Outcome of Cognitive Behavioral Therapy in Adolescents After
Mitra Hakim Shooshtary, M.D.a,*, Laily Panaghi, M.D., M.P.H.b,
and Jafar Attari Moghadam, M.D.a
aIran University of Medical Sciences, Tehran Institute of Psychiatry (Mental Health Research Center), Tehran, Iran
bFamily Research Institute, Shahid Beheshti University, Tehran, Iran
Manuscript received December 17, 2006; manuscript accepted September 7, 2007
AbstractPurpose: The authors evaluated the effectiveness of cognitive behavioral therapy (CBT) among
adolescents exposed to the 2004 earthquake in Bam, Iran.
Methods: Four months after the earthquake, 135 adolescents as a case group and 33 adolescents as
a comparison group were evaluated with the Impact of Event Scale Revised (IES-R). Two therapists
were trained in CBT in 3-day classes according to a manual provided by mental health services.
After conducting CBT in the case group, both groups were evaluated again with IES-R.
Results: The severity of posttraumatic stress symptoms significantly decreased among the subjects
given CBT in the case group. The improvement in posttraumatic stress symptoms was attributable
to improvement in each of three-symptom categories (intrusion, avoidance, and arousal) and in the
total score of posttraumatic stress disorder (p ? .05).
Conclusions: The findings demonstrate the efficacy of CBT in alleviating posttraumatic stress
symptoms among adolescents after a catastrophic disaster. © 2008 Society for Adolescent Medicine.
All rights reserved.
Earthquake; Adolescents; CBT; PTSD
On the morning of December 26, 2003, at 05:28 (local time)
a major earthquake measuring 6.5 on the Richter scale struck
the city of Bam, Kerman Province, southeastern Iran. The
epicenter of the earthquake, with a depth of 10 km, was near
the city of Bam, which was located at 180 km southeast of the
provincial capital of Kerman and 975 km southeast of Tehran.
The Iranian government estimated the deaths from the
earthquake at 41,000, with some figures exceeding 50,000.
More than 10,000 survivors were injured.
According to the USAID Disaster Assistance Response
Team (USAID/DART), 85 percent of the buildings had
been destroyed in Bam and the surrounding area.
Although most of the casualties occurred in Bam itself,
the impact on the surrounding rural areas was also severe.
According to a recent survey, more than 18,000 houses
across 250 villages were completely destroyed. As a result
of the earthquake, the electricity, water supply, and most
public health services were completely disrupted.
The earthquake occurred early in the morning, when
children and adolescents were asleep. Awakening to the
sound of people weeping and wailing in profound despair
brought their horrendous suffering home in a powerful way.
Serious and long-lasting psychiatric consequences can be
found in children and adolescents following major stressor
Previous studies in Armenia have documented severe
posttraumatic reactions and high rates of comorbid depres-
sion 18 months after the earthquake among children and
adolescents in cities that were close to the epicenter [3,4].
There is accumulating evidence that these sequelae have
adverse effects on their future development, including cog-
nition and attention, social skills, personality style, self-
concept and self-esteem, and impulse control . Stress and
*Address correspondence to: Mitra Hakim Shooshtary, M.D., P.O. Box
14565-441 Shahied Mansori St., Niayesh St., Sattarkhan Ave., Tehran
1443813444 I.R. Iran.
E-mail address: email@example.com
Journal of Adolescent Health 42 (2008) 466–472
1054-139X/08/$ – see front matter © 2008 Society for Adolescent Medicine. All rights reserved.
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