
Trauma-Focused Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy (CBT) is based on the theory that upsetting emotions (e.g., anxiety) are associated with physiological symptoms (e.g., racing heart), negative thoughts (e.g., “Everyone will laugh at me when I give my presentation”), and problematic behavior (e.g., not going to school to avoid doing the presentation). For children and adults exposed to trauma, the physiological, cognitive, and behavioral responses are often reactions to thinking and feeling they are in danger. During a traumatic experience, the danger is real. Problems arise when the person perceives they are still in danger, even when it is over and they are safe. This can happen when they are triggered, which means something reminds them of the trauma. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen, Deblinger, & Mannarino, 2017) incorporates CBT principles with a trauma perspective. TF-CBT therapists use a PRACTICE acronym to describe the treatment components:
- Psychoeducation about trauma and parenting strategies
- Relaxation training in portable techniques that children and caregivers can use anywhere when feeling anxious
- Affect identification to help children and caregivers label and identify emotions and teach them the connection between emotions, thoughts, and behaviors
- Cognitive processing to systematically identify and challenge negative or distorted thoughts that may be lead to emotional and behavioral problems
- Trauma narration to helps children learn to manage reactions to trauma reminders (e.g., smells, sights, sounds) without the feared consequences
- In vivo exposure to people and places that have been avoided
- Conjoint caregiver-child sessions to discuss the trauma and other family stressors
- Enhancing safety to prepare for situations that might put children at risk
When the traumatic event is associated with a death, the trauma work is followed by grief work. CBT techniques learned during PRACTICE are applied to promote coping with grief. Children and caregivers address any feelings about the deceased and current and future relationships, with the goal of increasing social connections. Additional activities enable the child to make meaning of the death. Joint child-parent time helps the caregiver practice communicating with the child about the deceased and plan together for upcoming challenging events like holidays and anniversaries.
What Happens in TF-CBT Sessions
TF-CBT is designed to be a short-term therapy, typically completed in 6-9 months (16-24 sessions). Children and caregivers meet separately with the same therapist for the psychoeducation, skill-building, parenting, and exposure components of treatment. Then, children and caregivers meet together for family work. Sessions include: planning the agenda for session, home practice review, focus on specific PRACTICE component, and home practice assignment.
Parents/caregivers are vital partners in a child’s TF-CBT work. They are taught the same coping skills because they may be experiencing their own stress, and they play an important role in coaching their child to use their new skills.
Family Stories
Please click the box to read the full story…
Matthew
Matthew: A child who experienced traumatic griefMatthew’s father went to work one morning and never came back. He had a heart attack, collapsed and died. Matthew felt like his life collapsed, too. He was just 6-years old and adored his father. After the death, Matthew was acting out in class, withdrawn at home, and wetting the bed at night....
Matthew and his mother received Trauma-Focused Cognitive-Behavioral Therapy for Traumatic Grief. They learned how trauma and grief affect feelings, thoughts, and behavior. They were then taught coping skills to handle anger and depression. Matthew and his mother taught his teacher the coping skills so she could support him in the classroom. As he used the skills, Matthew’s behavior improved. Once he learned the coping skills, Matthew’s therapist helped him write a book about his father and his father’s death. Matthew drew a picture for each of four chapters: life with his father, finding out that he died, going to the funeral, and life without his father. With his therapist’s help, Matthew added a chapter about how he had changed since his father’s death and what he learned in therapy. The therapist scheduled a time to share the book with his mother. She was sad, but also relieved and proud. When it was Matthew’s turn to share it with his mother, he cried and crawled under his mother’s chair. His mother supported him by sitting on the floor next to him. She told him that she was going to do some belly breathing; after a few seconds, he began to do it with her. He reached for her hand, and they read the story together, holding hands. When they finished, Matthew told the therapist that “Sometimes it is just someone’s time to go, and then they die.” He was beginning to make meaning of the tragedy. Matthew, his mother, and the therapist continued working on his grief, which included making a memory box that he filled with mementos of his father. Matthew opened it when he wanted to think or talk about his father. He and his mother planned for anniversaries, like his father’s birthday. They would tell stories and look at the memory box. Mathew still missed his father, but he was no longer afraid to think and talk about him.Maria
Maria: A pre-teen who experienced sexual abuseMaria loved soccer. Practicing penalty kicks was her favorite. But when she was sexually abused by her soccer coach, her 11-year-old life got turned upside down. She was having nightmares and refusing to walk onto any soccer field. Her parents didn’t know what was going on. When they asked Maria about the...
changes in her behavior, she told them about the sexual abuse. Her parents’ hearts broke as they listened to her blame herself. They tried to convince her that it wasn’t her fault, but it didn’t seem to work.... Maria’s parents reached out to CHP. After the initial assessment of Maria’s emotional and behavioral reactions to the abuse, the family was offered Trauma-Focused Cognitive-Behavioral Therapy. Maria and her parents each met with their therapist once a week. They learned about the prevalence of child sexual abuse, which made Maria feel less alone and lessened her self-blame. They also learned how common it is for children who have been through abuse to avoid people, places, and things that remind them of it. Maria and her parents were taught relaxation skills to calm their bodies. Belly breathing and progressive muscle relaxation helped her fall asleep. As part of the healing, her therapist worked with Maria to write a book about what happened and share it with her parents. This helped her understand that she was not responsible for the abuse. The next step was gradually overcoming avoidance of reminders of her abuse. This was done with in vivo exposure. Maria and her parents made a list of people, places, and things that made her panic. With her therapist, Maria put the situations in order, from least to most anxiety provoking. With support from her therapist and parents, she faced each situation, one at a time, using her coping skills to manage her worried feelings and recognize that the scary thing she thought would happen (i.e., being abused again) did not happen. After a few rounds of in vivo exposure, Maria told her parents that she was ready to play soccer. They found a new team and she was beaming when she came into therapy wearing her team jersey.Please swipe to read the next story…
Matthew and his mother received Trauma-Focused Cognitive-Behavioral Therapy for Traumatic Grief. They learned how trauma and grief affect feelings, thoughts, and behavior. They were then taught coping skills to handle anger and depression. Matthew and his mother taught his teacher the coping skills so she could support him in the classroom. As he used the skills, Matthew’s behavior improved.
Once he learned the coping skills, Matthew’s therapist helped him write a book about his father and his father’s death. Matthew drew a picture for each of four chapters: life with his father, finding out that he died, going to the funeral, and life without his father. With his therapist’s help, Matthew added a chapter about how he had changed since his father’s death and what he learned in therapy.
The therapist scheduled a time to share the book with his mother. She was sad, but also relieved and proud. When it was Matthew’s turn to share it with his mother, he cried and crawled under his mother’s chair. His mother supported him by sitting on the floor next to him. She told him that she was going to do some belly breathing; after a few seconds, he began to do it with her. He reached for her hand, and they read the story together, holding hands. When they finished, Matthew told the therapist that “Sometimes it is just someone’s time to go, and then they die.” He was beginning to make meaning of the tragedy.
Matthew, his mother, and the therapist continued working on his grief, which included making a memory box that he filled with mementos of his father. Matthew opened it when he wanted to think or talk about his father. He and his mother planned for anniversaries, like his father’s birthday. They would tell stories and look at the memory box. Mathew still missed his father, but he was no longer afraid to think and talk about him.
Maria’s parents reached out to CHP. After the initial assessment of Maria’s emotional and behavioral reactions to the abuse, the family was offered Trauma-Focused Cognitive-Behavioral Therapy. Maria and her parents each met with their therapist once a week. They learned about the prevalence of child sexual abuse, which made Maria feel less alone and lessened her self-blame. They also learned how common it is for children who have been through abuse to avoid people, places, and things that remind them of it. Maria and her parents were taught relaxation skills to calm their bodies. Belly breathing and progressive muscle relaxation helped her fall asleep.
As part of the healing, her therapist worked with Maria to write a book about what happened and share it with her parents. This helped her understand that she was not responsible for the abuse. The next step was gradually overcoming avoidance of reminders of her abuse. This was done with in vivo exposure. Maria and her parents made a list of people, places, and things that made her panic. With her therapist, Maria put the situations in order, from least to most anxiety provoking. With support from her therapist and parents, she faced each situation, one at a time, using her coping skills to manage her worried feelings and recognize that the scary thing she thought would happen (i.e., being abused again) did not happen. After a few rounds of in vivo exposure, Maria told her parents that she was ready to play soccer. They found a new team and she was beaming when she came into therapy wearing her team jersey.
CHP’s Impact
Outcome / Research Results
More than 20 randomized clinical trials have demonstrated the efficacy of TF-CBT compared to other forms of therapy in the reduction of PTSD, depression, and behavior problems in children who have experienced sexual abuse, domestic violence, natural disasters, terrorism, and other forms of trauma. At Child HELP Partnership, we want to ensure that our families have the same rates of improvement as those families who participated in the randomized trials.
The chart below presents our own outcomes at each stage of therapy at Child HELP Partnership.
Percentage of Children with Mental Health Problems at Each Stage of PARTNERS Therapy
No Data Found
As the chart shows, the percentages of children with PTSD, depression, and conduct problems decrease significantly over the course of therapy. Additionally, each phase of TF-CBT is important for recovery. By reducing rates of PTSD, depression, and conduct problems, we are not only easing the current pain of the children served, but preventing the need for long-term, expensive mental health care.
Contact Us about Trauma-Focused Cognitive-Behavioral Therapy
For more information about Child HELP Partnership’s Trauma-Focused Cognitive-Behavioral Therapy, contact us or fill out a referral form.