social problem solving in multicultural adolescent girls involved in child welfare (Auslander et al., 2020), reducing PTSD and depression symptoms in Spanish-speaking Latinx students (Allison & Ferreira, 2016), and reduced PTSD, psychosocial dysfunction, and depressive symptoms in a primarily Latinx middle school (Stein et al., 2003). Other clinical studies have found CBITS to be effective in reducing PTSD and depression symptoms in rural reservation-based Native American adolescents (Morsette et al., 2009). CBITS has also been adapted into the Mental Health for Immigrants Program, which was found to be effective in reducing PTSD and depressive symptoms in Latinx immigrants (Kataoka et al., 2003).
Allison, A. C., & Ferreira, R. J. (2016). Implementing cognitive behavioral intervention for trauma in schools (CBITS) with Latino youth. Child and Adolescent Social Work Journal, 34(2), 181-189. doi:10.1007/s10560-016-
Auslander, W., Edmond, T., Foster, A., Smith, P., Mcginnis, H., Gerke, D., Tlapek, S., Threlfall, J., Voth Shrag, R., Dunn, J., & Jonson-Reid, M. (2020). Cognitive behavioral intervention for trauma in adolescent girls in child welfare: A randomized controlled trial. Children and Youth Services Review, 119, 105602. doi:10.1016/j.childyouth.2020.105602
Cognitive Behavioral Intervention for Trauma in Schools (CBITS). (2021). Home. Retrieved from http://cbitsprogram.org/
Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., Tu, W., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 311-318. doi:10.1097/00004583-200303000-00011
Morsette, A., Swaney, G., Stolle, D., Schuldberg, D., Pol, R. V., & Young, M. (2009). Cognitive behavioral intervention for trauma in schools (CBITS): School-based treatment on a rural American Indian reservation. Journal of Behavior Therapy and Experimental Psychiatry, 40(1), 169-178. doi:10.1016/j.jbtep.2008.07.006
National Child Traumatic Stress Network (NCTSN). (2012). CBITS: Cognitive behavioral intervention for trauma in schools. Retrieved from https://www.nctsn.org/sites/default/files/interventions/cbits_fact_sheet.pdf
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence. JAMA, 290(5), 603. doi:10.1001/jama.290.5.603
Youth.GOV. (2021). Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Retrieved from https://youth.gov/content/cognitive-behavioral-intervention-trauma-schools-cbits