Treating maladaptive grief and posttraumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive-behavioral therapy

J Trauma Stress. 2014 Dec;27(6):664-71. doi: 10.1002/jts.21970. Epub 2014 Nov 21.


This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic stress and their guardians who participated in this open trial. The TF-CBT for Child Traumatic Grief protocol was adapted for use with a group, resulting in 12 weekly sessions for children and guardians separately with conjoint activities and 3 individual visits with child and guardian. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary child outcomes assessed were symptoms of grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pretreatment, posttreatment, and 3 and 12 months after the end of treatment. Results showed improved scores on all outcomes posttreatment, sustained at 3 and 12 months. Effect sizes (Cohen's d) for baseline to posttreatment were 1.36 for child reported grief symptoms, 1.87 for child-reported PTS, and 1.15 for guardian report of child PTS.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Attitude to Death*
  • Child
  • Child, Orphaned / psychology*
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Focus Groups
  • Grief*
  • HIV Infections / mortality
  • Humans
  • Legal Guardians / education
  • Legal Guardians / psychology*
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data
  • Psychotherapy, Group / methods
  • Qualitative Research
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy*
  • Tanzania / epidemiology