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.
7 What Does PTSD Really Mean Post = AfterTraumatic = Really scary, life and deathexperienceStress = My Body’s Alarm SystemDisorder = Gets in the Way of My Life
8 TF-CBT Components EDUCATION Learn about Trauma Look at parenting skills/behavior managementSymptoms 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 behaviorsRole play strategies with caregiverLook at fact sheets in regards to traumaPlay psycho educational card game with youth then youth and familyWhatdo A therapeutic cardyou game about childknow child sexual &? Physical abuse &domestic violence
10 EMOTION IDENTIFICATION AND EXPRESSION Ask client to talk about feelingsEncourage client to expand feelingsvocabulary and match feelings toappropriate situations/eventsEngage youth in activity that encouragesexpression of feelings
11 COPING SKILLSExplain 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 sessionAssign homework to practice skills at home
13 Provide relevant examples of automatic thoughts COGNITIVE TRIANGLETaught client the distinction and relationship between thoughts, feelings and behaviorsProvide relevant examples of automatic thoughtsThoughtsBehaviorsFeelings
14 Practice scenarios in which client change feelings and behaviors by thinking differently Explain cognitive distortionsTeach caregiver the cognitive triangleHelp caregiver identify inaccurate or unhelpful thoughtsPractice coping statements with caregiver
15 Trauma Narrative/Formal Gradual Exposure Get youth to talk about traumaWork on narrative each session, gradually leading up to the worst momentPrepare caregiver for narrative prior to sharingUse books to introduce the narrative
16 Review previous work each week Organize narrative into a coherent wholeAfter completing narrative client adds thoughts, feelings, and physiological responsesShare narrative with caregiver throughout process if safe
17 Cognitive Processing – Processing the Traumatic Experience Look for trauma related cognitive distortionsChallenge distortionsBest friend role play or other strategy to challenge cognitive distortionsIdentify & challenge caregiver’s own trauma-related cognitive distortions
18 Personal Safety Skills Identify good and bad touchUse “uh-oh” feeling analogyUse role play to teach client assertiveness skillsClient practice assertiveness skills in session or taught skills to caregiver
19 Additional Information TF-CBT is the #1 Evidence Based Treatment for use with PTSDOur 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 SDAnxiety (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 ConclusionHaving 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 LeaderGail Canario: Clinical DirectorNancy Baptist: TherapistJarvis Hodges: Therapist