Understanding Trauma-Focused Cognitive Behavioral Therapy

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach that has been proven to help children, adolescents, and their caregivers overcome the difficulties associated with trauma, such as child abuse. This type of therapy is a positive and effective way to treat post-traumatic stress disorder (PTSD). It works by challenging the thought processes of the patient, allowing them to recognize the reality of the trauma. Additionally, TF-CBT can help increase a person's emotional perception by exploring their responses to memories of trauma.

Joint parent-child sessions are included in the TF-CBT model to optimize communication between children and parents, both in general and in relation to the child's traumatic experiences. To implement in vivo mastery, the therapist, the child, and the parents develop a hierarchy of fear (sometimes referred to as the fear ladder), which ranges from the least dreaded scenarios (“1”) to the most dreaded (“10”), with 10 being the desired end point. For example, when Sarah's anxiety levels increase, the therapist helps her by pointing out unhealthy thinking or the increase in the response to stress and giving her time to practice restructuring her thoughts and participating in a breathing activity or to relax her muscles. At this point in TF-CBT, the therapist does not focus on trauma-related thoughts with the child, since it is more effective to process them during the narrative component of the trauma.

By repeatedly exposing themselves to the child's narrative, parents, like the child, acquire a new command in relation to the knowledge of their children's traumatic experiences and, therefore, are better able to model adaptive coping in the presence of the child during joint sessions. During joint sessions, the therapist may re-introduce What Do You Know or other therapeutic games previously used in TF-CBT for use in this regard. Her therapist begins to challenge her in each session to use healthier thinking patterns and to use coping techniques. From the start of treatment, it is important for the therapist to help the family understand that TF-CBT is a collaborative treatment between parents and children and focused on trauma.

Finally, listening to the child's trauma narrative in separate sessions with the therapist as they develop their narrative provides parents with sufficient time to prepare emotionally and cognitively for joint sessions between the child and their parents, during which they normally share their narrative directly with them. There is no official accreditation for trauma-focused cognitive behavioral therapy, although there are complementary training and courses available. A traumatic event or ongoing chronic trauma, such as domestic violence or physical or sexual abuse, can make it difficult for people to trust anything or anyone. For example, lower levels of parental distress over child trauma and greater parental support predict more positive outcomes after exposure to childhood trauma, while greater parental PTSD symptoms predict more negative outcomes for children.

Trauma-focused therapy can help parents recognize and respond appropriately to their children's trauma responses while setting appropriate behavioral limits.

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