Trauma-Focused Cognitive Behavioral Therapy
One of seven evidence-based practices used across agency
♦ California Evidence-Based Clearinghouse for Child Welfare = 1 (Well-Supported by Research Evidence)
♦ National Registry of Evidence-Based Programs and Practices = Avg. 3.7 Quality of Research (0-4 point scale)
♦ National Child Traumatic Stress Network = Well-Supported and Efficacious
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement. More than a dozen scientifically rigorous studies have demonstrated that TF-CBT helps children and families recover from the negative effects of traumatic experiences. Many of the studies compared TF-CBT to other treatments commonly provided to traumatized children and showed that children receiving TF-CBT improved faster and more completely than the children who received other treatments. Studies that followed children for as long as one to two years after the end of treatment found that these improvements were sustained.
The treatment model is designed to be delivered by trained therapists who initially provide parallel individual sessions with children and their parents (or guardians), with conjoint parent-child sessions increasingly incorporated over the course of treatment. TF- CBT has been shown to work even if there is no parent of caregiver to participate in treatment. It has been used successfully in clinics, schools, homes, residential treatment facilities, and inpatient settings.
Components of the TF-CBT Protocol are:
- Psychoeducation about the traumatic event, typical reactions of victims, normalization of reactions, safety skills and healthy sexuality (if sexual abuse).
- Stress management techniques such as focused breathing, progressive muscle relaxation, emotional expression skills, thought stopping, thought replacement, and cognitive therapy interventions.
- Constructing the Trauma Narrative – Gradual exposure techniques including verbal, written, and/or symbolic recounting (i.e., utilizing dolls, puppets, etc.) of traumatic event(s).
- Cognitive Reprocessing or Cognitive reframing consisting to exploration and correction of inaccurate or unhelpful attributions about the cause of, responsibility for, and results of the traumatic experience.
- Parental/Caregiver participation in parallel or conjoint treatment including psychoeducation, gradual exposure, anxiety management and correction of cognitive distortions.
- Parental instruction in child behavior management strategies.
- Family work to enhance communication and create opportunities for therapeutic discussion regarding the abuse.
Although TF-CBT is generally delivered in 12-16 sessions of individual and parent-child therapy, it also may be provided in the context of a longer-term treatment process or in a group therapy format.
Children who are experiencing significant Post-Traumatic Stress Disorder (PTSD) symptoms, whether or not they meet full diagnostic criteria. In addition, children with depression, anxiety, and/or shame related to their traumatic exposure. Children experiencing Childhood Traumatic Grief can also benefit from the treatment.
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