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PTSD and Evidence-Based Practices

Trauma-Focused Therapy

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PTSD DSM-IV-TR Diagnostic Criteria
PTSD Statistics and Co-Morbidity
Biological Mechanisms and PTSD
Exposure Therapy
Trauma-Focused Therapy
EMDR
Additional Information
Trauma-Focused Cognitive Behavioral Therapy
 
 
Adapted from Cognitive Behavioral Theory, Exposure Therapy, and work with adult PTSD survivors and child survivors of trauma.
 
Major Components
  • Skills Training
    • Emotional Expression
    • Coping and Stress Management
      • Thought Stopping - Trauma survivors can learn to escape their negative thought patterns by snapping a rubber band around their wrist and saying "snap out of it" to themselves
      • Thought Replacement - After stopping the cycle of intrusive thoughts, the survivor of trauma can then replace the negative emotions with a positive memory of some other pleasant event.
    • Relaxation Techniques
      • Breathing
      • Tensing then relaxing every muscle from toe to head

 

  • Exposure - Systematic Desensitization
    • Starting with thoughts of the trauma that aren't as painful, then slowly working up to more painful memories
    • Imaginal Flooding involves identifying particularly anxiety-provoking scenes from the trauma, then asking the survivor to recall specific details from that scene
    • Creating a trauma narrative allows the survivor of trauma to recount their story of what happened and build a better understanding of what the trauma meant to them
    • For more information on Exposure Therapy, click here.

 

  • Cognitive Therapy
    • Noticing the relationships between thoughts, feelings, and behaviors
    • Processing the abuse and integrating it into views of self and views of the world
    • Re-Framing
      • Systematically challenging and destroying the traumatic schemas and negative self-concept that developed from the cognitive distortions
      • Reframing the trauma and the resulting negative feelings as strengths

Author and Date
Sample
Primary Intervention and Findings

Control Intervention and Findings

Cohen, J.A., Mannarino, A.P., Knudsen, K.  (2005)
82 sexually abused children ages 8-15 and their primary caregivers, randomly assigned to the following two groups
TF-CBT for 12 sessions.
After a year, a variety of measures showed a significant improvement of PTSD symptoms (1.85), as well as a continued improvement over time (1.61).

Non-Directive Supportive Treatment for 12 sessions.
The same variety of measures showed slightly less initial improvement of symptoms (.91), and significantly lowered improvement over time (.32).

Cohen, J.A., Deblinger, E., Mannarino, A.P., Steer, R.A.  (2004)
203 children ages 8-14 and 189 of their primary caregivers, randomly assigned to the following two groups.  89% of the children met the DSM-IV diagnosis for PTSD, and over 90% had experienced severe trauma.
TF-CBT manualized treatment.
At completion of the 12-session treatment, 21% of the children met the PTSD diagnostic requirements.

Child-Centered Therapy manualized treatment
At the end of the 12 session treatment, 46% of the children met the PTSD diagnostic requirements.

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  • When working with children who have been victims of trauma, an additional portion is added that works with the parents' guilt and self-blame, and education about how the trauma may effect their child.
  • Goals of Intervention

    • Provide survivor with skills for dealing with stress in the future
    • Alleviate painful emotions through gentle exposure
    • Challenge negative self-image
    • Reframe the problematic cognitions that keep the survivor of the trauma on edge
    • In the case of childhood victims of trauma, educate parents on how to maintain the benefits of the intervention and heal themselves.

    Success of Trauma-Focused Cognitive-Behavioral Therapy is tracked mostly through survivor self-report and observations of family members.  Various measures can be used to track a survivors progress, including self-report scaling (1-10) and the variety of tests available (for example, the Sprint-4).

     

    Recommendations for Additional Research

    • Research that evaluates the efficacy of specific portions of the TF-CBT treatment, separately and together.
    • Research that determines what type of populations respond best to TF-CBT, controlling for age, gender, ethnicity, race, type of trauma, etc.
    • Research that evaluates TF-CBT as compared to other types of treatments, such as psychosocial, psychodynamic, pharmacological, and their combinations.

    Amber Hursh, Justin Reimenschneider, Justine Tedesco
    RSSW 705 Evidence-Based Practice in Mental Health
    Dr. Zvi Gellis, SUNY Albany, Rockefeller College of Social Work