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Trauma-Focused Cognitive Behavioral Therapy

A Treatment for Children with PTSD

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Updated October 25, 2011

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The consequences of being exposed to a traumatic event, including PTSD, are more commonly studied among adults; however, traumatic exposure and symptoms of PTSD can also occur in children, showing the need for therapy for children with PTSD.

Studies have found that a large number of children are exposed to traumatic events before the age of 16. Although the types of traumatic events children are exposed to and the effect they have on a child's well-being vary, one traumatic event that has a high likelihood of leading to mental health problems among children is the experience of sexual abuse.

When children are experiencing PTSD symptoms, what kind of treatment is best? There are a number of effective treatments for PTSD in adults. However, these treatments may not be as helpful for children. Children may have a lower awareness of emotions, or not have as good of an idea as adults about how to effectively express certain emotions. Children may also have a poorer understanding of their symptoms or why they are experiencing the symptoms they have. Finally, some of the concepts in common treatments for PTSD in adults may be too difficult for children to grasp. Given this, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed for children suffering with PTSD symptoms, primarily from the experience of sexual abuse.

An Overview of TF-CBT

TF-CBT is considered a cognitive-behavioral treatment. That is, it largely addresses PTSD symptoms by targeting maladaptive and unhealthy thoughts and behaviors that a victim of sexual abuse might experience. For example, TF-CBT may help children modify inaccurate beliefs that lead to unhealthy behaviors, such as beliefs that they are to blame for the abuse. It also identifies unhealthy patterns of behaviors (for example, acting out or isolating) or fear responses to certain stimuli and attempts to modify these by identifying healthier ways of responding to certain stimuli or in particular situations.

TF-CBT is also unique in that it incorporates an intervention for parents or caregivers who were not involved in the abuse. Children and parents each participate in therapy, first separately and then in joint sessions. Parents learn stress management techniques, healthy parenting techniques, and how to better communicate with their child. TF-CBT recognizes that the support of the parent or caregiver is very important to the recovery of the child. It also recognizes that parents may experience considerable distress as a result of their child's sexual abuse, and this distress needs to be addressed so it doesn't interfere with parenting.

How Does TF-CBT Address PTSD Symptoms?

TF-CBT is considered a short-term treatment. It generally lasts about 12 to 18 sessions and each session may last 60 to 90 minutes. TF-CBT addresses PTSD symptoms by taking children and parents/caregivers through the following components:

  • Psychoeducation and parenting skills. Therapists provide children and parents with information on sexual abuse and the types of symptoms that may come up in response to this kind of traumatic event. Parents are taught ways to effectively manage behavioral problems, as well as how to better communicate with their child.

  • Relaxation. Children are taught ways to manage their anxiety through relaxation.

  • Emotional expression and regulation. The therapist assists the child and parents in how to manage emotions related to the abuse in a healthy and effective way. For example, children are taught how to identify and express their emotions, as well as engage in self-soothing exercises when experiencing intense emotions.

  • Coping with thoughts. Children are assisted in identifying maladaptive thoughts about the sexual abuse (for example, self-blame) and how to work through these thoughts.

  • Creation of a trauma narrative. Children are taken through exposure exercises, such as talking about the event or writing about the event. Children may also create a symbolic representation of the event through drawing or play.

  • In vivo exposure. The therapist gradually exposes the child to trauma reminders so that the child learns how to effective manage their fear response, as well as reduce avoidance behaviors.

  • Joint parent-child sessions. The parent and child work together to improve communication and learn how to discuss the abuse in a healthy and therapeutic manner.

  • Staying safe and maintaining recovery. The therapist provides the child and parents with information on how to be safe in future situations, so as to avoid future abuse. Information on how to maintain and continue in the recovery process is also discussed.

Is TF-CBT Effective?

Overall, studies have found that TF-CBT is effective in reducing symptoms of PTSD, as well as other problems (for example, depression, behavioral problems, shame) among children exposed to sexual abuse. In addition, TF-CBT appears to be more effective than other types of treatment approaches that may be used with children with a history of sexual abuse, such as supportive therapy or play therapy. In addition, gains made in TF-CBT have been found to be maintained up to two years following the end of therapy.

TF-CBT also appears to help parents and caregivers who were not involved in the child's abuse. Parents report lower levels of depression, distress about the abuse, and symptoms of PTSD. It has also been found that TF-CBT increases parents' ability to support their child.

Finding A Therapist Who Provides TF-CBT

If you are interested in learning more about TF-CBT, you can visit the website of the Medical University of South Carolina National Crime Victims Research and Treatment Center. Information on TF-CBT is also provided on the website of the United States Department of Health and Human Services.

To find a therapist who provides TF-CBT, you would first want to find a therapist who specializes and has experience in the treatment of children with trauma. You may be able to find such a therapist through websites that are designed to connect you with treatment providers in your area. In addition to providing resources for families who have a child that is dealing with the consequences of sexual abuse, the Sidran Institute also provides information on therapists who may specialize in the treatment of children who are victims of sexual abuse.

Sources:

Cohen, J. A., Berliner, L. & March, J. S. (2000). Treatment of children and adolescents. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatment for PTSD (pp. 106-138). New York: Guilford Press.

Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive behavioral therapy: An empirical update. Journal of Interpersonal Violence, 15, 1203-1223.

Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guilford Press.

Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005) Treating sexually abused children: One year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-146.

Copeland, W.E., Keeler, G., Angold, A., & Costello, E.J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577-584.

Deblinger, E., Behl, L., & Glickman, A. (2006). Treating children who have experienced sexual abuse. In P. Kendall (Ed.), Child and adolescent therapy, 3rd ed.. New York: The Guilford Press.

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