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Trauma Focused CBT

Trauma focused cognitive behavioral therapy (TF-CBT) is a form of cognitive behavioural therapy (CBT) that helps people to overcome the negative effects associated with trauma or post traumatic stress disorder (PTSD).

Trauma-focused cognitive behavioral therapy is one of the most effective clinical treatment methods for overcoming a trauma-based disorder such as PTSD – particularly for adolescents and children.

What is Post Traumatic Stress Disorder (PTSD)?

Post traumatic stress disorder (PTSD) is a mental health condition that is triggered by experiencing a terrifying, distressing traumatic event, or in cases of complex PTSD several traumatic events. Common causes of posttraumatic stress disorder include physical abuse, child maltreatment, sexual assault, domestic violence and combat exposure. Not everyone who experiences trauma will develop PTSD, and there are a number of different factors that affect how a potentially traumatic event impacts each person. Young people are generally thought to be more susceptible to developing PTSD, however traumatized children can also be incredibly resilient when their mental health is supported and they are given coping skills to deal with PTSD symptoms and regulate their emotions.

Post traumatic stress disorder can cause a range of mental health problems in later life if not properly addressed. PTSD symptoms can range from mild to severe and can become debilitating in some cases. PTSD can cause intense nightmares and flashbacks in which an individual feels as if they are re-living the traumatic moment.

What is TF-CBT?

Trauma focused cognitive behavioural therapy was first designed in the 1990’s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino to take a trauma sensitive approach to supporting youth and adolescents who had experienced sexual abuse. Trauma focused cognitive behavioral therapy has expanded since then to address many other forms of severe traumatic experiences or abuse

Cognitive Behavioural Therapy

CBT is a form of therapy that helps people recognise unhelpful or even harmful behaviours and thought patterns and work out coping mechanisms for disrupting them, or dealing with the negative impacts of them.

TF-CBT is a skills-based model of therapy, meaning the child and parent must practice the techniques and components if they wish to see results. This often involves practice at home, which a practitioner will encourage and support as much as possible. Communication is an important part of this and a key goal of TF-CBT is to encourage the parent and child to continue developing and practicing healthy communication.

What to Expect from TF-CBT

TF-CBT is a short-term intervention meaning that it typically features anywhere between eight and 25 sessions, although the TF-CBT treatment length can vary greatly. The child centered therapy takes place in an outpatient mental health clinic but other settings such as community centers, group homes, schools or even at home are suitable and common settings for the TF-CBT model to take place.

Unlike standard CBT, a non-offending guardian (meaning a person who has not been the perpetrator or facilitator of abuse) is present in the therapy session, with the child or young person. It is also common for the child and the caregiver or guardian to have separate therapy sessions ahead of the joint sessions.

During therapy sessions, standard cognitive behavioral techniques will be used to support the young person in adapting and modifying distorted or unhelpful thinking patterns, as well as negative reactions and behaviors related to these thinking patterns and the traumatic event. During the course of treatment, young people learn how to challenge intrusive thoughts of guilt and fear that are common after a traumatic experience. This helps them to reorganize and adapt their thinking and behaviour toward a more healthy, happy way or life. Gradual exposure can be a transformational aspect of the treatment model, where traumatic grief can be addressed trough gradual exposure to memories of events such as sexual abuse in order to engage in cognitive processing. Gradual exposure is not appropriate for all, so a cognitive behavioural therapy practitioner will assess whether this should be part of treatment.

Why is this Important?

Treating trauma and providing supportive therapy as early as possible is incredibly important, as untreated childhood trauma can lead to young people developing unhealthy coping mechanisms such as substance abuse. Children affected by traumatic stress are more likely to develop psychological difficulties and physical health problems such as heart disease in the future. Therefore, therapies such as trauma focused cognitive behavioral therapy are an essential tool in supporting traumatized children, including those who have been trafficked, experienced war or natural disaster and in particular sexually abused children.

Trauma focused cognitive behavioral therapy has shown great results in helping to reduce PTSD symptoms in randomized clinical trials. TF-CBT treatment is associated with a significant reduction in anxiety, insomnia, flashbacks and other related symptoms, allowing children affected by trauma to return to school, maintain important relationships and meet normal developmental goals.

Family Therapy

One key difference of TF CBT is the family therapy aspect that allows family members who may be struggling with how to deal with the posttraumatic stress the child has dealt with to develop communication and stress management skills. Children who have experienced trauma can react in a wide range of ways from reckless and angry to apathetic and dissociative, as a parent or carer, knowing the best way to deal with the complexity of the trauma and emotional responses a child demonstrates can be incredibly challenging. This is why family therapy and joint sessions are so important. It is common for a traumatised child to lose their footing, and start to perceive the world as a dangerous, unpredictable place. It is the role of the parent or carer to restore a sense of stability and safety. This is why the TF CBT model focuses on caregiver involvement, recognising the importance of caregivers in helping a child continue to practice and develop strategies to cope with triggers associated with the traumatic experience. Exposure to the trauma narrative, in a safe environment with a mental health professional and parent or carer can help reduce avoidant behaviours and maladaptive associations with the trauma.

Other core aspects of trauma focused cognitive behavioral therapy include:

  • Psychoeducation and parenting skills 
  • Cognitive coping skills
  • Relaxation techniques including deep breathing
  • Development of affective expression and regulations skills
  • Cognitive processing of the trauma
  • Recognising emotional responses and emotional reactions to triggers related to traumatic experiences
  • Exposure to the trauma narrative and reprocessing of the trauma narrative
  • In vivo mastery of trauma reminders
  • Improving future development outcomes
Trauma focused CBT

Other Psychological Therapies for Trauma

It is common for other psychological therapies to be used alongside or prior to trauma focused cognitive behavioral therapy (TF-CBT) such as dialectical behaviour therapy. Stabilizing therapy approaches are often used before TF-CBT in cases of adolescents that are expressing suicidal ideation, have a history of running away or self harming behaviours.

There are cases in which trauma focused cognitive behavioral therapy may not be appropriate, such as those where a child is suicidal, has another mental health disorder or is severely dissociative. In this case, studies have shown that the exposure and reprocessing component may increase traumatic stress and worsen mental health and posttraumatic stress symptoms.

Contact us

At Addcounsel we understand how incredibly distressing it can be to live through traumatic events, or continued traumatic events such as domestic violence and sexual abuse. Trauma responses can vary from person to person, which is why we create individualised programs for every individual seeking psychiatric services. We take a trauma sensitive approach to therapy and ensure TF-CBT techniques take a gradual approach to reducing symptoms, so you can practice skills such as cognitive coping skills and cognitive reprocessing at your own pace. Posttraumatic stress disorder can be debilitating and overwhelming, but you don’t need to live with it forever. Contact us today to learn more about our top quality mental health services and speak to one of our expert mental health professionals.

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