Trauma Focused Cognitive Trauma Focused Cognitive Behavioral TherapyBehavioral Therapy

““TF-CBT”TF-CBT”

What is TF-CBT?What is TF-CBT?

Evidenced Based treatment model developed Evidenced Based treatment model developed by Deblinger, Cohen, and Mannarino that by Deblinger, Cohen, and Mannarino that integrates trauma sensitive interventions integrates trauma sensitive interventions with cognitive-behavioral strategies.with cognitive-behavioral strategies.

The therapist structures sessions such that The therapist structures sessions such that there is a focus on skill building and direct there is a focus on skill building and direct discussion and processing of the abuse discussion and processing of the abuse experience.experience.

TF-CBT is a time limited, structured model TF-CBT is a time limited, structured model that takes place over 12 – 20 sessions.that takes place over 12 – 20 sessions.

Youth between the ages of 3 and 18 that have Youth between the ages of 3 and 18 that have a memory of the trauma and have a a memory of the trauma and have a diagnosis of Post Traumatic Stress Disorder diagnosis of Post Traumatic Stress Disorder (PTSD) or Post Traumatic Symptoms.(PTSD) or Post Traumatic Symptoms.

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

TF-CBT is adaptable and flexible to address TF-CBT is adaptable and flexible to address developmental issues, gender, culture, developmental issues, gender, culture, family values (especially sensitive to family values (especially sensitive to sexuality and parenting styles).sexuality and parenting styles).

The therapeutic relationship is central.The therapeutic relationship is central.

TF-CBT STRUCTURETF-CBT STRUCTURE

Child’s TreatmentEducation

Skill BuildingExposure/Processing

Preparation forJoint Sessions

Parent’s TreatmentEducation

Skill BuildingExposure/Processing

Behavior Management

Preparation for Joint Sessions

Joint Sessions

Family Sessions

What Does PTSD Really MeanWhat Does PTSD Really Mean

PostPost == After After

TraumaticTraumatic == Really scary, life and death Really scary, life and death experienceexperience

StressStress = = My Body’s Alarm System My Body’s Alarm System

DisorderDisorder == Gets in the Way of My Life Gets in the Way of My Life

TF-CBT ComponentsTF-CBT Components

EDUCATIONEDUCATION

Learn about TraumaLearn about Trauma Look at parenting skills/behavior Look at parenting skills/behavior

managementmanagement Symptoms child is experiencing based on Symptoms child is experiencing based on

the clinical assessment and testing the clinical assessment and testing instruments.instruments.

Teach parents/caregivers active ignoring Teach parents/caregivers active ignoring and how to praise positive behaviorsand how to praise positive behaviors

Role play strategies with caregiverRole play strategies with caregiver Look at fact sheets in regards to trauma Look at fact sheets in regards to trauma Play psycho educational card game with Play psycho educational card game with

youth then youth and familyyouth then youth and family

Whatdo A therapeutic card

you game about child

know child sexual &

? Physical abuse & domestic violence

EMOTION IDENTIFICATION AND EMOTION IDENTIFICATION AND EXPRESSIONEXPRESSION

Ask client to talk about feelingsAsk client to talk about feelings Encourage client to expand feelingsEncourage client to expand feelings vocabulary and match feelings to vocabulary and match feelings to appropriate situations/eventsappropriate situations/events Engage youth in activity that encourages Engage youth in activity that encourages expression of feelingsexpression of feelings

COPING SKILLSCOPING SKILLS

Explain at least two of the following Explain at least two of the following strategies: (1) grounding, (2) mindfulness, strategies: (1) grounding, (2) mindfulness, and or (3) relaxation, including deep and or (3) relaxation, including deep breathing, progressive muscle relaxation or breathing, progressive muscle relaxation or guided meditation.guided meditation.

Review cognitive coping (thought stopping, Review cognitive coping (thought stopping, positive self-talk)positive self-talk)

Practice strategies in sessionPractice strategies in session Assign homework to practice skills at homeAssign homework to practice skills at home

COGNITIVE TRIANGLECOGNITIVE TRIANGLE

Taught client the distinction and relationship Taught client the distinction and relationship between thoughts, feelings and behaviorsbetween thoughts, feelings and behaviors

Provide relevant examples of automatic Provide relevant examples of automatic thoughtsthoughts

Thoughts Behaviors

Feelings

Practice scenarios in which client change Practice scenarios in which client change feelings and behaviors by thinking differentlyfeelings and behaviors by thinking differently

Explain cognitive distortionsExplain cognitive distortions Teach caregiver the cognitive triangleTeach caregiver the cognitive triangle Help caregiver identify inaccurate or Help caregiver identify inaccurate or

unhelpful thoughtsunhelpful thoughts Practice coping statements with caregiverPractice coping statements with caregiver

Trauma Narrative/Formal Gradual ExposureTrauma Narrative/Formal Gradual Exposure

Get youth to talk about traumaGet youth to talk about trauma Work on narrative each session, gradually Work on narrative each session, gradually

leading up to the worst momentleading up to the worst moment Prepare caregiver for narrative prior to Prepare caregiver for narrative prior to

sharingsharing Use books to introduce the narrativeUse books to introduce the narrative

Review previous work each weekReview previous work each week Organize narrative into a coherent wholeOrganize narrative into a coherent whole After completing narrative client adds After completing narrative client adds

thoughts, feelings, and physiological thoughts, feelings, and physiological responsesresponses

Share narrative with caregiver throughout Share narrative with caregiver throughout process if safeprocess if safe

Cognitive Processing – Cognitive Processing – Processing the Traumatic ExperienceProcessing the Traumatic Experience

Look for trauma related cognitive distortionsLook for trauma related cognitive distortions Challenge distortionsChallenge distortions Best friend role play or other strategy to Best friend role play or other strategy to

challenge cognitive distortionschallenge cognitive distortions Identify & challenge caregiver’s own trauma-Identify & challenge caregiver’s own trauma-

related cognitive distortionsrelated cognitive distortions

Personal Safety SkillsPersonal Safety Skills

Identify good and bad touchIdentify good and bad touch Use “uh-oh” feeling analogyUse “uh-oh” feeling analogy Use role play to teach client assertiveness Use role play to teach client assertiveness

skillsskills Client practice assertiveness skills in Client practice assertiveness skills in

session or taught skills to caregiversession or taught skills to caregiver

Additional InformationAdditional Information

TF-CBT is the #1 Evidence Based Treatment for TF-CBT is the #1 Evidence Based Treatment for use with PTSDuse with PTSD

Our Intern, Amber Yoder, did a paper on the Our Intern, Amber Yoder, did a paper on the effectiveness of TF-CBT on reducing PTSD effectiveness of TF-CBT on reducing PTSD symptoms among Sexually Abused Children. She symptoms among Sexually Abused Children. She took the testing instruments from Pre-intervention took the testing instruments from Pre-intervention to Post-intervention. She looked at a total of 31 to Post-intervention. She looked at a total of 31 youth. Out of the 31 youth, only 23 met the criteria youth. Out of the 31 youth, only 23 met the criteria for pre and post testing.for pre and post testing.

There were considerable differences between There were considerable differences between the pretest and posttest scores. She looked the pretest and posttest scores. She looked at the Pre Test Mean (SD) for three at the Pre Test Mean (SD) for three variables, and the Post-Test Mean (SD) for variables, and the Post-Test Mean (SD) for the same three variables.the same three variables.

The Next Slide will correlate the data to show The Next Slide will correlate the data to show how effective TF-CBT was.how effective TF-CBT was.

Trauma Symptom Checklist for Children Trauma Symptom Checklist for Children Pre and Post Test MeansPre and Post Test Means

N = 23N = 23

Variable Pre-test Mean SD Post-Test Mean SDVariable Pre-test Mean SD Post-Test Mean SD

Anxiety 54.17 (11.59) 45.91 (9.23)Anxiety 54.17 (11.59) 45.91 (9.23)

Depression 51.04 (11.71) 44.43 (9.00)Depression 51.04 (11.71) 44.43 (9.00)

Posttraumatic Stress 54.35 (11.55) 46.13 (9.74)Posttraumatic Stress 54.35 (11.55) 46.13 (9.74)

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

In ConclusionIn Conclusion

Having gone through this one year collaborative in Having gone through this one year collaborative in Huntsville, Alabama, Manatee Children’s Services Huntsville, Alabama, Manatee Children’s Services Therapists are now specialized in offering trauma Therapists are now specialized in offering trauma focused treatment. We have undergone one focused treatment. We have undergone one year’s intensive training and supervision through year’s intensive training and supervision through Duke University and the National Child Advocacy Duke University and the National Child Advocacy Center to become Specialized Trauma Focused Center to become Specialized Trauma Focused Cognitive Behavioral Therapists. Cognitive Behavioral Therapists.

Manatee Children’s Services was pro active in Manatee Children’s Services was pro active in financing a group of staff to go to Huntsville, financing a group of staff to go to Huntsville, Alabama. The following participants Alabama. The following participants attended: attended:

Danielle Foster: Senior LeaderDanielle Foster: Senior Leader

Gail Canario: Clinical DirectorGail Canario: Clinical Director

Nancy Baptist: TherapistNancy Baptist: Therapist

Jarvis Hodges: TherapistJarvis Hodges: Therapist