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Exposure to traumatic events among youth is relatively common. Almost all youth experience initial distress as a reaction to such events, but, for most, natural resilience causes the distress to gradually subside. However, a substantial minority continue to experience distress in the months after trauma exposure.

The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program was designed for use with groups of students who have experienced significant traumatic experiences and are suffering from related emotional or behavioral problems, particularly symptoms of posttraumatic stress disorder. Delivered by school-based clinicians and taking into account cultural context, it uses a variety of proven cognitive behavioral techniques in an early intervention approach, including psychoeducation about trauma and its consequences, relaxation training, learning to monitor stress or anxiety levels, recognizing maladaptive thinking, challenging unhelpful thoughts, social problem-solving, creating a trauma narrative and processing the traumatic event, and facing trauma-related anxieties rather than avoiding them. CBITS focuses primarily on three goals: decreasing current symptoms related to trauma exposure, building skills for handling stress and anxiety, and building peer and caregiver support.

In this new adaptation, a team of experts convened by the University of Montana adapted the CBITS program for American Indian youth, weaving in culturally appropriate and meaningful concepts about resilience and healing while maintaining CBITS' core cognitive-behavioral skill-building techniques.

Table of Contents

  • Group Session 1

    Introductions

  • Group Session 2

    Education and Relaxation

  • Individual Session 1

    Trauma Narrative: Processing the Trauma Memory

  • Individual Session 2

    Trauma Narrative: Processing the Trauma Memory

  • Individual Session 3

    Trauma Narrative: Processing the Trauma Memory

  • Group Session 3

    Introduction to Cognitive Therapy

  • Group Session 4

    Combating Unhelpful Negative Thoughts

  • Group Session 5

    Introduction to Real-Life Exposure

  • Group Session 6

    Exposure to Stress or Trauma Memory

  • Group Session 7

    Exposure to Stress or Trauma Memory

  • Group Session 8

    Introduction to Problem-Solving

  • Group Session 9

    Practice with Problem-Solving

  • Group Session 10

    Relapse Prevention and Graduation

  • Session 1

    Caregiver Education Program

  • Session 2

    Caregiver Education Program

  • Session 1

    Teacher Education Program

Research conducted by

The research described in this report was funded through a grant from the Substance Abuse and Mental Health Services Administration (an agency within the U.S. Department of Health and Human Services) and conducted by the Social and Behavioral Policy Program within RAND Social and Economic Well-Being.

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