Effectiveness of Trauma-Focused Interventions in Reducing Externalizing Behaviors Among Traumatized Adolescents: A Systematic Review and Meta-Analysis

Abstract

Despite existing literature suggesting the effectiveness of trauma-focused interventions in reducing trauma-related symptoms, notably post-traumatic stress disorder, depression, and anxiety, few studies have specifically evaluated the effectiveness of such interventions on externalizing behaviors—a prevalent concern among traumatized adolescents. Aiming to fulfill this research gap, this systematic review and meta-analysis conducted a thorough search in eight electronic databases, including EBSCO, ERIC, MEDLINE, PubMed, ProQuest, PsycINFO, Scopus, and Web of Science. Twelve studies, which included a total number of 1251 participants, were finalized, and we performed meta-analyses based on a random effect model on Review Manager software (Version 5.4). By systematically reviewing the included studies, we identified trauma-focused interventions—such as Trauma-Focused Cognitive Behavioral Therapy, Narrative Exposure Therapy, Prolonged Exposure Therapy, MASTR/EMDR therapy, and Cognitive Processing Therapy—as effective approaches for reducing externalizing behaviors in traumatized adolescents. Results of the meta-analysis showed a significant effect of trauma-focused interventions in reducing externalizing behaviors (SMD = −0.70, 95% CI [−0.98, −0.41], Z = 4.74, p < .001). Subgroup analyses identified several key factors influencing the effectiveness of interventions, including adolescent age, intervention duration, intervention methods, participant number, and intervention settings. Practical implications were also discussed according to the findings presented.