Transcript Trauma Focused Cognitive Behavioral Therapy

Trauma Focused Cognitive
Behavioral Therapy
“TF-CBT”
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.
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.
The Therapist sets an agenda and sticks to
the agenda, dealing with “COWS” or Crisis
of the Week at the end of each session.
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.
TF-CBT STRUCTURE
Child’s Treatment
Education
Skill Building
Exposure/Processing
Preparation for
Joint Sessions
Parent’s Treatment
Education
Skill Building
Exposure/Processing
Behavior Management
Preparation for
Joint Sessions
Joint Sessions
Family Sessions
What Does PTSD Really Mean
Post
=
After
Traumatic =
Really scary, life and death
experience
Stress
=
My Body’s Alarm System
Disorder
=
Gets in the Way of My Life
TF-CBT Components
EDUCATION
 Learn about Trauma
 Look at parenting skills/behavior
management
 Symptoms child is experiencing based on
the clinical assessment and testing
instruments.
 Teach parents/caregivers active ignoring
and how to praise positive behaviors
 Role play strategies with caregiver
 Look at fact sheets in regards to trauma
 Play psycho educational card game with
youth then youth and family
What
do
you
know
?
A therapeutic card
game about child
child sexual &
Physical abuse &
domestic violence
EMOTION IDENTIFICATION AND
EXPRESSION
 Ask client to talk about feelings
 Encourage client to expand feelings
vocabulary and match feelings to
appropriate situations/events
 Engage youth in activity that encourages
expression of feelings
COPING SKILLS
 Explain at least two of the following
strategies: (1) grounding, (2) mindfulness,
and or (3) relaxation, including deep
breathing, progressive muscle relaxation or
guided meditation.
 Review cognitive coping (thought stopping,
positive self-talk)
 Practice strategies in session
 Assign homework to practice skills at home
COGNITIVE TRIANGLE
 Taught client the distinction and relationship
between thoughts, feelings and behaviors
 Provide relevant examples of automatic
thoughts
Thoughts
Behaviors
Feelings
 Practice scenarios in which client change
feelings and behaviors by thinking differently
 Explain cognitive distortions
 Teach caregiver the cognitive triangle
 Help caregiver identify inaccurate or
unhelpful thoughts
 Practice coping statements with caregiver
Trauma Narrative/Formal Gradual Exposure
 Get youth to talk about trauma
 Work on narrative each session, gradually
leading up to the worst moment
 Prepare caregiver for narrative prior to
sharing
 Use books to introduce the narrative
 Review previous work each week
 Organize narrative into a coherent whole
 After completing narrative client adds
thoughts, feelings, and physiological
responses
 Share narrative with caregiver throughout
process if safe
Cognitive Processing –
Processing the Traumatic Experience
 Look for trauma related cognitive distortions
 Challenge distortions
 Best friend role play or other strategy to
challenge cognitive distortions
 Identify & challenge caregiver’s own traumarelated cognitive distortions
Personal Safety Skills
 Identify good and bad touch
 Use “uh-oh” feeling analogy
 Use role play to teach client assertiveness
skills
 Client practice assertiveness skills in
session or taught skills to caregiver
Additional Information
 TF-CBT is the #1 Evidence Based Treatment for
use with PTSD
 Our 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.
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.
Trauma Symptom Checklist for Children
Pre and Post Test Means
N = 23
Variable
Pre-test Mean SD
Post-Test Mean SD
Anxiety
54.17 (11.59)
45.91 (9.23)
Depression
51.04 (11.71)
44.43 (9.00)
Posttraumatic Stress
54.35 (11.55)
46.13 (9.74)
Amber wrote “these findings validate the
effectiveness of the program further showing
the growing need for increased funding.”
In Conclusion
Having 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.
Manatee Children’s Services was pro active in
financing a group of staff to go to Huntsville,
Alabama. The following participants
attended:
Danielle Foster:
Gail Canario:
Nancy Baptist:
Jarvis Hodges:
Senior Leader
Clinical Director
Therapist
Therapist