Trauma focused cognitive behavioral therapy

Trauma Focused Cognitive Behavioral Therapy

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based psychotherapy that aims at addressing the needs of children and adolescents (ages 3 to 18) with Post-Traumatic Stress Disorder (PTSD) and other difficulties related to traumatic life events. The goal of TF-CBT is to provide psychoeducation to both the child and the caregivers and help them to identify and cope with emotions, thoughts and behaviors. Research has shown TF-CBT to be effective in treating childhood Post-traumatic Stress Disorder (PTSD) and children who have experienced traumatic events

Description

TF-CBT is a treatment model that incorporates a various trauma-sensitive intervention components. . It aims at individualizing TF-CBT techniques to children and their circumstances while maintaining therapeutic relationship with both the child and parent. TF-CBT treatment can be used with children and adolescents who have experienced traumatic life events. It is a short-term treatment (typically 12-16 sessions) that combines trauma-sensitive interventions with cognitive behavioral therapy strategies. It can also be used as part of a larger treatment plan for children with other difficulties. TF-CBT includes individual sessions for both the child and the parents, as well as parent-child joint sessions.

Major Treatment Components

Major components of TF-CBT include psycho-education about childhood trauma and individualizing relaxation skills. The therapeutic elements of TF-CBT are denoted by the “PRACTICE” acronym.

• Psychoeducation and Parenting skills
• Relaxation
• Affective Expression and Regulation
• Cognitive Coping
• Trauma Narrative Development and Processing
• In Vivo Gradual Exposure
• Conjoint Parent-Child sessions
• Enhancing Safety and Future Development

Child-Specific Sessions

During the child therapy sessions, therapists focus on relaxation training such as deep breathing and muscle relaxation skills, emotion regulation (identifying feelings), trauma narrative and processing (discussing the overwhelming events and associated feelings), as well as cognitive coping strategies (identifying and replacing negative thoughts).

Parent-Specific Sessions

Parents or primary caregivers are considered as the central therapeutic agents for improvement in TF-CBT. During the parent sessions, therapists discuss the appropriateness of the treatment and safety plans with the parents and encourage positive parenting skills to maximize effective parenting.

Parent-Child Conjoint Sessions

During the conjoint sessions, therapists share the trauma narratives and challenges to incorrect/negative thoughts as means to encourage and facilitate parent-child communication. Therapists would only intervene when inaccurate cognitions were not addressed. .

Methods of Access

Therapist

TF-CBT can be delivered by a variety of mental health professions ranging from clinical social workers, counselors to psychologists and psychiatrists. Qualified therapists are required to be trained and experienced in TF-CBT. Therapists can be trained by the online TF-CBT certified training course.

Implementation and Adaptations

Since its development in the1980s, TF-CBT has been used by therapists in many countries such as Australia, Cambodia, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Pakistan, Sweden, United States and Zambia. It has also been used with children in foster care system , as well as with those who have suffered from traumatic life events including the 9-11 terrorist attacks and Hurricane Katrina . TF-CBT has also been adapted to different cultures, including Latino populations and the treatment manual book has been translated into other languages such as Dutch, German, Japanese, Korean and Mandarin.

Evaluation of Effectiveness

Randomized clinical trials examining the efficacy of TF-CBT have found TF-CBT to be an effective treatment plan for a variety of disorders in both children and adolescents. TF-CBT has been proven to effectively reduce symptoms of PTSD, depression , anxiety, externalizing behaviors, sexualized behaviors and feelings of shame in traumatized children. TF-CBT has been shown to improve positive parenting skills and support of the child through the enhancement of parent-child communication.

A study examining the combinatorial effect of TF-CBT with sertraline has found that there were only minimal benefits associated with adding sertraline to the treatment, providing evidence for initial trial of TF-CBT before medication.

External links

• http://tfcbt.musc.edu/
• https://www.childwelfare.gov/pubs/trauma/
• http://clinicaltrials.gov/show/NCT00614068

References

 # ^Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press
 #   ^Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive behavioral therapy for children and adolescents an empirical update. Journal of Interpersonal Violence, 15(11), 1202-1223.
 #   ^Cohen, J. A., Mannarino, A. P., Perel, J. M., & Staron, V. (2007). A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 811-819.
 #  ^ Ford, J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: trauma adaptive recovery group education and therapy (TARGET).American Journal of Psychotherapy, 60(4).
 #  ^ Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004). Treating childhood traumatic grief: A pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 43(10), 1225-1233.
 #  ^ Cohen, J. A., Mannarino, A. P., & Staron, V. R. (2006). A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG).Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1465-1473.
 #   ^Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Archives of pediatrics & adolescent medicine,165(1), 16-21.
 #   Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135-145.
 #   Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press
 #   http://www.thereachinstitute.org/tf-cbt-training-course.html
 #   Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive behavioral therapy for children and adolescents an empirical update. Journal of Interpersonal Violence, 15(11), 1202-1223.
 #   Cohen, J. A., & Mannarino, A. P. (2008). Trauma‐Focused Cognitive Behavioural Therapy for Children and Parents. Child and Adolescent Mental Health, 13(4), 158-162.
 #   Cohen JA, Mannarino AP, Deblinger E Child and Parent Trauma-focused Cognitive
 # Behavioral Therapy Treatment Manual. Drexel University College of Medicine
 # (available from the authors at jcohen1@wpahs.org).
 #   http://academicdepartments.musc.edu/projectbest/tfcbt/tfcbt.htm
 #   http://tfcbt.musc.edu/ 
 #   http://www.nrepp.samhsa.gov/viewintervention.aspx?id=135
 #   Dorsey, S. (2012). Trauma-focused CBT for youth in foster care: Preliminary findings from a randomized controlled trial. In Presented at the San Diego conference on child and family maltreatment San Diego, January, (p. 2012).
 #   Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., ... & Schonlau, M. (2010). Children's mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies.Journal of Traumatic Stress, 23(2), 223-231.
 #   http://promising.futureswithoutviolence.org/?program=trauma-focused-cognitive-behavioral-therapy-tf-cbt
 #   Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. (2004). A multi-site randomized controlled trial for children with sexual abuse-related PTSD. Journal of the American Academy Child Adolescent Psychiatry, 43, 393–402.
 #   Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child abuse & neglect, 34(4), 215-224.
 #   Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological medicine, 36(11), 1515-1522.
 #   Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135-145.
 #   Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748-757.
 #   Cohen, J. A., Mannarino, A. P., Perel, J. M., & Staron, V. (2007). A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 811-819.