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    7b Trauma Focued CBT 18052023 114318am

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    7b Trauma Focued CBT 18052023 114318am

    Uploaded by

    ayesha kamal
    7 views31 pages

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    7b--Trauma-Focued-CBT-18052023-114318am

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    7 views31 pages

    7b Trauma Focued CBT 18052023 114318am

    Uploaded by

    ayesha kamal

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    INTRODUCTION TO

    TRAUMA-FOCUSED
    COGNITIVE BEHAVIORAL THERAPY
    THE ORIGINS OF TF – CBT

     Trauma-Focused – Cognitive Behavioral Therapy, was developed jointly


    by Esther Deblinger, Ph.D., Co-Director of the New Jersey CARES Institute
    Judith Cohen, M.D., and Anthony Mannarino, Ph.D.
     C.A.R.E.S (Child Abuse Research Education & Service).
     TF-CBT was primarily developed for addressing the needs of children who have
    suffered sexual abuse; the model has also been adapted for use with children who
    have suffered a variety of traumatic experiences, such as physical abuse, exposure
    to domestic violence, and traumatic grief.
     Viewed working with parents as an integral part of treatment.
    MAJOR GOALS

     Teaching children and their non-offending caregivers adaptive coping skills.


     Assisting children to emotionally and cognitively process their traumatic experiences.
     Reducing the emotional and behavioral reactions exhibited by children.
     Facilitating children's adjustment when needed.
     Assisting non-offending caregivers in responding to their child's reactions as well as helping
    them cope with their own feelings related to the trauma(s).
     Working with caregivers and children in joint sessions to improve interaction, enhance
    communication, and practice personal safety skills to help reduce the risk of future
    victimization.
    UNDERSTANDING PTSD

     What is Post-Traumatic Stress Disorder?

    1) Traumatic Event
    2) Avoidance
    3) Re-Experiencing
    4) Hyperarousal
    5) Interference with Daily Functioning
    COMPLEX PTSD

     Ongoing, chronic exposure to traumatic events.


     No one, isolated trauma.
     Symptoms can be wide-ranging, but should still meet criteria for PTSD.
    Working
    Model of
    Trauma
    COMMON THEMES OF PTSD
     Loss of Trust in Self & Others
     Self-Blame
     Shame & Guilt
     Anger
     Relationship Difficulties
     Behavior Problems
     School Failure
     Difficulty Managing Affect
     Hopelessness
     Depression
    COMMON CAREGIVER THEMES

     Inappropriate Self-Blame & Guilt


     Inappropriate Child Blame
     Over-Protectiveness
     Post-Traumatic Stress Disorder/Symptoms
     Anger, Aggression
     Hopelessness, Worry, Depression
    TF-CBT IS NOT FOR:

     Clients with extreme therapy-resistant behavior.

     Clients with active suicidal behavior.

     Clients with severe cognitive disabilities.


    TFCBT – ‘A PRACTICE!’:
    IMPLEMENTATION
     Assessment!
     Psychoeducation and Parenting Strategies
     Relaxation
     Affective Expression and Regulation
     Cognitive Coping
     Trauma Narrative and Processing
     In-vivo Exposure
     Conjoint Parent Child Sessions
     Enhancing Personal Safety and Future Growth
    TRAUMA-FOCUSED
    COGNITIVE BEHAVIORAL
    THERAPY
    Child’s Treatment Caregiver’s Treatment
    Coping Skills Training: Coping Skills Training:
    Emotional Expression Emotional Expression
    Cognitive Coping Cognitive Coping
    Relaxation Relaxation

    Gradual Exposure & Gradual Exposure &


    Processing Processing

    Education: Education (like child sessions)


    Child Sexual Abuse
    Healthy Sexuality Behavior Management
    Joint Sessions
    Personal Safety Coping Skills Exercises
    Gradual Exposure &
    Processing
    Education Regarding Sexuality
    and Sexual Abuse
    Personal Safety Skills
    Family Sessions
    From Deblinger & Heflin (1996)
    TF-CBT Sessions Flow
    Entire process is gradual exposure

    Baseline
    1/3 1/3 1/3
    assessment

    Sessions 1 - 4 Sessions 5 - 8 Sessions 9 - 12


     Psychoeducation  Trauma Narrative
     Conjoint Parent
    /Parenting Skills Development and
    Child Sessions
    Processing
     Relaxation
     In vivo Gradual  Enhancing
     Affective
    Exposure Safety and
    Expression and
    Future
    Regulation
    Development
     Cognitive Coping
    ASSESSMENT
    Goal: Identify trauma history and presence of trauma-related symptoms.

     Observation.
     Clinical interview.
     Trauma must be explicitly discussed.
     Assess for nature of trauma.
     Assess for immediate response to trauma.
     Assess for re-experiencing.
     Assess for hyper arousal.
     Assess for numbing.
    PSYCHOEDUCATION
    Goal: Normalize symptoms, validate experience and reactions, instill hope for recovery.

    1) What is trauma?
    2) What is PTSD?
    3) What is TF-CBT?

    A key requirement of TF-CBT is the therapist’s ability to tolerate hearing and talking about
    children’s trauma experiences.
    There is evidence that becoming able to remember and talk about the trauma without extreme
    distress is central to resolving trauma’s impact.
    Therefore, it is crucial for children to see that their TF-CBT therapists can tolerate hearing about
    their traumatic experiences, as well as their accompanying emotional reactions. Therapists’ comfort
    with and commitment to the positive value of openly addressing the trauma encourages both
    PARENTING STRATEGIES
    Goal: Support caregivers to reduce their own stress/anxiety, improve the child-adult relationship, help
    the caregiver support the child’s recovery.

    1) Praise
    2) Rewards
    3) Active Ignoring
    4) Time Out

    Specific for kids with PTSD:


     Confidence in limit-setting.
     Not reinforcing avoidance.
     Coping coaching.
    RELAXATION
    Goal: Create “tool box” that client can use in their own environment to manage symptoms.

    Relaxation is not just progressive muscle relaxation and deep breathing…

     What do you do to relax?

     Coping Cat!
    AFFECTIVE EXPRESSION AND
    REGULATION
    Goal: Address multiple conflicting feelings, teach varying levels of feelings, teach vocabulary for talking
    about traumatic events competently.

     Feelings Education (What are emotions?)


     Connecting Feelings to Traumatic or Difficult Events
     Feelings Thermometers
     Learning Self-Soothing Techniques
    COGNITIVE COPING
    Goal: To help clients/families evaluate the ways in which trauma changed their thinking
    and correct distorted thoughts.

    Make sure clients don’t define themselves by their traumatic experiences!

    "Cognitive Processing occurs before and after the Trauma


    Narrative;
    first teach the skill, then use it!
    COGNITIVE COPING
    THE HEART OF TF-CBT:
    Goals:
     Clarify the difference between thoughts, feelings, and behaviors.
     Demonstrate how thoughts, feelings, and behaviors affect each other.

    Thoughts

    Behaviors Feelings
    TRAUMA NARRATIVE

    Goal: To gradually expose client to thoughts, memories, and other mild reminders of the abusive
    experience until they can tolerate those memories without significant emotional distress and no longer
    need to avoid them.

     Un-pairing of harmless stimuli with learned anxiety response.


    TRAUMA NARRATIVE
    Should include:
     Before the trauma.
     Components of the trauma (chapters)
    with specific details, thoughts, feelings,
    and associated memories.
     The “worst” part.
     “What I learned” or “What I would tell
    other kids”.
     The future.
    COGNITIVE PROCESSING OF THE
    TN:
    Goal: Identify latent or overt cognitive distortions or unhelpful beliefs and challenge them with the
    client.

     Revisit the cognitive triangle, add consequences.


     Use Socratic questioning.
     Never “tell” the clients to change their beliefs.
    IN-VIVO EXPOSURE

    Goal: Unpair feared stimuli (triggers) from the learned response of anxiety/fear.
    Examples:
     The Dark
     Streets
     Men

     Use general and specific fear ladders, set up homework and practice activities with reward
    systems.
     EMDR (Eye-Movement Desensitization and Reprocessing)
    CONJOINT SESSIONS

    Goals:
    1) Increased exposure/opportunity for mastery.
    2) Increase child & caregiver communication.
    3) Support asking and answering questions.

     Essential to prepare adequately.


     Invite prepared questions, comments, and feedback.
     Celebrate success!
    ENHANCING SAFETY

    Goal: Prepare for the future!

     Learn to recognize signs/symptoms that indicate the need for a return to treatment.
     Create usable, meaningful safety plans.
     Plan for using coping skills.
     Consider environmental supports.
    TFCBT – ‘A PRACTICE!’:
    IMPLEMENTATION
     Assessment!
     Psychoeducation and Parenting Strategies
     Relaxation
     Affective Expression and Regulation
     Cognitive Coping
     Trauma Narrative and Processing
     In-vivo Exposure
     Conjoint Parent Child Sessions
     Enhancing Personal Safety and Future Growth
    THANK YOU!

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