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To The Editor: In their randomized controlled trial of school-based CBT, Dr Stein and colleagues¹ excluded children "with symptoms of PTSD . . . that they were not willing to discuss in a group." The scientific and ethical value of this restriction, however, has not always been appreciated in international psychosocial relief efforts. Group interventions for children traumatized by civil wars and genocide in the developing world have used methods similar to the approach of Stein et al, emphasizing exposure to trauma memories through imagination and artistic expression.² However, children uncomfortable with emotional self-disclosure have been included and sometimes pressed to participate actively.² Perhaps not surprisingly, uncontrolled trials of these interventions found that a substantial proportion of children experienced symptom exacerbation, rather than alleviation.³

Although Stein et al found CBT to be safe and effective for children sufficiently willing to discuss their problems, it would be of interest to know . . . [Full Text of this Article]

Richard Neugebauer, PhD, MPH
Department of Epidemiology of Developmental Brain Disorders
New York State Psychiatric Institute
New York

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