1

Trauma-Focused CBT

Judy Cohen, M.D. & Tony Mannarino, Ph.D.

Allegheny General HospitalEsther Deblinger, Ph.D.

New Jersey CARES Institute

2

Theoretical Underpinnings of TF-CBT

• A hybrid model incorporating CBT, attachment, family, psychodynamic and empowerment principles

• Goals: resolve PTSD, depressive, anxiety and other trauma-related symptoms in children and adolescents; optimize adaptive functioning; and enhance safety, family communication and future developmental trajectory

3

TF-CBT Or Not?• Target symptoms: PTSD, depression,

anxiety, and behavioral symptoms secondary to trauma.

• Children presenting with predominance of behavioral problems may benefit more from a different treatment.

• TF-CBT has been used for all types of traumas

• TF-CBT has been used for children ages 3-18, with and without parental participation, in schools, group home, foster home and in-home settings but is most commonly provided individually to child and parent in clinical settings.

4

Evidence That TF-CBT Works

• Six randomized controlled trials have been conducted for sexually abused/multiply traumatized children comparing TF-CBT to other active treatments

• In all six studies children receiving TF-CBT experienced significantly greater improvements in a variety of symptoms, both at immediate post-treatment and up to 2 years post-treatment.

• PTSD symptoms consistently improved significantly more in the TF-CBT groups.

5

Evidence That TF-CBT Works

• CATS Project: TF-CBT used following 9-11 terrorist attacks in NYC demonstrated significantly greater improvement in PTSD among children receiving TF-CBT than those receiving usual treatment.

• Two open studies of TF-CBT for Childhood Traumatic Grief CTG) have offered preliminary support of effectiveness of adding grief-focused module to TF-CBT for children experiencing CTG.

• Current ongoing randomized trial for children with PTSD secondary to domestic violence.

6

•TF-CBT Components: PRACTICE

• Psycoeducation• Parent Component includes parenting

skills• Relaxation • Affect identification and regulation• Cognitive coping• Trauma narration and cognitive processing

of these experiences• In vivo desensitization to trauma

reminders• Conjoint child-parents sessions• Enhancing safety and future development

7

TF-CBTTF-CBTWebWeb is a is a web-based, web-based, distance education distance education training course for training course for learning Trauma-learning Trauma-Focused Cognitive-Focused Cognitive-Behavioral Therapy Behavioral Therapy (TF-CBT).(TF-CBT).

TF-TF-CBTCBTWebWebwww.musc.edu/tfcbtwww.musc.edu/tfcbt

8

•Web-based learningWeb-based learning•Learn at your own paceLearn at your own pace•Learn when you wantLearn when you want•Learn where you wantLearn where you want•Return anytimeReturn anytime•10 hours of CE10 hours of CE

TF-CBTTF-CBTWebWeb is is offered free of offered free of charge.charge.

TF-TF-CBTCBTWebWebwww.musc.edu/tfcbtwww.musc.edu/tfcbt

9

Each module hasEach module has::•Concise explanationsConcise explanations•Video demonstrationsVideo demonstrations•Clinical scriptsClinical scripts•Cultural considerationsCultural considerations•Clinical ChallengesClinical Challenges

TF-TF-CBTCBTWebWebwww.musc.edu/tfcbtwww.musc.edu/tfcbt

10

TF-CBTTF-CBTWebWeb is sponsored by:is sponsored by:

TF-CBTTF-CBTWebWeb was developed and is maintained through grant No. 1-UD1-SM56070-was developed and is maintained through grant No. 1-UD1-SM56070-01 from the Substance Abuse and Mental Health Services Administration.01 from the Substance Abuse and Mental Health Services Administration.

TF-TF-CBTCBTWebWebwww.musc.edu/tfcbtwww.musc.edu/tfcbt