Treatment strategies such as behavior modeling and body safety skills training are also used.
Key elements of the intervention include psychoeducation (for example, common reactions to trauma exposure), coping skills (for example, relaxation, identification of feelings, and cognitive coping), gradual exposure (for example, through imagination or in-vivo exposure), cognitive processing of trauma-related thoughts and beliefs, and caregiver involvement (for example, parent training and conjoint child-parent sessions). The approach uses cognitive-behavioral principles and exposure techniques to address symptoms of posttraumatic stress following trauma exposure as well as symptoms of depression, behavior problems, and caregiver difficulties. TF-CBT is a direct service for children and adolescents and their nonoffending caregivers. Table 1 Description of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) Feature Treatment of trauma-related symptoms secondary to a range of traumatic events (for example, sexual abuse, physical abuse, domestic violence, community violence, and natural disasters) occurs in a variety of settings that include university-affiliated and community-based outpatient clinics. TF-CBT has been widely used and disseminated, including through the National Child Traumatic Stress Initiative ( 8).
In this review, we sought to augment that definition with specific information about the key components of TF-CBT as described by its developers ( 1). The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a general definition of TF-CBT as a treatment that uses cognitive-behavioral principles, including exposure techniques, to address the various symptoms that children and adolescents may experience after a traumatic event ( Table 1). The high rates of trauma among children and the potential long-term impact of PTSD and related conditions have necessitated the development of interventions designed specifically to meet the needs of children and adolescents in the aftermath of trauma, and this has been an important advancement in the field. However, between 20% and 50% of children exposed to trauma experience some level of posttraumatic stress symptoms ( 3). The lifetime prevalence rate of diagnosable posttraumatic stress disorder (PTSD) among children and adolescents is approximately 5% ( 7). The experience of trauma increases a child’s risk of posttraumatic stress symptoms as well as depression and behavior problems ( 6). The authors interpreted trends between 20 as suggesting more stability than change.
#TRAUMA FOCUSED CBT UPDATE#
In a 2011 update with a nationally representative sample of individuals aged one month to 17 years, the authors reported that in the past year over 57% of participants had experienced at least one of five types of victimization (physical victimization or bullying, sexual victimization, child maltreatment, damage to property, or witnessing victimization) ( 5). A national survey of children aged 2–17 years or their caregivers conducted in 2008 found that more than 69% had experienced at least one of 33 types of victimization ( 2).
Published estimates indicate that 75% or more of children and adolescents experience some form of trauma by the age of 18 ( 2– 4). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a manualized intervention for children who are exposed to trauma and experience trauma-related mental health symptoms ( 1).
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