Trauma-Focused Cognitive Behavioral Therapy: Addressing the Mental Health of Sexually Abused Children

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You are in section: Table of Contents 1. What Makes TF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of TF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources 8. References

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1. What Makes TF-CBT Unique

TF-CBT addresses the negative effects of sexual abuse and other traumatic events by integrating several therapeutic approaches and treating both child and parent in a comprehensive manner.

Addresses the Effects of Sexual Abuse and Trauma

In the immediate as well as long-term aftermath of sexual abuse, children are at risk of developing significant emotional and behavioral difficulties (see, for example, Briere & Elliott, 2003; Berliner & Elliott, 2002; Chadwick Center, 2004). For example, victims of sexual abuse often experience:

• Maladaptive or unhelpful beliefs and attributions related to the abusive events, including:
  
  • A sense of guilt for their role in the abuse
  • Anger at parents for not knowing about the abuse
  • Feelings of powerlessness
  • A sense that they are in some way “damaged goods”
  • A fear that people will treat them differently because of the abuse
• Acting out behaviors, such as engaging in age-inappropriate sexual behaviors
• Mental health disorders, including major depression
• Posttraumatic stress disorder (PTSD). PTSD symptoms are characterized by:
  • Intrusive and reoccurring thoughts of the traumatic experience
  • Avoidance of reminders of the trauma (often places, people, sounds, smells, and other sensory triggers)
  • Emotional numbing
  • Irritability
  • Trouble sleeping or concentrating
  • Physical and emotional hyperarousal (often characterized by emotional swings or rapidly accelerating anger or crying that is out of proportion to the apparent stimulus)

These symptoms can impact the child's daily life and affect behavior, school performance, attention, self-perception, and emotional regulation.

To date, numerous studies have documented the effectiveness of TF-CBT in helping children overcome these and other symptoms following child sexual abuse and similar traumatic experiences (e.g., Deblinger, Lippman, & Steer, 1996; Cohen & Mannarino, 1996a, 1996b, 1998a, 1998b; Deblinger, Stauffer, & Steer, 2001; Cohen, Deblinger, Mannarino, & Steer, 2004). The program helps children to process the traumatic memories, overcome problematic thoughts and behaviors, and develop effective coping and interpersonal skills. (See also Effectiveness of TF-CBT.)

Treats Nonoffending Parents in Addition to the Child

Recognizing the importance of parental support in the child's recovery process, TF-CBT includes a treatment component for parents (or caregivers) who were not abusive. Children and parents first participate separately in therapy and then attend several joint child-parent sessions. The parent component teaches stress management, parenting, and communication skills. As a result, parents are better able to address their own emotional distress associated with the child's trauma, while also supporting their children more effectively.

Integrates Several Established Treatment Approaches

TF-CBT combines elements drawn from:

• Cognitive therapy, which aims to change behavior by addressing a person's thoughts or perceptions, particularly those thinking patterns that create distorted views
• Behavioral therapy, which focuses on modifying habitual responses (e.g., anger, fear) to identified situations or stimuli
• Family therapy, which examines patterns of interactions among family members to identify and alleviate problems

TF-CBT uses well-established cognitive-behavioral therapy and stress management procedures originally developed for the treatment of fear, anxiety, and depression in adults (Wolpe, 1969; Beck, 1976). These procedures have been used with adult rape victims with symptoms of PTSD (Foa, Rothbaum, Riggs, & Murdock, 1991) and have been applied to children with problems with excessive fear and anxiety (Beidel & Turner, 1998). The TF-CBT protocol has adapted and refined these procedures to target the specific difficulties exhibited by children who are experiencing PTSD symptoms in response to sexual abuse or other childhood traumas. In addition, well-established parenting approaches (e.g., Patterson, 2005; Forehand & Kotchick, 2002) also are incorporated into treatment to guide parents in addressing their children's behavioral difficulties.

Successful in Various Environments and Appropriate for Multiple Traumas

TF-CBT has been implemented successfully in urban, suburban, and rural environments and has demonstrated success with Caucasian, African-American, and Hispanic children from all socioeconomic environments. It has been adapted for Latino and hearing-impaired populations. In addition, recent research findings suggest that TF-CBT may be preferable to less directive treatment approaches for children who have a history of multiple traumas (e.g., sexual abuse, exposure to domestic violence, physical abuse, as well as other traumas) and those with high levels of depression prior to treatment (Deblinger, Mannarino, Cohen, & Steer, in press). The model also has been tested with children who are experiencing traumatic grief after the death of a loved one (Cohen, Mannarino, & Knudsen, 2004; Cohen, Mannarino, & Staron, in press).

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You are in section: Table of Contents 1. What Makes TF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of TF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources 8. References

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