Presentation on theme: "Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)1"— Presentation transcript:
1 Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)1 Michael A. de Arellano, Ph.D.National Crime Victims Research and Treatment CenterMedical University of South CarolinaDee Norton Lowcountry Children’s CenterCharleston, SC1 Judy Cohen, Anthony Mannarino, & Esther Deblinger, 2006
2 A Learning Resource for TF-CBT Web-based learningLearn at own paceConcise explanationsVideo demonstrationsClinical scriptsCultural considerationsClinical ChallengesResourcesLinks10 hours of CEFree of chargeAccess at:
4 Other resources www.musc.edu/ctg www.musc.edu/tf-cbt-consult
5 Consequences of Abuse Acute distress almost universal Overall, abused kids report more problems than nonabused childrenPTSD, depression, aggression/sexual behavior problemsImpact can be long lastingChildhood trauma is risk factor for adult problemsImpact varies; most recover over time with/without txDOES EVERYONE WHO IS ABUSED NEED TREATMENT?HOW ABOUT IF THERE IS AN ABSENCE OF ACUTE SYMPTOMS, DO THEY STILL NEED TREATMENT?RE: LAST BULLET: WHAT DO YOU THINK ABOUT THAT?
12 Evidence-Based Treatments Defined in child abuse services as:“…competent and high-fidelity implementation of practices that have been demonstrated safe and effective, usually in randomized controlled trials (RCTs)…” (Chaffin & Friedrich, 2004)Expert review of child abuse and neglect field services suggest that treatments are not based on any clear evidence (Kauffman Best Practices Project, 2004; Saunders et al., 2004)
13 Evidence-Based Practices Movement towards identifying EBPs for maltreated children and familiesU.S. Office for Victims of Crime (OVC, 2001)Reviewed 24 treatment protocolsOne treatment was “well-supported and efficacious”Kauffman Foundation of St. LouisIdentified small number of under-disseminated EBPs for abused children and their familiesEmpirical support, soundness of theory, general clincial acdeptance, size of literature, tx’s potential for benefits and harm
14 Identified as Best Practices for in Child Abuse Treatments Trauma Focused Cognitive Behavioral Therapy (TF-CBT)Judith Cohen and Tony MannarinoAbuse Focused Cognitive Behavioral Therapy (AF-CBT)David KolkoParent Child Interaction Therapy (PCIT)Sheila Eyberg, M. Chaffin
15 What Are Evidence-Based Treatments for Traumatized Children? What They Are Not:RigidLockstepInflexible…
17 What is TF-CBT? A hybrid treatment model that integrates: Trauma sensitive interventionsCognitive-behavioral principlesAttachment theoryDevelopmental NeurobiologyFamily TherapyEmpowerment TherapyHumanistic Therapy
18 Treatment ResearchTrauma-Focused CBT is the most rigorously tested treatment for traumatized children6 randomized trialsImproved PTSD, depression, anxiety, shame and behavior problems compared to supportive treatmentsPTSD improved more with direct child treatmentImproved parental distress, parental support, and parental depression compared to supportive treatment
20 Respectful of Cultural Values Adaptable and Flexible Family Focused Core Values of TF-CBTCRAFTSComponents-BasedRespectful of Cultural ValuesAdaptable and FlexibleFamily FocusedTherapeutic Relationship is CentralSelf-Efficacy is emphasized
21 Cultural Sensitivity and Competence Essential to understand family’s values related to religion, ethnicity, and culturePrevious treatment outcome studies (Cohen & Mannarino; Deblinger et al.) - successful treatment for diverse ethnic and racial populationsChild Maltreatment article (Cohen et al., 2001)
22 Child and Parent Components Individual sessions for both child and parentParent sessions - generally parallel child sessionsSame therapist for both child and parent
23 Is TF-CBT the Right Treatment What is the diagnosis?Is the diagnosis and/or symptomatology related to the trauma?Can TF-CBT interventions be integrated with other treatment strategies which address non-trauma problems?
24 Contraindications for TF-CBT Dangerous behaviors (e.g, suicidality; severe aggressionUnsafe environment (e.g, trauma is ongoing or there is high risk for reoccurence)Unstable placement
25 TF-CBT Components PRACTICE Psychoeducation and Parenting Skills RelaxationAffective ModulationCognitive ProcessingTrauma NarrativeIn Vivo DesensitizationConjoint parent-child sessionsEnhancing safety and social skills
26 TF-CBT Sessions Flow Sessions 1-4 5-8 9-12 Entire Process is Gradual ExposureBaselineAssessmentSessionsPsychoeducation Trauma Narrative Conjoint ParentParenting Skills Development and Child SessionsProcessingRelaxation EnhancingIn-vivo Gradual Safety andAffective Exposure FutureExpression and DevelopmentRegulationCognitive Coping
27 Psychoeducation Goals: Normalize child and parent reactions to severe stressProvide information about psychological and physiological reactions to stressInstill hope for child and family recoveryEducate family about the benefits and need for early treatment
28 Parenting Skills Parents as central therapeutic agent for change Establish parent as the person the child turns to for help in times of troubleAddress behavior problems that may be caused or worsened by trauma exposure.Prioritize concerning behaviors such as sexualized or aggressive behaviors.Flexibility to include different parenting strategies (PCIT).
29 Treatment of Parents Research Evidence that treating parent is important:Deblinger et al. (1996): Treating parents resulted in decreased behavioral and depressive symptoms in childCohen and Mannarino (1996): Parents’ emotional reaction to trauma was the strongest predictor of treatment outcome (other than treatment type)Cohen and Mannarino (1997): At the 12 month follow-up, parental support was significantly related to decreased symptoms in child
30 Relaxation Reduce physiologic manifestations of stress and PTSD Explain body responses to stressShallow breath, muscle tension, headachesFocused breathing/mindfulness/meditationProgressive Muscle RelaxationPhysical ActivityIdentify what is relaxing for the child and parent.
31 Learn to apply coping skills to effectively manage affect Affective ModulationFeeling IdentificationAccurately identify and express a range of different feelingsBoard games (e.g., Emotional Bingo)Feeling brainstormColor My Life or personLearn to apply coping skills to effectively manage affect
32 Cognitive ProcessingHelp children and parents understand the cognitive triad: connections between thoughts, feelings and behaviors, as they relate to everyday eventsHelp children distinguish between thoughts, feelings, and behaviorsHelp children and parents view events in more accurate and helpful waysEncourage parents to assist children in cognitive processing of upsetting situations, and to use this in their own everyday lives for affective modulation
34 Direct Discussion of Traumatic Events Reasons we avoid this with children:Child discomfort or Parent discomfortTherapist discomfortLegal issuesReasons to directly discuss traumatic events:Gain mastery over trauma remindersResolve avoidance symptomsCorrection of distorted cognitionsModel adaptive copingIdentify and prepare for trauma/loss remindersContextualize traumatic experiences into life
35 Cognitive Processing of the Traumatic Experience Develop optimal understanding of the trauma within the context of the child’s lifeCommon negative distortionsSelf-blameOverestimating dangerChanged world view
36 Conjoint Sessions: Sharing the Trauma Narrative with the Parent Parent may not know details of what happenedAvoidanceLegal issuesExplore what parent knows about the traumatic eventShare with parent what child has said in therapy
37 In-Vivo Mastery of Trauma Reminders Resolve generalized avoidant behaviorsGradually help the child get used to the feared situationIdentify the feared situationDesign the in vivo desensitization planPraise and reinforce in vivo workTherapist MUST have confidence that this will work or it won’t
38 Enhancing Safety Skills Typically done in conjoint parent-child sessions, but may also be done individuallyDevelop a safety plan which is responsive to the child’s and family’s circumstances and the child’s realistic abilitiesPractice these skills outside of therapy alsoFor sexually abused children, include education about healthy sexualityFor children exposed to DV, PA, CV, may include education about bullying, conflict resolution, etc.
40 ResourcesCohen, Mannarino, & Deblinger (2006). Treating Trauma and Traumatic Grief in Children and Adolescents Sage Publications.Cohen, Mannarino & Deblinger (2012). Trauma-Focused CBT for Children and Adolescents: Treatment Applications. Guilford Press: New York, NY.Deblinger, E. & Heflin, A.H. (1996). Treating sexually abused children and their nonoffending parents. Sage Publications: Thousand Oaks, CA.
41 For More Information about Training Developers: Judy Cohen, MD, Alleghany General Hospital, Anthony Mannarino, PhD, Alleghany General Hospital, or Esther Deblinger, PhD, CARES Institute, UMDNJ-School of Osteopathic Mediciine.Website:
42 Michael A. de Arellano, Ph.D. firstname.lastname@example.org