TF-CBT: A Literature Review

PTSD is one mental health issue that can result from a great deal of distress that a person may experience after a devastating event involving any type of physical trauma or threat of physical harm (American Psychiatric Association, 2013). A child who develops PTSD either “directly experienced the traumatic event(s), witnessed, in person, the event(s) as it occurred to others, learned that the traumatic event(s) occurred to a close family member or friend or experiencing repeated or extreme exposure to aversive details of the traumatic event(s)” (American Psychiatric Association, 2013). Traumatic events are normally unavoidable and uncontrollable. It may overwhelm a child and affect his or her sense of control and safety. Single, brief, and unanticipated events are classified as

CBITS is the most appropriate intervention program due to its focus on symptom reduction, improved functioning, improved grades and attendance, peer and parent support, and increased coping skills. The program reports use with students from 5th grade through 12th grade who have witnessed or experienced traumatic life events such as community and school violence, accidents and injuries, physical abuse and domestic violence, and natural and man-made disasters (CBITS, 2016). As compared to the other programs CBITS appeared to be all encompassing and showed better outcomes at 3-month follow-up. Additionally, CBITS is specifically designed to be administered by mental health clinicians in an actual school setting.

Researchers on Cognitive-behavior Therapy (CBT) report that CBT interventions are the most effective evidence-based treatments to treat depression among Latino youth (Feldman, Trupin, Walker & Hansen). CBT consist of pyscho-education, coping skills, exposure, monitoring of thoughts, moods and activities, illogical thinking, self-regulation and parent education/training when treating children (Carr, 2004). One specific CBT is Trauma-focused which focuses on youth who experience complex trauma. With Trauma-focused Cognitive-behavior Therapy (TF-CBT) therapist gather basic background to make the

A series analyses of covariance appears to have indicated that children assigned to TF-CBT, compared to those participants who were assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, guilt, and other abuse-related attributions. (Cohen, Deblinger, Mannarino, & Steer, 2004, p.400). Similarly, parents or guardians who were assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices allowing them to parent more effectively. (Cohen, Deblinger, Mannarino, & Steer, 2004, p. 401). TF-CBT assists both the primary caregivers along with the child to ensure everyone in the situation who experiences negative symptoms are addressed and helped therapeutically, to create an outcome where children and their families can live successfully together. This can also include communities as whole TF-CBT helps bring empowerment to its participants and allows them to face their issues head on.

This discussion is a review of the Cognitive Behavior Intervention for Trauma in Schools program also known as CBITS. This discussion will include an overview of the program and descriptions of components that are included within the program. The program has been introduced into two other programs that are specifically for children that have experienced trauma and how the program effected children who have been diagnosed with post-traumatic stress disorder. The implementation and effectiveness of this program and its transportability will be discussed. Cost Effectiveness and the quality of care that is received by the clients will also be evaluated. The program will also be reviewed for factors that will influence a provider’s decision to utilize the program and possible institutional obstacles and possible future opportunities will also be discussed.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a conjoint child and parent psychotherapy approach for children and adolescents who are experiencing significant emotional and behavioral difficulties related to traumatic life events. This online TF-CBT course shows step by step instruction in ten modules for each component of therapy. According to the introduction on the Trauma-Focused Cognitive Behavioral Therapy website it states that, “There is strong scientific evidence that TF-CBT helps children, adolescents, and their parents overcome many of the difficulties associated with abuse and trauma.” This is a very detailed online course that gives live video examples on how each process is done.

This treatment approach is based on cognitive and learning theories, tackling-misleading beliefs related to the traumatic events of acknowledgments related to the abuse and provides a supportive environment of which individuals are encouraged to talk about their traumatic experience. A numerous amount of research has been carried out to investigate into how effective CBT really can be for PTSD. (Resick et al, 2002) carried out an investigation comparing CBT with strong cognitive restructuring focus and CBT with a strong exposure focus and to a waiting-list control of rape survivors. Prior to this experiment approximately 80% of patients who completed either form of CBT no longer met the criteria for PTSD. Once this investigation was complete a follow up treatment took place of which it was noted 2% of the waiting list group had lost the PTSD diagnoses. Only a year after this investigation Bryant, Moulds, Guthrie, Dang & Nixon, (2003) restructured the experiment comparing exposure alone, exposure plus cognitive restructuring, and supportive counselling in civilians with PTSD resulting from various traumatic events. At this particular follow up 65-80% of participants who either completed either form of CBT were now clear of PTSD diagnosis, compared to less than 40% of those who completed supportive counselling.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a psychotherapeutic approach that involves conjoint therapy sessions of with the child and the parent. This approach is employed among children and/or adolescents that are experiencing emotional and behavioral difficulties that are significant and related to life events that are traumatic (Cohen, Mannarino, & Deblinger, 2012). TF-CBT is a components-based model of treatment that includes intervention that are trauma-sensitive and cognitive behavioral, family and humanistic therapy

As children go through life, they will come upon stressful situations and experiences. Many children will work through the challenges that life brings, build resilience and move forward, however, some children may experience more extreme traumatic events that can result in life difficulties due to serious trauma symptoms that are much harder to manage. Trauma-Focused-Cognitive Behavioral Therapy is an evidence based treatment model designed to help youth who have experienced a significantly traumatic life event. TF-CBT uses skills and strength based therapy to address symptoms of post-traumatic stress disorder (PTSD), depression and anxiety (Cohen et al, 2006). This research is an examination of trauma focused cognitive behavior therapy as a model of practice including the areas of history and development of the model, its relationship with other models of practice, considerations of appropriate populations, methods and components for treatment, effectiveness of the intervention and relevance for social work practice.

The National Child Traumatic Stress Network (NCTSN) was stablished by Congress in 2000 and brings a comprehensive focus to childhood trauma. This network raises the average standard of care and improves access to services for traumatized children, their families and communities throughout the United States. The NCTSN defines trauma‑focused cognitive behavioral therapy (TF‑CBT) as an evidence‑based treatment approach that is shown to help children, adolescents, and their caregivers overcome trauma‑related difficulties. It is designed to reduce negative emotional and behavioral responses following a traumatic event. The treatment addresses distorted beliefs related to the abuse and provides a supportive environment so the individual can talk about their traumatic experience. TF‑CBT also helps parents cope with their own emotional issues and develop skills to support their children.

A., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child abuse & neglect, 36(6), 528-541.

The American Counseling Association’s fact sheets provides various symptoms for children and adolescents that are experiencing trauma. According to the American Counseling Association’s Traumatology Interest Network and facilitator, Karin Jordan (2015) children exhibit different trauma related symptoms at different periods in their lives (ACA et al., 2015). While I am providing therapy as a new LCPC, my client may not explicitly say that they have undergone some sort of trauma, but may unknowingly talk about their symptoms. It will then be my responsibility to consult a colleague, or in this case, the ACA to better serve my client’s needs. I will study the specified age group symptoms, while comparing the symptoms of my client and continue with the diagnosis of trauma (ACA et al., 2015).

TF-CBT is an evidence based practice that has evolved in the past 25 years and has been extensively researched within the treatment of PTSD and trauma effects such as depression, distress, anxiety, and cognitive and behavioral problems. This paper will contain a detailed description of the methodology of TF-CBT and an examination of a few peer reviewed studies, which tests the effectiveness TF-CBT has on children and adolescents who suffer from PTSD, neglect, or other trauma impacts.

Studies estimate that over one in four children will experience trauma before the age of sixteen, and many of these youth will go on to develop Post-Traumatic Stress Disorder as a result of their trauma (Silverman, Oritz, Viswesvaran, Burns, Kulko, Putnam, & Amaya-Jackson, 2008). Children and adolescents with PTSD can benefit from a mixture of the Cognitive and Behavioral models, presented in the form of Cognitive-Behavioral Therapy (CBT). Specifically, Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is the most effective method to treat PTSD, utilizing techniques from two different perspectives (cognitive and behavioral) that can

However, Diaz and Motta focused their study on adolescent participants and on PTSD. For this study, participants were between the ages of 14 and 17 and were all female from a residential treatment facility that met the criteria for PTSD (Diaz & Motta, 2008). The researchers used the following self-report inventories to measure the level of PTSD: (a) Child PTSD Symptom Scale [CPSS] (Foa, Johnson, Feeny, & Treadwell, 2001), (b) Trauma Symptom Checklist for Children [TSCC] (Briere, 1996), (c) Multidimensional Anxiety Scale for Children [MASC] (March, 1997), (d) Children’s Depression Inventory [CDI] (Kovacs, 1992) (Diaz & Motta, 2008).