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Use of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in Treating Childhood Sexual Abuse (CSA) By: Justin McLendon Trauma Focused Cognitive Behavioral Therapy (TF-CBT) A recent CBT-based treatment that was originally developed by Judith Cohen, Anthony Mannarino, and Esther Deblinger Was primarily intended to address the needs of children and adolescents (ages 3-18) who suffer from PTSD due to sexual abuse The TF-CBT model has been adapted for use with children and adolescents who have suffered a variety of traumatic experiences Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Childhood sexual abuse (CSA) does not necessarily lead to PTSD, and might in fact result in other emotional or behavioral symptoms, such as disruptive behaviors, depression, or anxiety due to trauma Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Symptoms of child traumatic stress include but are not limited to: Recurrent upsetting memories of the traumatic event Flashbacks, or reliving the experience Very upset by sights, sounds, or smells that trigger the memory of the traumatic event Avoiding places or people that are reminders of the event Increased startle response Showing very little emotion, seeming “numb” regarding the event Nightmares Difficulty concentrating Lack of interest in usual activities or personal relationships the child once enjoyed Trauma Focused Cognitive Behavioral Therapy (TF-CBT) TF-CBT involves the non-offending parent or guardian in the counseling process, but is not necessary for effective treatment outcomes Improve child externalizing behavior problems (including sexual behavior problems) Improving parenting skills and parental support of the child, and reducing parental distress Enhancing parent-child communication, attachment, and ability to maintain safety Improving child's adaptive functioning Reducing shame and embarrassment related to the traumatic experiences Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Therapeutic elements of TF-CBT = PRACTICE Psychoeducation and Parenting skills Relaxation Affective Expression and Regulation Cognitive Coping Trauma Narrative Development and Processing In Vivo Gradual Exposure Conjoint Parent - Child Sessions Enhancing Safety and Future Development Involves both child and parent specific components Does TF-CBT Work? (Reliability and Validity) Does TF-CBT consistently and effectively treat what it is intended to treat? Significant research shows TF-CBT to have more effective outcomes than other treatments (McDonagh, Friedman, Ford, Senqupta, Mueser, Demment, Fournier, Schnurr, & Descamps, 2005). The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74) (McDonagh, Friedman, Ford, Senqupta, Mueser, Demment, Fournier, Schnurr, & Descamps, 2005). Compared: TF-CBT Present-centered therapy (PCT) a problem solving therapy Wait-list (WL) control CBT participants were significantly more likely than PCT and WL participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments (Kar, 2011). The author conducted a literature review to asses the effectiveness of CBT-based treatments for PTSD After carful analysis yielded data on 31 randomized controlled trials involving the use of CBT-based treatment in PTSD participants (Kar, 2011). The literature review suggested that TF-CBT has demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions in sexually abused children than compared modalities This conclusion is thought to be due to the inclusion of parent/caregiver education and support found in TF-CBT The combination of TF-CBT and Eye Movement Desensitization Reprocessing (EMDR) reflected a more significant reduction of PTSD symptoms (Passarela, Mendes, & Mari, 2009). Conducted a systematic review (meta-analysis) of three studies investigating the use of CBT-based treatments of sexually abused children and adolescents with PTSD (Passarela, Mendes, & Mari, 2009). Measuring Outcomes Most diagnosis of PTSD were applied through subjective analysis of client presentation and self report Child Behavior Checklist (CBCL) Has a test-retest reliability of .88 measures behavior problems and social competence in children Parenting Practices Questionnaire (PPQ) Claims of Clinical Significance and Effect Size Most available research shows substantial improvement in PTSD symptoms after receiving TF‐CBT treatment, but there is still not a clear answer about how clinically significant these results are Many studies do not discuss or report effect sizes, which makes it very difficult to know the true difference between treatment outcomes Efficacy and Clinical Utility TF-CBT is considered an evidence based psychological practice (EBPP) (APA Presidential Taskforce on Evidence-Based Practices, 2006) Due to evident strength of the relationship between disorder and intervention Clinical consensus regarding benefits of treatment, costs, and generalizabilty There is still room for improvement in these areas Recommendation Keeping all of this in mind, TF‐CBT used for sexually abused children with PTSD seems to be an effective treatment when considering the evidence that is currently available References Passarela, C., Mendes, D., & Mari, J. (2009). A systematic review to study the efficacy of cognitive behavioral therapy for sexually abused children and adolescents with posttraumatic stress disorder. Psiquiatria Clinca, 37(2), 60-65. Retrieved from http://www.hcnet.usp.br/ipq/revista/ vol37/n2/eng/69.htm McDonagh, A., Friedman, M., McHugo, G., Ford, J., Senqupta, A., Mueser, K., . . . Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(3), 515-524. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15982149 APA Presidential Taskforce on Evidence-Based Practices. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285. http://dx.doi.org/10.1037/0003066X.61.4.271 Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: A review. Neuropsychiatric Disease and Treatment, 7, 167-181. http://dx.doi.org/10.2147/NDT.S10389