Trauma focused cognitive behavioral therapy

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents (ages 3 to 18) with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. The goal of TF-CBT is to provide psychoeducation to both the child and the caregivers and help them to identify and cope with emotions, thoughts and behaviors. Research has shown TF-CBT to be effective in treating childhood Post-traumatic Stress Disorder (PTSD) and children who have experienced traumatic events.

Description

TF-CBT is a treatment model that incorporates various trauma-sensitive intervention components. It aims at individualizing TF-CBT techniques to children and their circumstances while maintaining therapeutic relationship with both the child and parent. TF-CBT treatment can be used with children and adolescents who have experienced traumatic life events. It is a short-term treatment (typically 12-16 sessions) that combines trauma-sensitive interventions with cognitive behavioral therapy strategies. It can also be used as part of a larger treatment plan for children with other difficulties. TF-CBT includes individual sessions for both the child and the parents, as well as parent-child joint sessions.

Major treatment components

Major components of TF-CBT include psycho-education about childhood trauma and individualizing relaxation skills. The therapeutic elements of TF-CBT are denoted by the “PRACTICE” acronym.

• Psychoeducation and Parenting skills
• Relaxation
• Affective Expression and Regulation
• Cognitive Coping
• Trauma Narrative Development and Processing
• In Vivo Gradual Exposure
• Conjoint Parent-Child sessions
• Enhancing Safety and Future Development

Child-specific sessions

During the child therapy sessions, the therapist focuses on relaxation training such as deep breathing and muscle relaxation skills, emotion regulation (identifying feelings), a trauma narrative and processing (discussing the overwhelming events and associated feelings), as well as cognitive coping strategies (identifying and replacing negative thoughts).

Parent-specific sessions

Parents or primary caregivers are considered as the central therapeutic agents for improvement in TF-CBT. During the parent sessions, the therapist discusses the appropriateness of the treatment and safety plans with the parents and encourages positive parenting skills to maximize effective parenting.

Parent-child conjoint sessions

During the conjoint sessions, the therapist shares the trauma narratives and challenges to incorrect/negative thoughts as a means to encourage and facilitate parent-child communication. The therapist would only intervene when inaccurate cognitions were not addressed.

Evaluation of effectiveness

Randomized clinical trials examining the efficacy of TF-CBT have found it to be an effective treatment plan for a variety of disorders in both children and adolescents. TF-CBT has been proven to effectively reduce symptoms of PTSD, depression, anxiety, externalizing behaviors, sexualized behaviors, and feelings of shame in traumatized children. TF-CBT has been shown to improve positive parenting skills and support of the child through the enhancement of parent-child communication. A study examining the combinatorial effect of TF-CBT with sertraline has found that there were only minimal benefits associated with adding sertraline to the treatment, providing evidence for an initial trial of TF-CBT before medication.

Methods of access

Therapist

TF-CBT can be delivered by a variety of mental health professionals ranging from clinical social workers, counselors to psychologists and psychiatrists. Qualified therapists are required to be trained and experienced in TF-CBT. Therapists can be trained by the online TF-CBT certified training course.

Implementation and adaptations

Since its development in the 1980s, TF-CBT has been used by therapists in many countries such as Australia, Cambodia, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Pakistan, Sweden, United States, and Zambia. It has also been used with children in the foster care system, with those who have suffered from traumatic life events, including the 9-11 terrorist attacks, and those who experienced Hurricane Katrina. TF-CBT has also been adapted to different cultures, including Latino populations. The treatment manual book has been translated into a variety of languages, such as Dutch, German, Japanese, Korean, and Mandarin.

External links

• http://tfcbt.musc.edu/
• https://www.childwelfare.gov/pubs/trauma/
• http://clinicaltrials.gov/show/NCT00614068