aPPROACHES
TF-CBT
Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment model designed to assist children, adolescents, and their families in overcoming the negative effects of a traumatic experience. The team at It Begins Within is focused on providing TF-CBT to the Tampa & St. Petersburg communities.
What is TF-CBT?
Trauma Focused-Cognitive Behavioral Therapy is an evidence-based, family driven psycho-therapy model for youth who have witnessed or experienced a trauma event that has caused clinically significant emotional and behavioral difficulties. The Trauma Focused-Cognitive Behavioral Therapy model is intended for short-term (typically 12-20 sessions) application.
This is a components-based treatment model, in that it’s structured and builds on itself throughout treatment. This heavily scientific research-based based model incorporates interventions and techniques based on various theories, which include: cognitive, behavioral, family therapy, and humanistic principles.
How TF-CBT Works
The treatment involves individual sessions with the you and parent (or caregiver) separately. There are also joint sessions with the youth and parent together. Each individual session is designed to build the therapeutic relationship. The conjoint sessions are designed to help parents and youth practice or use the skills they learned. The end goal is for the youth to create a narrative that the youth and parent can process together. This model allows for a gradual way to foster effective communication skills between the youth and parent about the abuse or related issues.
Understanding “PRACTICE”
The components of the Trauma Focused-Cognitive Behavioral Therapy protocol spell out the word “PRACTICE”. This stands for: Psychoeducation and parenting skills, Relaxation techniques, Affective expression and regulation, Cognitive coping and processing, Trauma narrative and processing, In vivo exposure, Conjoint parent/child sessions, and Enhancing personal safety and future growth. These topics guide the techniques, and procedures the therapist utilizes in treatment and can be adapted to many diverse clinical settings, situations, and families.
A highlighted focus throughout the model is education for the youth and parent. The Trauma Focused-Cognitive Behavioral Therapy therapist will assess the youth and parent's knowledge and beliefs about their specific trauma type. Each session will seek to provide targeted information about specific trauma type gradually and ongoing typical behavioral or emotional responses to specific trauma type.
Sessions will facilitate ways to role play or practice how to support the youth's acquisition of trauma-specific knowledge to their life.
How Does TF-CBT differ from other approaches?
This model utilizes therapeutic interventions that focus of TF-CBT is to enable youth and their caregivers who have experienced traumatic events. The model serves to support the purpose effective skills to cope with trauma-related emotional and behavioral problems. This model allows for a family focused direction to enhance ways to manage trauma symptoms and enhance communication.
This model has been proven to provide guidance and the education to support parents to cope adaptively with their own emotional distress or mental health symptoms associated with the trauma. This model can also allow for a parent to understand how their own history of trauma can interfere with the understanding the role of a caregiver or child rearing capabilities.
In addition, this model gradually create opportunities for therapeutic discussion regarding the traumatic event for the youth and caregiver to create a shared narrative. The trauma narrative is different from other models. In that this model is for youth with a known history of traumatic events and supports to conceptualize the trauma history as a coherent, meaningful narrative. The youth and parent work alongside the therapist to identify of cognitive distortions and trauma-related themes in the narrative. This psychological therapy model seeks to support the identification of effective youth responses during the trauma experience and during treatment.
Issues Treated with TF-CBT
The main focus is to help traumatized children heal from those events in a safe and adaptive manner. The first phase of treatment is focused on the reduction of negative emotional and behavioral responses to the trauma. The goal is to effectively process trauma experiences gradually and one way is to support the identification of trauma reminders, triggers, and ways to reduce them in the youth's environment. This model allows for the identification and coping for maladaptive or unhelpful beliefs associated with the traumatic experience (e.g., the world is dangerous, I'm a bad kid, I want to get back at others, etc.).
This model allows for a family be engaged in resources or interventions to encourage or teach healthy, age appropriate sexual development and boundaries. In addition, this model serves to treat childhood traumatic grief, which is a condition in which youth develop significant trauma symptoms related to the death of an loved one, attachment figure, or another important person.
Clinically, TF-CBT is designed to reduce symptoms of Post-traumatic Stress Disorder (PTSD). These symptoms can include a wide range of symptoms, which can include: depression, anxiety, anger management problems, fear, shame, embarrassment, guilt, and self-blame. TF-CBT is applicable to treat significant symptoms of PTSD and this has been supported in its many clinical trials. It should be noted that the youth do not have to meet full diagnostic criteria for PTSD. Research has found that children consistently experiencing four or more trauma related symptoms can benefit from TF-CBT.
Examples of potentially traumatic events
Examples of events that produce PTSD symptoms can include:
Experiencing or witnessing interpersonal violence, such as sexual abuse/assault, physical abuse/assault, bullying
Intimate partner violence
Domestic violence
Impaired caregiving due to substance abuse or untreated mental health symptoms
Unexpected or traumatic death of a loved one
Motor vehicle accident,
Divorce or separation from a caregiver
Adoption
Medical diagnosis
Experiencing a natural or man-made disaster such as a tornado, flood, earthquake, hurricane, chemical spill, train or airplane crash
Dog or other animal attack
Exposure to war or combat violence
This model allows for a youth to process multiple traumas at once.
Who Provides TF-CBT?
A licensed mental health provider (therapist, social worker, or psychologist) who has completed the TF-CBT certification model can provide this therapy. A TF-CBT Certified therapist has completed a learning collaborative, engaged in-person clinical training, and participated in ongoing consultation calls on cases for over a year.
How Effective Is TF-CBT?
Some research shows that trauma symptom scores decreased in youth by 81.9% among those who received TF-CBT. Randomized controlled trials has shown that 80% of children show significant improvement in less than 16 weeks. There are now more than 25 studies have been conducted to evaluate TF-CBT and it’s effectiveness on childhood trauma symptoms. The results consistently show TF-CBT to be useful in the reduction of symptoms of PTSD. The Mental Health Services Administration and American Psychological Association recommend the TF CBT treatment model. This model was originally designed for youth that have experienced sexual abuse. Now it is known that this model serves to treat various trauma experiences, including complex trauma. In the review of research and clinical trials it was found that TF-CBT, when compared to other tested models and services, yielded better post treatment results and suggested this model can promote enhanced progress in fewer clinical sessions. Follow-up studies suggest progress is maintained long term and over time.
Limitations of TF-CBT
TF-CBT may not be appropriate for youth and adolescents with risky or dangerous symptoms, such as serious conduct problems, psychosis, or other significant behavioral problems. If someone is suicidal or engages in abuse of substances should not be recommended for TF-CBT initially. The gradual exposure and in-vivo exposure component of TF-CBT may cause symptoms to worsen temporality.
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