4 - (SYM 14) Modular CBT for Victims of Bullying with Co-occurring Mental Health Needs: Results from a Pilot Study

Background: Bullying is a potentially traumatic stressor that can increase youth’s risk for a wide range of mental health difficulties. However, few studies have evaluated interventions for victims, and research has yet to investigate individual therapy approaches. The goal of the current pilot study is to evaluate a modular cognitive behavioral intervention for child and adolescent victims of bullying with co-occurring mental health needs.

Method: Participants to date include 11 youth in grades 4-8 (55% boys; 82% non-Hispanic White; ages 9-14) who met criteria for posttraumatic stress disorder or an adjustment disorder due to their experiences of bullying at intake; five also met criteria for an anxiety or mood disorder. Youth participated in outpatient individual therapy. Weekly ratings were obtained from youth, parents, and clinicians, and families participated in more comprehensive assessments at baseline, mid-treatment, and end-of-treatment.

Results: Three participants are actively in treatment, seven participants have completed treatment, and one participant was removed from the trial due the severity of symptoms and the need for a higher level of care. Intent-to-treat analyses with the eight participants who are not currently receiving treatment were conducted using a series of multilevel models. The number of sessions for these youth ranged from 13-44 (M = 24). Results indicated that there were significant decreases in youth’s and caregivers’ weekly ratings of internalizing symptoms (b = –0.87, p < .001 and b = –0.54, p < .001, respectively) as well as clinicians’ weekly ratings of symptom severity (b = –0.19, p < .001). Moreover, there were significant decreases in youth-reports of bullying victimization (b = –1.96, p = .001) and trauma symptoms (b = –2.71, p < .001) and caregiver-reports of overall social problems (b = –0.71, p = .03). Based on a semi-structured diagnostic interview, 100% of completers no longer met criteria for posttraumatic stress disorder or and adjustment disorder at the end-of-treatment, and 60% of the secondary anxiety/mood disorders were fully remitted.

Discussion: Preliminary findings suggest that modular CBT is a promising approach to addressing the mental health needs of victims of bullying. Children and adolescents in this trial exhibited improvements in their social functioning over the course of treatment along with corresponding decreases in their trauma, anxiety, and depressive symptoms. For many youth, it may be necessary to directly process the traumatic nature of their victimization experiences.