Monthly Archive November 2016

ByStacy Garcia, MA, LPC, NCC

What is Trauma-Focused CBT?

Trauma can happen to anyone, including children and adolescents. For some time, many people believed that trauma only happened to military servicemen (and women) and veterans, that trauma was only the experience of events like war and related situations. While trauma can most definitely result from these events and in this population, it is now known that it can also occur in the lives of civilians and it can result from other events that may not necessarily be war-related. It can happen to adults, and it can happen to kids, including those very young children who may still lack the verbal communication skills to express their thoughts and feelings in words.

What is trauma?

Before I dig into what Trauma-Focused CBT (Cognitive Behavioral Therapy) is, it’s important to first know exactly what trauma is. If you google the definition of trauma, you will find that besides being described as a “physical injury,” it’s also defined as a “deeply disturbing or distressing experience.” Wikipedia specifically defines psychological trauma as a “type of damage to the mind that occurs as a result of a severely distressing event.” That “severely distressing event” can be a number of things, including being the victim of or witness to abuse or assault; surviving a natural disaster such as a tornado or fire; being a direct witness to an act of terrorism; learning that your close relative has tragically died all of a sudden; being the EMT who needs to treat victims of a fatal car accident; being involved in a car accident yourself; and so on. As you can see, there are a number of ways a person might experience trauma!

What is child traumatic stress?

According to The National Child Traumatic Stress Network (NCTSN), “child traumatic stress occurs when children and adolescents are exposed to traumatic events or traumatic situations, and when this exposure overwhelms their ability to cope with what they have experienced.” The definition of trauma is actually subjective, differing among individuals. Two or more children (or people, in general) can experience the same traumatic event but react completely differently: one may go on to experience symptoms related to Post-traumatic Stress Disorder (PTSD), while another may experience a few days or few weeks (sometimes months) in which they are strongly affected and then proceed to live a healthy, functional life. In other words, not all children who experience a potentially traumatic event will necessarily become “psychologically traumatized.”

Children can respond to traumatic stress in a number of ways. According to NCTSN, when confronted by something that reminds them of their traumatic experience, a child might show signs of intense distress, including disturbed sleep, trouble paying attention and concentrating, anger, withdrawal, repeated and intrusive thoughts. Some of these children may develop psychiatric conditions such as PTSD, depression, anxiety, and/or behavior disorders. Other children seem to “bounce back” after adversity, though it’s important to continue to watch for disruptions in their development, as trauma can have profound long-term consequences. Even adult survivors of trauma can display difficulty in functioning as a result of childhood trauma.

 Fortunately, there’s help…

There are effective treatments for childhood traumatic stress, and one that is growing increasingly popular as more and more evidence proves its effectiveness is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). TF-CBT is a components-based model of conjoint child and parent therapy that addresses the unique needs of kids with PTSD symptoms, depression, behavior problems, and other difficulties related to traumatic experiences. I think the National Crime Victims Research & Treatment Center at MUSC describes it best: In TF-CBT, “children and parents learn new skills to help process thoughts and feelings related to traumatic life events; manage and resolve distressing thoughts, feelings and behaviors related to such events; and enhance safety, growth, parenting skills, and family communication.”

The essential components of TF-CBT can be described using the acronym PRACTICE:

  • Psychoeducation about childhood trauma and PTSD
  • Parenting, which includes parent management skills
  • Relaxation and stress management skills, all individualized to the child and parent
  • Affective (emotion) expression and modulation
  • Cognitive coping and processing: connecting thoughts, feelings, and behaviors related to the traumatic experience(s)
  • Trauma narrative, which entails assisting the child in sharing a verbal, written, or artistic narrative about the trauma(s) and related experiences and uses cognitive and affective processing of these experiences
  • In vivo exposure (gradual exposure) and mastery of trauma reminders
  • Conjoint parent-child sessions to practice skills and increase comfort and enhance trauma-related discussions
  • Enhancing future personal safety and developmental trajectory via providing safety and social skills training

Trauma-Focused Cognitive Behavioral Therapy has been proven successful with children and adolescents ages 3 to 18 who are experiencing significant emotional and behavioral problems related to the traumatic event(s) they have endured. Among other things, it has specifically been found to improve depression, anxiety, behavior issues, sexualized behaviors, trauma-related shame, traumatic grief, social competenence, and interpersonal trust. Through psychoeducation and safety and social skills training, children and teens are also taught how to recognize not only their own trauma symptoms but also how to identify potentially dangerous situations (such as the behaviors a potential sexual predator may exhibit, for example) and what to do and how to cope when confronted with such.

Typical length of treatment using TF-CBT can vary depending on each individual child and the symptoms and/or other issues they may present with, but it is generally designed to be a relatively short-term treatment (typically 12 to 16 sessions). According to research on the effectiveness of TF-CBT, over 80 percent of traumatized children and adolescents who receive this type of treatment experience significant improvement after just this short amount of time! For those children experiencing more complex difficulties, TF-CBT can be used as part of a larger treatment plan.

Who can offer TF-CBT?

Trauma-focused CBT can be used by certain mental health professionals (e.g., professional counselors, clinical social workers, psychologists, psychiatrists, or clinical counselors) trained in the use and implementation of the TF-CBT model.

The author of this post, Stacy Garcia, MA, LPC, NCC at Creative Resilience Counseling, LLC, is currently at the end of the TF-CBT certification process and has been providing treatment for trauma-affected children and adolescents using this model for over four years.  For a free phone consultation to discuss whether TF-CBT may appropriate for your child or teenager, please don’t hesitate to contact the CRC office at 304-292-4050 or via the form on our Contact Us website page.

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