Trauma focused cognitive behavioral therapy

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events.[1] The goal of TF-CBT is to provide psychoeducation to both the child and the non-offending caregivers and help them to identify and cope with emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced traumatic events.[2][3][4]

Trauma focused cognitive behavioral therapy
Specialtypsychology

Description

TF-CBT is a treatment model that incorporates various trauma-sensitive intervention components.[5] It aims at individualizing TF-CBT techniques to children and their circumstances while maintaining therapeutic relationship with both the child and parent.[6] 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.[7] It can also be used as part of a larger treatment plan for children with other difficulties.[8] 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.[9]

  • 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, the therapist focuses on relaxation training such as deep breathing and muscle relaxation skills, emotion regulation (identifying feelings), a trauma narrative and processing (discussing the overwhelming events and associated feelings), as well as cognitive coping strategies (identifying and replacing negative thoughts).[10]

Parent-specific sessions

Parents or primary caregivers are considered as the central therapeutic agents for improvement in TF-CBT.[11] During the parent sessions, the therapist discusses the appropriateness of the treatment and safety plans with the parents and encourages positive parenting skills to maximize effective parenting.[12]

Parent-child conjoint sessions

During the conjoint sessions, the therapist shares the trauma narratives and challenges to incorrect/negative thoughts as a means to encourage and facilitate parent-child communication. The therapist would only intervene when inaccurate cognitions were not addressed.[13]

Group sessions

Group TF-CBT is an alternative to individual TF-CBT that reduces individual therapist hours and provides relief after disasters or in areas with limited resources.[14] Similar to individual TF-CBT, group TF-CBT involves both child and caregiver and utilizes the ‘PRACTICE’ elements, typically delivered through 12 structured sessions that target the reduction of distress and feelings of shame.[15]

Evaluation of effectiveness

Randomized clinical trials examining the efficacy of TF-CBT have found it to be an effective treatment plan for a variety of disorders in both children and adolescents.[16][17] TF-CBT has been proven to effectively reduce symptoms of PTSD, depression, anxiety, externalizing behaviors, sexualized behaviors, and feelings of shame in traumatized children.[18] TF-CBT has been shown to improve positive parenting skills and support of the child through the enhancement of parent-child communication.[19] 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 an initial trial of TF-CBT before medication.[20]

While TF-CBT has been shown to just as effective as Eye movement desensitization and reprocessing (EMDR) for the treatment of chronic post-traumatic stress disorder (PTSD) in adults, the results were tentative given low numbers in the studies, high drop out rates, and high risk of experimenter bias.[21]

Methods of access

Therapist

TF-CBT can be delivered by a variety of mental health professionals ranging from clinical social workers, counselors to psychologists and psychiatrists.[22] Qualified therapists are required to be rostered or nationally certified in TF-CBT. Part of the training for this treatment includes an online TF-CBT certified training course.[23] Additional criteria are required in order for a clinician to be rostered or nationally certified. [24]

Implementation and adaptations

Since its development in the 1980s, 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.[25] It has also been used with children in the foster care system, with those who have suffered from traumatic life events, including the 9-11 terrorist attacks, and those who experienced Hurricane Katrina.[26] TF-CBT has also been adapted to different cultures, including Latino populations. The treatment manual book has been translated into a variety of languages, such as Dutch, German, Japanese, Korean, and Mandarin.[27]

References
  1. Cohen, Judith A. (2006). Treating trauma and traumatic grief in children and adolescents ([Online-Ausg.]. ed.). New York: The Guilford Press. ISBN 978-1593853082.
  2. 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. doi:10.1097/chi.0b013e3180547105. PMID 17581445.
  3. COHEN, J. A.; MANNARINO, A. P.; BERLINER, L.; DEBLINGER, E. (1 November 2000). "Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: An Empirical Update". Journal of Interpersonal Violence. 15 (11): 1202–1223. doi:10.1177/088626000015011007.
  4. 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).
  5. COHEN, JUDITH A.; MANNARINO, ANTHONY P.; KNUDSEN, KRAIG (October 2004). "Treating Childhood Traumatic Grief: A Pilot Study". Journal of the American Academy of Child & Adolescent Psychiatry. 43 (10): 1225–1233. doi:10.1097/01.chi.0000135620.15522.38. PMID 15381889.
  6. COHEN, JUDITH A.; MANNARINO, ANTHONY P.; STARON, VIRGINIA R. (December 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. doi:10.1097/01.chi.0000237705.43260.2c. PMID 17135992.
  7. Cohen, JA; Mannarino, AP; Iyengar, S (Jan 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. doi:10.1001/archpediatrics.2010.247. PMID 21199975.
  8. Cohen, JA; Mannarino, AP; Knudsen, K (Feb 2005). "Treating sexually abused children: 1 year follow-up of a randomized controlled trial". Child Abuse & Neglect. 29 (2): 135–45. doi:10.1016/j.chiabu.2004.12.005. PMID 15734179.
  9. Cohen, Judith A. (2006). Treating trauma and traumatic grief in children and adolescents ([Online-Ausg.]. ed.). New York: The Guilford Press. ISBN 978-1-59385-308-2.
  10. "Trauma-Focused CBT Training". Retrieved 20 April 2014.
  11. COHEN, J. A.; MANNARINO, A. P.; BERLINER, L.; DEBLINGER, E. (1 November 2000). "Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: An Empirical Update". Journal of Interpersonal Violence. 15 (11): 1202–1223. doi:10.1177/088626000015011007.
  12. Cohen, Judith A.; Mannarino, Anthony P. (November 2008). "Trauma-Focused Cognitive Behavioural Therapy for Children and Parents". Child and Adolescent Mental Health. 13 (4): 158–162. doi:10.1111/j.1475-3588.2008.00502.x.
  13. Cohen, Judith A. (2006). Treating trauma and traumatic grief in children and adolescents ([Online-Ausg.]. ed.). New York: The Guilford Press. ISBN 978-1593853082.
  14. Deblinger, Esther; Pollio, Elisabeth; Dorsey, Shannon (2015-12-23). "Applying Trauma-Focused Cognitive–Behavioral Therapy in Group Format". Child Maltreatment. 21 (1): 59–73. doi:10.1177/1077559515620668. ISSN 1077-5595. PMID 26701151.
  15. Deblinger, Esther; Pollio, Elisabeth; Dorsey, Shannon (2015-12-23). "Applying Trauma-Focused Cognitive–Behavioral Therapy in Group Format". Child Maltreatment. 21 (1): 59–73. doi:10.1177/1077559515620668. ISSN 1077-5595. PMID 26701151.
  16. Cohen, JA; Deblinger, E; Mannarino, AP; Steer, RA (Apr 2004). "A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms". Journal of the American Academy of Child and Adolescent Psychiatry. 43 (4): 393–402. doi:10.1097/00004583-200404000-00005. PMC 1201422. PMID 15187799.
  17. Cohen, JA; Berliner, L; Mannarino, A (Apr 2010). "Trauma focused CBT for children with co-occurring trauma and behavior problems". Child Abuse & Neglect. 34 (4): 215–24. doi:10.1016/j.chiabu.2009.12.003. PMID 20304489.
  18. Seidler, GH; Wagner, FE (Nov 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): 1515–22. doi:10.1017/S0033291706007963. PMID 16740177.
  19. Cohen, JA; Mannarino, AP; Knudsen, K (Feb 2005). "Treating sexually abused children: 1 year follow-up of a randomized controlled trial". Child Abuse & Neglect. 29 (2): 135–45. doi:10.1016/j.chiabu.2004.12.005. PMID 15734179.
  20. Cohen, JA; Mannarino, AP; Perel, JM; Staron, V (Jul 2007). "A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (7): 811–9. doi:10.1097/chi.0b013e3180547105. PMID 17581445.
  21. Bisson J, Roberts NP, Andrew M, Cooper R, Lewis C (2013). "Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults". Cochrane Database of Systematic Reviews. 12 (12): CD003388. doi:10.1002/14651858.CD003388.pub4. PMID 24338345
  22. "What is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)?". Retrieved 20 April 2014.
  23. "TF-CBT Web: A web-based learning course for trauma focused cognitive behavioral therapy". Retrieved 20 April 2014.
  24. "TF-CBT.org Certification Criteria".
  25. "Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)". Retrieved 20 April 2014.
  26. 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.
  27. "Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)". Retrieved 20 April 2014.
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