Trauma-Focused Cognitive Behavioral Therapy (CBT) for Children
By Gina Cipriano
Unfortunately, children can endure a variety of traumatic situations. Adverse childhood experiences (such as abuse, neglect, and bullying) negatively influence adults later in life. Children who have experienced trauma may exhibit the following behaviors: aggression, self-harm, difficulties concentrating, substance use, and ritualistic behavior (Price et al., 2013). There have been interventions adapted to assist children and caregivers process and resolve symptoms after a traumatic experience has occurred. One such approach is trauma focused cognitive behavioral therapy (TF-CBT). In TF-CBT, clinicians work closely both with caregivers and their children.
TF-CBT is appropriate for children ages 3-18 and sessions typically run for 60-90 minutes long. The sessions of TF-CBT follow a prescribed protocol that can be remembered by using the acronym PRACTICE:
Psychoeducation and Parenting skills: Children and caregivers are provided with education regarding trauma and its effects. Additionally, caregivers are given education on how to support positive behaviors and decrease negative behaviors of their children. For instance, active ignoring entails ignoring behaviors that a child is doing that are not dangerous. Active ignoring is best when utilized in conjunction with praising a child’s positive behavior. Praise is not as simple as a pat on the back or a “good job.” It entails clearly identifying the behavior a child did and reinforcing that behavior. For instance, a caregiver could say enthusiastically, “I can see how hard you worked on drawing that picture. Wow!”Relaxation: Children are taught relaxation techniques to utilize (such as breathing exercises and muscle relaxation techniques) to cope with traumatic symptoms. Further, parents are encouraged to reinforce these techniques at home.Affect Expression and Regulation: Children then learn how to label various emotions so that they can begin to identify with feelings they may have numbed. Additionally, children learn behaviors they can use, in different scenarios, to manage emotions triggered by trauma.Cognitive Coping: Next, children learn the difference between thoughts, feelings, and behaviors. Children learn the power that thoughts can have and begin disputing negative thoughts to ultimately change their feelings and behaviors.Trauma Narrative and Processing: During this process, the child is asked to recall the most significant traumas they endured. The therapist will help the child write down their trauma and focus on thoughts and feelings that arise. Further, they will utilize emotional regulation skills learned earlier to reinforce adequate coping strategies while recalling the trauma, and unhelpful thoughts will be challenged. The end goal of the narrative is to help the child write about their future desires so that hope for the future can be fostered and prevents a child from defining themselves by what happened to them. In Vivo Mastery of Trauma Reminders: During this time, the child will confront situations that they avoided or endured with intense anxiety due to the trauma. This means they will write a list about the least to most distressful situations. Then, they will work their way up to confronting these situations in a safe and controlled way until they can do so with minimal anxiety.Conjoint Caregiver-Child Sessions: These sessions are conducted with the caregiver and the child. The goal of these sessions is to assist children in sharing about their experiences with the caregiver and to assist the caregiver in offering support to the child. Enhancing Safety and Future Development: The goal of this session is to ensure that children have a safety plan in place so that they can ensure continued safety for themselves such as setting boundaries and learning how to ask for help.
References Price, M., Higa-McMillan, C., Kim, S., & Frueh, B. C. (2013). Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity. Journal of Anxiety Disorders, 27(7), 652-660. https://doi.org/10.1016/j.janxdis.2013.07.009Medical University of South Carolina. (2017). A course for trauma-focused cognitive behavioral therapy. TFCBT-Web. https://tfcbt2.musc.edu/ The National Child Traumatic Stress Network. (2018, August 20). Trauma-focused cognitive behavioral therapy. https://www.nctsn.org/interventions/trauma-focused-cognitive-behavioral-therapy We offer trauma-focused CBT for children in children’s therapy in Palm Beach.
