1. Trauma Focused Cognitive Behavioral Therapy
“TF-CBT”

2. What is TF-CBT?
Evidenced Based treatment model developed by Deblinger, Cohen, and Mannarino that integrates trauma sensitive interventions with cognitive-behavioral strategies.
The therapist structures sessions such that there is a focus on skill building and direct discussion and processing of the abuse experience.

3. TF-CBT is a time limited, structured model that takes place over 12 – 20 sessions.
Youth between the ages of 3 and 18 that have a memory of the trauma and have a diagnosis of Post Traumatic Stress Disorder (PTSD) or Post Traumatic Symptoms.

4. The Therapist sets an agenda and sticks to the agenda, dealing with “COWS” or Crisis of the Week at the end of each session.

5. TF-CBT is adaptable and flexible to address developmental issues, gender, culture, family values (especially sensitive to sexuality and parenting styles).
The therapeutic relationship is central.

6. TF-CBT STRUCTURE Joint Sessions Family Sessions Parent’s Treatment
Education
Skill Building
Exposure/Processing
Behavior Management
Preparation for
Joint Sessions
Child’s Treatment
Education
Skill Building
Exposure/Processing
Preparation for
Joint Sessions
Joint Sessions
Family Sessions

7. What Does PTSD Really Mean
Post = After
Traumatic = Really scary, life and death
experience
Stress = My Body’s Alarm System
Disorder = Gets in the Way of My Life

8. TF-CBT Components EDUCATION Learn about Trauma
Look at parenting skills/behavior management
Symptoms child is experiencing based on the clinical assessment and testing instruments.

9. Role play strategies with caregiver
Teach parents/caregivers active ignoring and how to praise positive behaviors
Role play strategies with caregiver
Look at fact sheets in regards to trauma
Play psycho educational card game with youth then youth and family
What
do A therapeutic card
you game about child
know child sexual &
? Physical abuse &
domestic violence

10. EMOTION IDENTIFICATION AND EXPRESSION
Ask client to talk about feelings
Encourage client to expand feelings
vocabulary and match feelings to
appropriate situations/events
Engage youth in activity that encourages
expression of feelings

11. COPING SKILLS
Explain at least two of the following strategies: (1) grounding, (2) mindfulness, and or (3) relaxation, including deep breathing, progressive muscle relaxation or guided meditation.

12. Review cognitive coping (thought stopping, positive self-talk)
Practice strategies in session
Assign homework to practice skills at home

13. Provide relevant examples of automatic thoughts
COGNITIVE TRIANGLE
Taught client the distinction and relationship between thoughts, feelings and behaviors
Provide relevant examples of automatic thoughts
Thoughts
Behaviors
Feelings

14. Practice scenarios in which client change feelings and behaviors by thinking differently
Explain cognitive distortions
Teach caregiver the cognitive triangle
Help caregiver identify inaccurate or unhelpful thoughts
Practice coping statements with caregiver

15. Trauma Narrative/Formal Gradual Exposure
Get youth to talk about trauma
Work on narrative each session, gradually leading up to the worst moment
Prepare caregiver for narrative prior to sharing
Use books to introduce the narrative

16. Review previous work each week
Organize narrative into a coherent whole
After completing narrative client adds thoughts, feelings, and physiological responses
Share narrative with caregiver throughout process if safe

17. Cognitive Processing – Processing the Traumatic Experience
Look for trauma related cognitive distortions
Challenge distortions
Best friend role play or other strategy to challenge cognitive distortions
Identify & challenge caregiver’s own trauma-related cognitive distortions

18. Personal Safety Skills
Identify good and bad touch
Use “uh-oh” feeling analogy
Use role play to teach client assertiveness skills
Client practice assertiveness skills in session or taught skills to caregiver

19. Additional Information
TF-CBT is the #1 Evidence Based Treatment for use with PTSD
Our Intern, Amber Yoder, did a paper on the effectiveness of TF-CBT on reducing PTSD symptoms among Sexually Abused Children. She took the testing instruments from Pre-intervention to Post-intervention. She looked at a total of 31 youth. Out of the 31 youth, only 23 met the criteria for pre and post testing.

20. There were considerable differences between the pretest and posttest scores. She looked at the Pre Test Mean (SD) for three variables, and the Post-Test Mean (SD) for the same three variables.
The Next Slide will correlate the data to show how effective TF-CBT was.

21. Trauma Symptom Checklist for Children Pre and Post Test Means
Variable Pre-test Mean SD Post-Test Mean SD
Anxiety (11.59) (9.23)
Depression (11.71) (9.00)
Posttraumatic Stress (11.55) (9.74)

22. Amber wrote “these findings validate the effectiveness of the program further showing the growing need for increased funding.”

23. In Conclusion
Having gone through this one year collaborative in Huntsville, Alabama, Manatee Children’s Services Therapists are now specialized in offering trauma focused treatment. We have undergone one year’s intensive training and supervision through Duke University and the National Child Advocacy Center to become Specialized Trauma Focused Cognitive Behavioral Therapists.

24. Manatee Children’s Services was pro active in financing a group of staff to go to Huntsville, Alabama. The following participants attended:
Danielle Foster: Senior Leader
Gail Canario: Clinical Director
Nancy Baptist: Therapist
Jarvis Hodges: Therapist