This is a cognitive–behavioral intervention for children who have been exposed to traumatic events, and for their parents. The goal is to help children improve their symptoms of posttraumatic stress, depression, and anxiety. The program is rated Promising. Children who received the treatment demonstrated significant improvements on measures of posttraumatic stress, anxiety symptoms, and emotional regulation; however, there were no significant effects on measures of depression or coping efficacy.
Bounce Back is a cognitive–behavioral program for children in grades one through five who have been exposed to traumatic events. The goal is to reduce their posttraumatic stress, anxiety, and depressive symptoms and to improve functioning in school.
Program Components/Target Population
The program targets children who have experienced one or more traumatic events, and have current symptoms of posttraumatic stress disorder (PTSD). The program takes place during the school day. It consists of 10 group sessions, lasting between 50 to 60 minutes, and 2 to 3 individual sessions, lasting for 30 to 50 minutes. There are also 1 to 3 parent sessions.
The intervention uses a combination of therapeutic elements similar to other cognitive–behavioral interventions for youths with PTSD, including psychoeducational, relaxation training, cognitive restructuring, social problem solving, positive activities, and trauma-focused intervention strategies such as a gradual approach of anxiety-provoking situations and trauma narrative. The trauma narrative involves repeated retelling of the traumatic event to decrease anxiety and fear associated with the memory.
The group sessions include four to six students who are within one grade year of each other. Each group session includes setting an agenda, reviewing activity assignments, introducing new concepts (through a combination of didactics, games, sorties, and other experiential activities), and assigning activities for the next group session. The group sessions introduce more foundational elements (such as identifying feelings before describing the link between thoughts and feelings), making concepts very concrete (such as trauma narratives conveyed through pictures created by students), and creating games and other activities to engage younger students in the taught skills and strategies. Parents are invited to one-on-one sessions with the child and the group leader to enable the child to share his or her trauma narrative. Parents and teachers of students in the Bounce Back program also receive weekly handouts or emails describing the skill covered during group session that week.
Research has found that untreated PTSD symptoms put children at a much greater risk for other mental health disorders (Copeland et al. 2007). Based on the research behind the adverse effects of PTSD, the Bounce Back program targets these youths and provides treatment options for significant symptoms of depression, anxiety, and disruptive behavior (Freeman, Mokros, and Poznanski1993; Kliewer, et al. 1998; Lynch and Cicchetti 1998).
Overall, Langley and colleagues (2015) found mixed results when studying the effectiveness of the Bounce Back program. There were no significant improvements on measures of depression or coping efficacy; however, there were significant improvements for program participants on measures of posttraumatic stress, anxiety, and emotional regulation.
Child Reports of Posttraumatic Symptoms
The intervention group showed significant improvement in child reports of posttraumatic stress symptom frequency during the first 3 months of the program, compared with comparison group.
Parent Reports of Posttraumatic Symptoms
The intervention group showed significant improvement in parent reports of posttraumatic stress symptom frequency during the first 3 months of the program, compared with comparison group.
Child Reports of Depressive Symptoms
There were no significant differences between the intervention and comparison groups at 3 months measuring for children’s depressive symptoms.
Screen for Child Anxiety Related Emotional Disorders (SCARED)
The intervention group showed significant improvement in child reports of anxiety disorders during the first 3 months of the program, compared with comparison group.
Parent Reports of Strength and Difficulties
The intervention group showed significant improvement on assessment of emotional, conduct, hyperactivity/inattention, peer relationships, functional impairment, and prosocial behavior during the first 3 months of the program, compared with comparison group.
Parent Reports of Emotion Regulation Checklist-Negativity/Lability
The intervention group showed significant improvement on parent reports of negative moods, mood lability, and emotion regulation during the first 3 months of the program, compared with comparison group.
Child Reports of Coping Efficacy
There were no significant differences between the intervention and comparison groups at 3 months measuring for children’s handling of past and current stressors.
Langley and colleagues (2015) conducted a randomized controlled trial in four Los Angeles, California elementary schools to examine the effects of the Bounce Back cognitive–behavioral therapy program on first through fifth graders who had been exposed to trauma. This study examined the child-reported and parent-reported symptoms of posttraumatic stress and child-reported symptoms of anxiety.
Four elementary schools were used as the sites to recruit 1,050 first through fifth graders by survey. After returning the survey and screening for consent, only 113 students were eligible for the study. Eligibility was determined by two criteria: 1) experience of one or more traumatic events, and 2) current symptoms of posttraumatic stress disorder (PTSD) indicating moderate or higher levels of symptoms severity. However, students who had severe psychiatric symptoms such as acute suicidal behavior, and students who reported only sexual abuse as the one traumatic event were excluded from consideration. After students had been excluded, there were 74 children randomly assigned to the treatment or wait-list comparison groups. The 36 students in the treatment group received the Bounce Back program during the fall semester. The 38 students in the comparison group were randomly assigned to the spring semester wait-list comparison group and did not have exposure to the intervention during the fall semester.
The mean age for the treatment and comparison group was 7.65 years old, and 50 percent of the students were male. The race/ethnicity breakdown was as follows: 49 percent Latino, 27 percent white, 18 percent African American, 1 percent Asian,1 percent African American/Hispanic, 1 percent Asian/white and 2 percent Hispanic/white. Close to one quarter of the families (24.3 percent) had a highest household education of less than high school. Nearly half (43.3 percent) had a household income of $40,000 or less. The two groups were only significantly different on the highest parental education level; this variable was included as a covariate in the statistical analysis.
The assessment instruments of this study were administered at baseline, at 3-month follow up, and at 6-month follow up. To measure trauma exposure, a modified version of the Traumatic Events Screening Inventory for Children–Brief Form (TESI-C-Brief) was used. Additionally, the UCLA Posttraumatic Stress Disorder Reaction Index, Children’s Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED-C) were used to measure trauma exposure. The Strengths and Difficulties Questionnaire (SDQ), the Social Adjustment Scale–Self-Report for Youth (SAS-SR-Y), Coping Efficacy measure, and Emotion Regulation Checklist (ERC) were used as secondary outcome measures. Cohen’s f2 was used in the analysis of the data. A Benjamini-Hochberg analysis was also performed.
There is no cost information available for this program.
School-based clinicians have implemented the intervention, as part of their job responsibilities. The clinicians were master’s-level social workers or licensed clinical psychologists. Clinicians received a 1-day training session. Clinicians would meet weekly as a group for consultation with the program developer during the first year of the program and would meet biweekly during the second year of the program (Langley et al. 2015). Additional implementation information can be found at https://bouncebackprogram.org
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1
Langley, Audra, Araceli Gonzalez, Catherine Sugar, Diana Solis, and Lisa Jaycox. 2015. “Bounce Back: Effectiveness of an Elementary School-Based Intervention for Multicultural Children Exposed to Traumatic Events.” Journal of Consulting and Clinical Psychology
These sources were used in the development of the program profile:
Copeland, William, Gordon Keeler, Adrian Angold, and Jane Costello. 2007. “Traumatic Events and Posttraumatic Stress in Childhood.” Archives of General Psychiatry
Freeman, Linda, Hartmut Mokros, and Elva Poznanski. 1993. “Violent Events Reported by Normal Urban School-Aged Children: Characteristics and Depression Correlates.” Journal of the American Academy of Child & Adolescent Psychiatry
Kliewer, Wendy, Stephen Lepore, Deborah Oskin, and Patricia Johnson. 1998. “The Role of Social and Cognitive Processes in Children’s Adjustment to Community Violence.” Journal of Consulting and Clinical Psychology
Lynch, Michael, and Dante Cicchetti. 1998. “An Ecological-Transactional Analysis of Children and Contexts: The Longitudinal Interplay Among Child Maltreatment, Community Violence, and Children’s Symptomatology.” Development and Psychopathology