Some children develop ongoing fears and avoidance of situations that are inherently innocuous. When this avoidance significantly interferes with children’s adaptive functioning, it becomes an important issue to address in treatment; the TF-CBT therapist uses clinical judgment to determine which children require this component. For example, a child who was sexually abused in her bedroom by a perpetrator who is no longer in the home was still be afraid to sleep in her own bed, and eventually afraid to sleep at night at all, and was disrupting other family members’ sleep. Another child who witnessed his sibling’s sudden death at home avoided attend school for fear that his mother or another younger sibling would also die when he wasn’t home. In distinction to the trauma narrative, which involves imaginal exposure to children’s trauma experiences, “in vivo” (“in real life”) mastery involves exposure to the actual innocuous situation (e.g., sleeping in one’s own bed; returning to school, etc.) that the child fears and avoids.
- That is, the child can be engaged in an activity (e.g. drawing shapes) and thoughts about that activity can be elicited as it happens.
- At a minimum this includes interviewing the child and parent, but school reports, pediatric records, and/or other information should also be obtained as clinically indicated.
- Their role is critical to understanding the child’s trauma reactions, providing a consistent safe environment, and reinforcing skills learned in therapy over time.
- Thus, it is important to educate caregivers about common reactions to trauma as well as normative behavioural, emotional, and sexual development (Friedrich, Grambsch, Broughton, Kuiper, & Beilke, 1991) and help them respond effectively (Allen & Armstrong Hoskowitz, 2017; Deblinger et al., 2015).
” These questions often facilitate open discussion of deeper feelings and cognitions related to the child’s trauma experiences and many families report that these sessions were the most valuable part of their TF-CBT treatment. During the trauma narrative and processing phase, the therapist and child engage in an interactive process during which the child describes increasingly difficult details about personal trauma experiences, including thoughts, feelings, and body sensations that occurred during these traumas. Through this process the child speaks about even the most horrific and feared traumatic memories, thus “speaking the unspeakable” which enables the child to learn a mastery rather than avoidance response to these memories. Through the cognitive processing strategies learned previously the therapist helps the child to process trauma-related maladaptive cognitions. The child develops a written summary of the trauma narrative process, usually in the form of a book, poem or song.
Trauma-focused Cognitive Behavioral Therapy
Children who have experienced sexual abuse are often taught the doctors’ names for private parts (with caregiver permission). Although this is typically taught earlier in treatment, it is helpful to encourage cbt interventions for substance abuse the use of this language again as treatment nears its conclusion. As with all skills taught to children (especially young children), it is helpful to find creative and engaging ways to teach the skills.
The guidelines and strong research evidence suggest that PE, CPT and trauma-focused CBT should be the first line of treatment for PTSD whenever possible, considering patient preferences and values and clinician expertise. Research examining patient preferences suggests that individuals prefer PE, CPT and trauma-focused CBT to other treatments. Analog studies have demonstrated that participants have preferences for CT and exposure therapy over psychodynamic psychotherapy, EMDR, and therapies using novel technologies (e.g., virtual reality, computer-based therapy; Tarrier et al., 2006; Becker et al., 2007). In addition, results https://ecosoberhouse.com/ from studies examining clinical samples show that patient prefer psychotherapy, such as PE and CBT, to medication (Angelo et al., 2008; Feeny et al., 2009; Zoellner et al., 2009). APA included both trauma-focused and non-trauma-focused CBT in its recommendations including CBT-mixed, which included studies using cognitive behavioral techniques that did not fit in well with other categories, and CT, which included CT studies that were not specifically CPT. Brief trauma-focused CBT categorized by the VA/DoD included studies examining trauma-focused cognitive and/or behavioral techniques that were not specifically PE or CPT.