Trauma Focused Cognitive Behavioral Therapy

1. Trauma Focused Cognitive Behavioral Therapy “TF-CBT”

2. 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.

3. 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.

4. The Therapist sets an agenda and sticks to the agenda, dealing with “COWS” or Crisis of the Week at the end of each session.

5. 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.

6. TF-CBT STRUCTURE Parent’s Treatment Education Skill Building Exposure/Processing Behavior Management Preparation for Joint Sessions Child’s Treatment Education Skill Building Exposure/Processing Preparation for Joint Sessions Joint Sessions Family Sessions

7. 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

8. 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.

9. 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 doA therapeutic card you game about child knowchild sexual & ?Physical abuse & domestic violence

10. 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

11. 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.

12. Review cognitive coping (thought stopping, positive self-talk) Practice strategies in session Assign homework to practice skills at home

13. COGNITIVE TRIANGLE Taught client the distinction and relationship between thoughts, feelings and behaviors Provide relevant examples of automatic thoughts Thoughts Behaviors Feelings

14. 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

15. 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

16. 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

17. 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 trauma-related cognitive distortions

18. 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

19. 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.

20. 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.

21. 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)

22. Amber wrote “these findings validate the effectiveness of the program further showing the growing need for increased funding.”

23. 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.

24. Manatee Children’s Services was pro active in financing a group of staff to go to Huntsville, Alabama. The following participants attended: Danielle Foster: Senior Leader Gail Canario: Clinical Director Nancy Baptist: Therapist Jarvis Hodges: Therapist