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Trauma Focused Cognitive Behavior Therapy

Cognitive Behavior Therapy: CBT is a briefer, time-limited form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.   A psychoeducational approach, it is designed to make the patient into her or his own therapist.  The focus is on the present and the future, addressing past events only to the extent necessary to help the patient move forward with his or her life.  That is, “insight” is not our goal, though the patient may gain a better understanding in the process of therapy.  Click here for more information about Cognitive Behavior Therapy.

Trauma Focused: Refers to the fact that the sole purpose of treatment is to assist the individual in learning to manage the current and lasting effects of some recent or distant past trauma.   The goal is to enable the individual to make sense of the trauma, putting it into perspective, assigning blame (if appropriate), and enabling her or him to take the aftermath of the trauma in stride.

Research: TF-CBT has been shown to be effective in the treatment of children who have been sexually abused, many of whom were also victims of physical abuse, domestic violence, and other traumatic events.  It has been found to be superior to other active treatments for traumatized children and teens suffering from:

  • Posttraumatic Stress Disorder (PTSD)
  • Depression
  • Anxiety
  • Internalizing, Externalizing and Sexualized Behaviors
  • Shame
  • Abuse-related cognitions (thoughts)

Components of the Treatment Process (“PRACTICE”)

  • Psychoeducation – general information about the specific type of trauma experienced, as well as common emotional and behavioral responses to the event, both immediate and delayed.  The therapist may also provide information about the patient’s diagnosis, symptoms, and the usefulness of the model in treating that condition.
  • Relaxation – training in specific techniques for bringing about the “relaxation response.”  This is critical, because it is not possible to be both relaxed and tense at the same time.
  • Affective (emotional) expression and modulation (control) – many of us have been taught from an early age to carefully control our emotions, keeping them “in check,” so as not to disturb other people.  This is especially true of persons who have experienced traumatic events.  For example, children who are traumatized often hide their emotions, to avoid hurting their parents.  During this phase of treatment, the patient is taught and encouraged to express those emotions safely.
  • Cognitive (thinking) coping and processing – many persons who have been traumatized learn to avoid thinking about the trauma; however, this is rarely completely successful, with “intrusive” thoughts interfering with their day-to-day lives.  During this phase of treatment, the patient learns to manage those thoughts, controlling when they occur, and coping with them when they do.  This involves learning simple and effective techniques that can be used anywhere.
  • Trauma narrative development and processing – When the patient is ready, having developed the skills necessary to manage problematic emotions and thoughts, he or she will work with the therapist to tell his or her story.  This could take the form of a book, a video, a song, a poem, a series of drawings, or anything else that works for the patient.  It is important to know that whatever form this takes, it will belong to the patient, and will never be seen by anyone without her or his permission.  One of the goals of treatment is for the patient to be able to tell the story of the traumatic event(s) without experiencing any of the troubling symptoms that brought him or her to treatment.
  • In vivo (real life) mastery of trauma reminders (triggers) – during this phase of treatment, the patient learns to manage the events in their lives, such as sounds, smells, touches, places, times of day, seasons of the year, holidays, etc., that might remind her or him of the trauma, triggering intrusive thought and emotions.
  • Conjoint sessions (with parents, partners, or other appropriate persons identified by the patient) – in some cases, the patient desires assistance in helping other persons in their lives to understand what has happened to them, and how those traumatic events affect their behavior and needs today.  This phase is optional for adults, but can be very helpful to the patient and his or her family, friends, etc., and can make additional support available to the patient.
  • Enhancing future safety and development – research shows that persons who have experienced traumatic events may be at increased risk for future traumatic events.  During this final phase of treatment, the therapist will assist the patient in developing a “safety plan,” to prevent future trauma, or reduce the severity of such trauma.  If the patient is in danger, this phase of treatment may occur sooner in the process.
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