TF-CBT [TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY] FOR CHILDREN WHO HAVE BEEN AFFECTED BY SEXUAL ABUSE OR OTHER TRAUMATIC EXPERIENCES

It has become very clear how damaging chronic stress is for our bodies and our minds.  It is also becoming clearer how many children are traumatized by different types of events and suffer from chronic stress.  TF-CBT was developed to specifically treat symptoms of chronic stress [Post Traumatic Stress Disorder (PTSD)].  This has been adapted for use with children and recent studies have demonstrated it's effectiveness.  To review some of these studies you can go to: The California Evidence-Based Clearinghouse For Child Welfare (2011) at http-//www.cebc4cw.org; or SAMHSA Model Programs: National Registry of Evidence-Based Programs and Practices at http://ncrepp.samhsa.gov. There have also been studies showing benefit for children who have witnessed violence, see Cohen, Mannarin, & Lyengar, 2011 and also benefiting parents. Children who have experienced abuse often experience: feelings of guilt for what they see as their role in the abuse; anger toward their parents for not knowing about the abuse and for not protecting them; feelings of being powerless; feeling that they are "damaged goods"; and fears that they will be treated differently because of the abuse. They also may demonstrate negative behaviors, have other mental health problems such as depression and have PTSD symptoms that include: intrusive and traumatic thoughts of the abuse; avoidance of reminders of the abuse; emotional numbing; irritability; trouble with sleep and concentration; and physical and emotional hyperarousal with sudden and more extreme emotional reactions than is indicated for different situations. 

Benefits of TF-CBT for abused children include: reduced symptoms of PTSD and depression and also reduced behavioral problems while providing support and positive coping skills for non-offending parents.  TF-CBT components are described using the word PRACTICE.  P = psychoeducation and parenting skills. R = relaxation techniques. A= affective expression and regulation.  C= cognitive coping and processing.  T= trauma narrative and processing.  I= in vivo exposure.  C= conjoint parent and child sessions.  E= enhancing personal safety and future growth.   The therapy involves individual and parent and child sessions.  In our hospital based treatment program at the Copestone Child and Adolescent Inpatient Programs at Mission Hospital, we have found that a group therapy focus can more rapidly help children and adolescents to feel less stressed about their problems and to learn positive coping skills as they support each other in talking about their problems and learning better coping skills. 

Hopefully, more children who have been abused will be identified and referred to therapists who have been trained in TF-CBT.  It is important to note that some children or adolescents who have been running away, cutting themselves or are actively suicidal should be stabilized first using DBT [dialectical behavioral therapy] before TF-CBT is used.  For more information on TF-CBT you can go to the Child Welfare Information Gateway at http://www.childwelfare.gov/pubs/trauma.