TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY|2023/24 UPDATE|GRADED A+

Trauma-Focused Cognitive Behavioral Therapy A hybrid treatment model that integrates: 1) Traumatic sensitive interventions 2) Cognitive behavioral principles 3) Attachment theory 4) Developmental neurobiology 5) Family Therapy Developed out of _________. Work with sexually abused children Intended for what ages? 4 and up Session Information -20 to 24 parallel joint sessions with parent and child -Individual sessions for both as well -Parent sessions parallel child sessions -Same therapist for both Difficulties Addressed (CRAFTS) Cognitive problems Relationship problems Affective problems Family problems Traumatic behavior problems Somatic problems Children's Goals -Reduce negative, emotional, behavioral responses to trauma -Correct maladaptive or unhelpful beliefs related to the abusive experience Caregiver Goals -Provide support and skills to help cope effectively with their own emotional distress -Provide skills to respond optimally to support the child Indications -Identifiable traumas -Known trauma history -Prominent trauma symptoms -Behavioral symptoms can be managed without dominating treatment -Placement is stable enough to complete treatment through the trauma narrative -Parental involvement is optimal Rationale for TF-CBT -Research indicates improvements in symptoms among children exposed to abuse, violence, grief, and other traumas -Reductions in PTSD symptoms, depression, self-blame, anxiety, and behavior problems -Improvements in parenting skills and improvements maintained at 2 years post treatment Child Sessions Comprised of education, coping skills, emotion processing Parent Sessions Comprised of education, skill building, emotion processing, behavior management PRACTICE Model Psychoeducation and parenting Relaxation Affect modulation Cognitive coping Trauma narrative In-vivo exposure Conjoint parent-child sessions Enhancing safety and development Psychoeducation -What is trauma? -Common responses to traumatic events -Why children may not want to talk about it -Information about specific trauma types -Risk reduction and safety planning -What to expect from TF CBT Parenting Skills -Caregivers = central therapeutic agents of change -Parent is not part of the problem, but rather the child's strongest source of support -Modeling healthy coping -Power of parental influence in improving child's behavior -Refocus attention on child's strengths and encourage praise -Highlight positive parenting skills -Encourage parents to increase the frequency of enjoyable interactions -Decrease negative attention to problem behaviors -Create or re-establish structure, rituals, rules -Utilize effective negative consequences (time-out) Common Issues Experienced by Parents Inappropriate self blame and guilt Inappropriate child blame Overprotectiveness Overly permissive PTSD symptoms Relaxation Teaching children and parents relaxation techniques can help with traumatic symptoms and decrease behavioral issues and aniety Relaxation Techniques 1) Controlled breathing 2) Belly breathing 3) Progressive muscle relaxation 4) Guided imagery 5) Yoga 6) Mindfulness Affective Expression and Relaxation -Accepting feelings -Labeling feelings -Expressing feelings -Identifying feelings -Coping w/ wide array of feelings -Feeling identification -Practice expressing range of feelings -Teach intensity modulation -Review relaxation strategies -Anger management techniques -Exercise/Physical activities Cognitive Coping Goals -Educate children and parents about connections between thoughts, feelings, and behaviors -Start by reviewing identification skills -Make connections between feelings and behaviors -Use common scenarios - Encourage self-talk and the acknowledgement of internal thoughts and self-dialogue Cognitive Coping Steps 1) Review the difference between thoughts and feelings 2) Outline the "cognitive triangle" 3) Use examples to explain how thoughts affect feelings and behaviors 4) Generate scenarios and have child identify thoughts, feelings, and likely behaviors 5) Help child consider more accurate and helpful thoughts 6) Discuss how to apply this skill to real life Trauma Narratives Help to create an understanding of the trauma within the broader context of a child's life Encourage "telling the story" Facilitating Trauma Narratives Ask broad, open-ended questions EX: What were you thinking? How were you feeling? What happened next? In-Vivo Exposure Helps gradually desensitize children to reminders of trauma and promotes resolution of avoidant behaviors Set SMALL, ACHIEVABLE goals, and start with the least threatening experience first In-Vivo Exposure Steps 1) Identify the feared situation 2) Design a desensitization plan 3) Try to do exposure at the beginning of a session to allow for time to process the experience Conjoint Therapy Sessions -Therapist models appropriate support of the child to the parents -Caregiver models skillful coping strategies to the child -Therapist encourages optimal parent-child communication