Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
OVERVIEW
This cognitive-behavior therapy program is targeted at children who are experiencing symptoms of post-traumatic stress disorder (PTSD). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) involves individualized therapy sessions in which children are given emotional skills training and later, with the help of trained therapists, children begin to confront the experience which initialized the PTSD symptoms. The studies outlined below found that TF-CBT was effective in reducing the symptoms of PTSD.
DESCRIPTION OF PROGRAM
Target population: Children and adolescents who have been diagnosed with post-traumatic stress disorder (PTSD)
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is used for children and adolescents who have developed clinical levels of PTSD. In young children, this disorder is often the result of sexual or physical abuse. The program seeks to teach children skills to cope with the difficulties that this disorder creates. At the same time, therapy sessions are used to help children confront and deal with painful or scary past experiences.
EVALUATION(S) OF PROGRAM
Cohen,
J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A
multisite, randomized controlled trial for children with sexual abuse-related
PTSD symptoms. Journal of the
Evaluated population: 229 children ages 8-14 (M = 10.76 years) who had met at least 5 of the 6 DSM-IV criteria for PTSD. The sample was 60% white, 28% African-American, 4% Hispanic, 7% bi-racial, and 1% other ethnicity.
Approach: Participants were given an initial screening by evaluators and then randomly assigned to either a TF-CBT group or a comparison group which used a Child-Centered Therapy (CCT) program. CCT programs are focused on the development of a trusting relationship between the child and therapist. During therapy sessions, children choose what topics to discuss and largely lead the direction of the sessions. The TF-CBT treatment program focused on expressing feelings, training in coping skills, understanding relationships between thoughts and behaviors, and gradual exposure to the traumatic event. Both treatments were given once a week and involved two consecutive 45 minute sessions, one for the child and one for the child’s parent, for a total of 90 minutes of treatment sessions each week. Additionally, TF-CBT treatment included 3 joint parent-child sessions which lasted 30 minutes instead of consecutive 45 minute sessions. The total session breakdown for these 3 weeks was: 30 minutes for joint session, 30 minutes for child’s individual session, and 30 minutes for child’s parent’s individual session. Parents and children attended treatment sessions once per week for a total of 12 weeks.
Results: Participants in both conditions improved scores on all measures for post-traumatic stress disorder symptoms over the course of the study; however, TF-CBT therapy participants had significantly lower scores on survey measures of post-traumatic stress disorder (Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), Child Behavior Checklist (CBCL), Children’s Depressive Inventory (CDI), Children’s Attributions and Perceptions Scale (CAPS), Shame Questionnaire, Beck Depression Inventory (BDI), and Perceived Emotional Response Questionnaire (PERQ)) when compared with children and adolescents in CCT treatment groups indicating that they were displaying fewer symptoms of post-traumatic stress disorder. TF-CBT participants likewise were less likely to be diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defined post-traumatic stress disorder (21%, 19 out of 89) at the end of the study when compared with participants in CCT groups (46%, 42 out of 91).
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-145.
Evaluated Population: 82 children and adolescents ages 8-15 who were referred to a traumatic stress program. 60% of participants were Caucasian, 37% African-American, 2% bi-racial, and 1% Hispanic. To be included in the study these children and adolescents had to have had contact sexual abuse within the past 6 months, significant symptoms of PTSD (i.e. clinical levels), and an available non-offending caretaker.
Approach: After an initial interview which assessed eligibility for the study, participants were randomly assigned to TF-CBT or Non-Directive Supportive Therapy (NST). NST therapists fostered the development of therapeutic, trusting relationships and encouraged children and parents to choose which topics the therapy sessions would focus on. TF-CBT treatments focused on the topics of feeling identification, stress inoculation techniques, direct discussion and gradual exposure of traumatic events, education about healthy sexuality, and safety skill building. The therapy sessions for both treatments were individual and lasted a total of 90 minutes with 45 minutes devoted to individual child therapy and 45 minutes devoted to individual therapy for the child’s parent. Parents and children attended treatment sessions once per week for a total of 12 weeks.
Results: Participants in the TF-CBT group had greater improvement in scores over time on the CDI, State-Trait Anxiety Inventory for Children (STAIC), and Trauma Symptom Checklist for Children (TSCC) (Anxiety, Depression, and Sexual Problems subscales) scales compared to participants in the control group. This improvement in scores indicates that TF-CBT participants exhibited fewer and/or less pervasive symptoms of post-traumatic stress disorder. At a 6-month follow-up interval, participants in the TF-CBT group had greater improvement in scores on the STAIC-State, STAIC-Trait, and TSCC (Anxiety, Depression, Sexual Problems, and Dissociation subscales) scales compared with participants in the control group. At a 12-month follow-up interval, participants in the TF-CBT group had greater improvement in scores on the TSCC (PTSD and Dissociation subscales) scale. All of these results indicate that participants in the TF-CBT group were displaying fewer and/or less pervasive symptoms of post-traumatic stress disorder compared with participants in control groups.
SOURCES FOR MORE INFORMATION
References
Cohen,
J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A
multisite, randomized controlled trial for children with sexual abuse-related
PTSD symptoms. Journal of the
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-145.
Program categorized in this guide according to the following:
Evaluated participant ages: 8-15 years/ Program age ranges in the Guide: 8-15 years
Program components: clinic-based, provider-based, or miscellaneous; counseling/therapy; parent or family component
Measured outcomes: social and emotional health and development; mental health
KEYWORDS: Middle Childhood (6-11), Adolescence (12-17), Children (3-11), Clinic-based, White or Caucasian, Black or African American, Hispanic or Latino, Urban, Suburban, Rural, Child Maltreatment, Parent-management Skills, Family Therapy, Behavior Problems, Post-traumatic Stress Disorder, Mental Health, Social Emotional Health
Program information last updated 1/10/07
|
|
|
© Child Trends 2003 |
|
|
|
