Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a therapeutic intervention designed to help children and their parents overcome the negative and often devastating effects of trauma. Traumatic life events that children experience may include child sexual or physical abuse; traumatic loss of a loved one; exposure to domestic, school or community violence; exposure to disaster, terrorist attacks, or war trauma; serious accident such as car or plane; and serious medical procedures, operations or hospitalizations.
TF-CBT was developed by integrating cognitive and behavioral interventions with traditional child abuse therapies that focus on enhancement of interpersonal trust and empowerment. The intervention can be provided to children ages 3-18 and their parents.
TF-CBT is designed to reduce symptoms of Post-traumatic Stress Disorder (PTSD), which often co-occurs with depression and behavior problems. TF-CBT also addresses issues commonly experienced by traumatized children, such as poor self-esteem, difficulty trusting others, mood instability, relationship issues and negative coping skills.
As the result of a trauma, children may develop extreme fears of anything that reminds them of the traumatic event. This can lead to avoidance of certain reminders of the event and can cause significant emotional and physiological withdrawal, guardedness or acting out. Even without experiencing PTSD, child victims of trauma can have symptoms that significantly interfere with their ability to function and develop normally. TF-CBT helps children talk directly about their traumatic experience in a supportive environment where they can become less fearful, less avoidant and more able to tolerate trauma related thoughts and feelings.
TF-CBT helps the client develop stress management skills, affect regulation, problem solving and safety skills, communication skills, self-esteem empowerment and interpersonal trust. For the parent of children suffering from the effects of one or more traumatic events, this therapy helps the parent learn optimal ways to support the child and the skills the child is learning in therapy. It also teaches parents effective parenting skills in dealing with the behaviors that often accompany child victims of trauma and develop stress management skills of their own. During the therapy the child participates in a series of 12-20 (approximately) therapy sessions that address feeling identification, relaxation techniques, an introduction to how thoughts, feelings and behaviors are linked, how to examine his/her thoughts, feelings and behavior and how to change these in order to feel better.
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During the therapy the child creates a “trauma narrative” or their story of the traumatic event(s). The therapist then helps them examine their thoughts and feelings about the event and empowers them to move forward without the trauma ruling their lives. The therapy includes 2-4 joint parent child sessions and a graduation. During these sessions the child is encouraged to discuss the traumatic experience directly with the parent, and both the parent and the child learn to discuss questions, concerns and feelings about the event more openly. Although this is a child centered therapy, the parent participates throughout the process, through either separate meetings with the therapist or through consultation at the beginning or end of each session with the child, so that the parents are aware of the content covered during the sessions with the child and are therefore prepared to support the child between sessions and after treatment has concluded. In addition, parents are encouraged to explore their own thoughts and feelings about what the child experienced and are assisted with resolving their own personal trauma related distress. Sessions last 60 to 90 minutes and are provided on a weekly basis.
Some outcomes of TF-CBT are the following:
- Reduction or elimination of PTSD symptoms
- Reduction or elimination of symptoms of depression
- Reduction or elimination of self-blaming for the event
- Reduction or elimination of defiant, aggressive, oppositional or avoidant behaviors
- Reduction or elimination of anxiety symptoms
- Increased social competence
- Increased skills for stress management
- Increased personal safety skills
- Reduction or elimination of parental distress about the child’s experience
- Increased parental support of the child
- Increase in the child’s ability to cope with reminders and anniversaries of the traumatic event(s)
TF-CBT was originally developed and tested for sexually abused boys and girls, ages 3-14 years old. The original children studied were from diverse socioeconomic backgrounds and were primarily White and African American. Since, the treatment has been studied by numerous entities and over larger age ranges. TF-CBT has been found to be successful with children ages 3-18 years old, male or female, with diverse socioeconomic background and across ethnicities. Studies of TF-CBT have included both open treatment studies and randomized controlled trials. These studies have included looking at multiple domains such as: depression; PTSD; anxiety; behavioral problems; family and social functioning; and education among others. TF-CBT is currently being evaluated in a randomized clinical trial for children who have experienced traumatic loss as a result of terrorism.