Trauma-Focused Cognitive-Behavioral Therapy for Children Sustained Impact of Treatment 6 and 12 Months Later PMC

During this component the therapist helps children to become comfortable with expressing a variety of different feelings and to develop skills for managing negative affective states. These may include strategies such as problem solving, seeking social support, positive distraction techniques (e.g., humor, journaling, helping others, perspective taking, reading, taking a walk, playing with a pet, etc.), focusing on the present, and a variety of anger management techniques. The therapist encourages the child to develop a “tool kit” of these skills that work in different settings and for different negative feelings9. These skills are familiar to most child therapists; however, in contrast to other child treatments, in TF-CBT the therapist encourages the child to implement the affective modulation skills in response to trauma reminders. From the beginning of treatment it is important for the therapist to help the family understand that TF-CBT is a collaborative child-parent, trauma-focused treatment. The therapist may find it useful to review the information from the child’s assessment that led the therapist to conclude that trauma-focused treatment was appropriate.

Five core elements of the TF-CBT model

• Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL.
• Young children’s emotions and behaviours in the aftermath of trauma can be worrisome to their caregivers.
• The authors would like to especially thank Beth Cooper for her always outstanding editing and manuscript review.

For instance, a person who was involved in a car accident on a freeway may avoid driving on freeways or be afraid to get into a car at all, says Workman. PE and CPT are the front-line treatments for trauma as they have the most research evidence demonstrating their effectiveness, according to Workman. This form of therapy can help you if you are unable to cope with the trauma you experienced, or if it’s affecting your ability to function. Postassessments were completed within 1 month after TF-CBT completion (for the TAU participants, approximately 4 months after baseline). To ensure masked assessment, assessors from a site other than where the participant received services completed the postassessment. The authors would like to especially thank Beth Cooper for her always outstanding editing and manuscript review.

• Children who have experienced sexual abuse are often taught the doctors’ names for private parts (with caregiver permission).
• The model also addresses the emotional reactions of nonoffending parents and caregivers.
• The first conjoint session is usually devoted to the child sharing the trauma narrative.
• The therapist encourages the child to develop a “tool kit” of these skills that work in different settings and for different negative feelings9.
• The authors reviewed two studies by TF-CBT developers that are covered here (24,25) but no others.

Effectiveness of the service

Collaborative child-parent treatment means that the child and parent will both receive about equal time each session and that the treatment will include two-way open communication about important issues. The parent and child may express discomfort about this (e.g., lack of confidentiality in therapy). The therapist can often address this by asking each what their concerns are about sharing information and making appropriate adjustments to the extent to which this occurs when indicated. For example, youth with complex trauma who are attending TF-CBT with new foster parents often have understandable issues with trusting these new caregivers or even in trusting the therapist; the therapist needs to attend to this appropriately or the therapy may be derailed11. As described below, including foster parents in treatment can enhance engagement and treatment completion for these children. In these cases, the therapist can also include the birth parent in TF-CBT if the therapist considers this to be clinically appropriate (e.g., if the child is having regular visits with this parent and/or reunification is anticipated in the near future).

Trauma-Focused Cognitive Behavioral Therapy for Traumatized Children and Families

Often parents expect, take for granted, and/or ignore children when they are behaving well, and only give attention to negative or problematic behaviors. Since all children crave parental attention, this paradigm tends to reinforce children’s negative behaviors –the exact opposite of what parents intend. In order to reverse this, positive attention requires parents to look for, attend to and promptly provide positive attention (hugs, high fives, verbal praise and/or other positive attention) in response to children’s positive behaviors. Therapists use a variety of techniques to aid patients in reducing symptoms and improving functioning. These are intended to help the person reconceptualize their understanding of traumatic experiences, as well as their understanding of themselves and their ability to cope.

• It is important for children to develop a variety of different relaxation strategies since a particular strategy (e.g., exercise) may be effective in some settings (e.g., after school or with peers) but not in others (e.g., when going to sleep at night).
• Another study applied TF-CBT in group format with children as young as 2½ years of age (Deblinger et al., 2001).
• In this manner, the parent is able to help the child to practice using the appropriate TF-CBT skills during the week when the child is not in therapy.
• Such children often become angry at and stop trusting their parents, leading parents to become confused and upset.
• Visit our homepage for helpful tools and resources, use our search filters in All Resources and throughout our website, or contact us and we will point you in the right direction.

If people cannot access TF-CBT where they are or would prefer to try something else, other types of therapy may help with trauma. TF-CBT adapts these principles specifically to trauma, which is an emotional and physical response to a shocking or dangerous event. TF-CBT can be delivered by counselors, social workers, psychologists, https://ecosoberhouse.com/ or psychiatrists. To be considered a TF-CBT therapist, mental health providers have to receive specialized training and supervision and obtain TF-CBT certification. This therapy involves psychoeducation, a therapeutic intervention based on learning information to better understand and cope with illnesses or diagnoses.

Similarly, 14 (73.7%) of the participants who reported using tobacco, 38 (79.2%) who reported drinking alcohol, and 8 (61.5%) who reported using inhalants changed their responses at postassessment to never having used these substances. Because of the small sample size and inconsistent responses, no additional analyses were performed. We did not analyze the caretaker Child Behavior Checklist32 because of a very low response rate (33.9% cognitive behavioral therapy at baseline and 6.2% at follow-up) due to competing demands (eg, other children and selling at the market). The SAS Multiple Imputation and Multiple Imputation Analysis procedures were also used to estimate the missing 6- and 12-month follow-up outcome scores, and 10 maximum-likelihood complete sets of data were again generated for each of the 14 outcome measures based on the initial number of respondents with posttreatment scores.

These may include focused (yoga) breathing, progressive muscle relaxation and visualization, skills that have been demonstrated to produce physiologic relaxation responses; but therapists may also encourage children to use a variety of other relaxation strategies based on the child’s own interests and developmental level. For example, younger children often like to relax through blowing bubbles, dance (e.g., “Hokey Pokey”, Chicken Song) and song (“Row, Row, Row Your Boat”); while teens often prefer to relax using their favorite music, physical activities or crafts such as crochet or knitting. It is important for children to develop a variety of different relaxation strategies since a particular strategy (e.g., exercise) may be effective in some settings (e.g., after school or with peers) but not in others (e.g., when going to sleep at night). Trauma-focused CBT is a family-based treatment for traumatized children with strong empirical support for improving PTSD, depressive, anxiety, behavioral, cognitive, relationship and other problems. Parents or caregivers participate in all components of TF-CBT during initial parallel individual parent sessions and later conjoint parent-child sessions. Several studies document that parental inclusion significantly contributes to positive child outcomes.

Assessing the Evidence Base Series

The local supervisor and counselor discussed and/or role-played the component and planning for the next session. A TF-CBT expert (L.K.M., S.S., or S.D.) recorded detailed notes from the supervisors’ weekly verbal reports, checking that all TF-CBT components were provided with proper technique or, if not, asked for those components to be provided again. A safety protocol was developed as part of the standard assessment procedures for both conditions.17 The protocol specified steps for assessing risk, a notification tree, and possible referrals. The Institutional Review Board of Johns Hopkins Bloomberg School of Public Health and the local Zambian institutional review board, ERES Converge, approved the study protocol. Conclusions and Relevance  The TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma.

Trauma-focused cognitive behavioural therapy for young children: clinical considerations

Through this process the child speaks about even the most horrific and feared traumatic memories, thus “speaking the unspeakable” which enables the child to learn a mastery rather than avoidance response to these memories. Through the cognitive processing strategies learned previously the therapist helps the child to process trauma-related maladaptive cognitions. The child develops a written summary of the trauma narrative process, usually in the form of a book, poem or song.