The Impact of Cognitive Behavioral Intervention for Trauma In Schools (CBITS) on Depression: A Meta-Analysis

Background: Adolescent depression is an escalating public health concern, with prevalence rates nearly doubling over the past two decades in the United States (Wilson & Dumornay, 2022; Brody & Hughes, 2025). Despite the availability of evidence-based treatments, significant barriers to access including cost, stigma, and provider shortages limit their reach (Bekker et al., 2017; Dwyer & Bloch, 2019). School-based interventions offer a promising pathway to address these gaps (Bodicherla et al., 2021). One such intervention is Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a 10-session group-based program originally designed to target trauma symptoms in youth, employing CBT techniques such as relaxation training, cognitive restructuring, social problem-solving, and trauma narrative development (Pfeiffer et al., 2024). Given the well-documented overlap between trauma and depression in adolescent populations, and CBITS' demonstrated effectiveness for PTSD (Author, under review), this study aimed to evaluate its effectiveness in reducing depressive symptoms across diverse settings and populations.

Methods: Following PRISMA guidelines, a systematic search of electronic databases was conducted in Fall 2024. A total of 15 studies met inclusion criteria, with 14 providing sufficient data for meta-analysis, yielding 20 analytic samples. Of these, 7 analytic samples were drawn from randomized controlled trials (RCTs; n = 717) and 13 from intervention-only studies (n = 220).

Result: The majority of participants were female youth from minoritized backgrounds, predominantly Hispanic, American Indian/Native American, and Black adolescents. Most studies were conducted in school settings, with two conducted in residential treatment and mental health agency settings. Several studies adapted the CBITS model to better serve specific populations, including extensions for youth in child welfare, cultural adaptations for American Indian youth, and the addition of family components. RCTs demonstrated a small but meaningful overall effect size of 0.29 (95% CI: -0.14, -0.06) for depressive symptom reduction, with individual effect sizes (Hedges' g) ranging from -0.80 to 0.33. Intervention-only studies showed a substantially larger overall effect size of 1.02 (95% CI: 4.43, 9.45), with stronger outcomes observed in studies targeting high-risk populations and those that incorporated culturally tailored adaptations.

Conclusion: This meta-analysis provides evidence that CBITS is an effective and adaptable school-based intervention for reducing depressive symptoms among adolescents, with particularly robust outcomes in high-risk and culturally diverse populations. Implications for practice and future research will be discussed.