TF-CBT

Trauma-focused cognitive behavioral therapy

Dynamics of How TF-CBT is Performed

When Treatment Should be used

Children and adolescents

struggling with..

History of TF-CBT and Professionals credited

Considered a highly collaborative therapy approach

• therapist
• parents
• child

all work together to identify common goals and attain them.

• short-term treatment
• typically provided in 12 to 18 sessions of 50 to 90 minutes (depending on treatment needs)

TF-CBT in other types of populations

History and Professionals Credited

Continued

Dynamics continued:

Interventions are provided

History and Professionals Credited

• outpatient mental health facilities
• hospitals
• group homes
• schools
• communities
• residential Tx Facilities
• home settings
• clinics
• inpatient

• intrusive and upsetting memories, thoughts or dreams about the trauma

• Avoidance of things, situations, or people which are trauma reminders

• Physical reactions of hyper arousal, trouble concentrating, and/or irritability

Protocol Components Summarized by the Acronym: PRACTICE

• hearing-impaired populations
• traumatic grief after the death of a loved one

TF-CBT has been empirically proven to be effective

• 22 studies

The effects of the program were compared to client-centered therapy

• 12 randomized controlled trials

2006: published Trauma Focused CBT manual "Treating Trauma and Traumatic Grief in Children and Adolescents”

2012: expanded their earlier volume and created a new book “Trauma-focused CBT for Children and Adolescents. Treatment Applications”

Dynamics Continued:

Dynamics Continued:

The treatment involves

Joint parent-child sessions Goal:

Polyvictimizations

Parents/caregivers

• created off the format of cognitive behavioral therapy

• originally developed for sexually abused boys and girls, ages 3-14

• diverse socioeconomic backgrounds; though primarily white and african american

• Has been modified to address diverse needs

• After collaborating for over 25 years Mannarino, Cohen, and Deblinger created TF-CBT

P: Psychoeducation and

parenting skills

• individual sessions with the child and parent (or caregiver)
• joint sessions with the child and parent together.

Dynamics Continued:

• help parents and children practice and use the skills they learned
• child to share his/her trauma narrative
• fostering more effective parent-child communication about the abuse and related issues

Demographics

individual session Goal:

T: Trauma narrative

• build the therapeutic relationship
• provide education, skills, and a safe environment
• Address and process traumatic memories

TF-CBT > effective than non-directive or client-centered treatment approaches for children who have a history of multiple traumas

encompassing Children and families ...

History and Professionals Credited

Continued

• telling the story of the trauma
• making meaning of the traumatic experiences to empower healing

• Discussion and education about child abuse in general and the typical emotional and behavioral reactions to sexual abuse
• training for parents in child behavior management strategies and effective communication

• All socioeconomic backgrounds

• Overcome general feelings of depression

• Reduce PTSD symptoms

• Reduce emotional distress about child’s trauma

• Improve parenting practices

• Enhance their ability to support their children

• sexual abuse
• exposure to domestic violence
• physical abuse
• exposure to community violence

ethnicity

I: In vivo exposure

E: Enhancing safety

Communities

• Caucasian
• African-American
• Hispanic
• Latino
• Native American

• name and practice ways to stay emotionally and physically safe
• Building assertiveness and help-seeking skills
• create a safety plan

• Desensitizes youth to emotional aspects of trauma memories
• Encourage youth to master fear reactions and substitute healthy responses

R: Relaxation techniques

Teaching relaxation methods

• Goal: to bring together data and experiences from various therapists and trainers that Mannarino, Cohen, and Deblinger trained in a number of different countries

• Motivation for creating new volume: It will help clinicians in implementing TF-CBT to various populations and settings

• Contains highly valuable information for clinicians who have been trained in the application of TF-CBT

Target Population:

• Urban
• Suburban
• rural environments

• focused breathing
• progressive muscle relaxation
• visual imagery

• sexually abused children
• children exposed to trauma ages 3 to 18
• parents or caregivers who did not participate in the abuse

C: Conjoint parent-child sessions

Efficacy: WHy and how TF-CBT works

• preparing caregiver to hear and respond to the Trauma Narrative reading
• practice reading the Trauma Narrative
• read Trauma Narrative

A: Affective expression and regulation

Children and adolescents who..

C: Cognitive coping skills

and processing

• Helping the child/parent manage their emotional reactions to reminders of the abuse,
• improve their ability to identify and express emotions
• participate in selfsoothing activities

Cautions

• recognizing and share their internal dialogue
• target inaccurate and unhelpful thoughts
• bodily sensations, emotional feelings and thoughts

• show elevated levels of depression, anxiety, shame or dysfunctional abuse-related feelings, thoughts, or developing beliefs

• Demonstrate Bx problems ie., age inappropriate sexual Bxs

• Symptoms of depression, anxiety, PTSD

• significant conduct issues
• substance abuse
• self-harm/suicidal
• runaways

Case examples

• Structured, short term treatment; PRACTICE
• Process traumatic memories, overcome problematic thoughts and behaviors, and develop effective coping and interpersonal skills
• participants showed a significant reduction in internalizing symptoms
• external symptoms have rebounded somewhat over a 6 month check-in
• parent involvement is crucial
• tf-cbt has enhanced parenting and child personal safety skills
• trauma narrative is helpful

• Deena
• Maya