TF-CBT Questions and Answers (2022/2023) with Verified Solutions

TF-CBT Questions and Answers (2022/2023) with Verified Solutions What is TF-CBT? An evidence-based, conjoint child and parent/caregiver psychotherapy model for children and adolescents who are experiencing clinically significant emotional and behavioral difficulties related to traumatic life events they have experienced. How long is the treatment? Relatively brief (typically 12-20 sessions) What modalities is it based off of? Cognitive, family therapy, behavior, and humanistic principles. What are the 3 general goals? To enable children + their supportive caregivers, 1) to learn effective skills to cope with trauma-related emotional and behavioral problems 2) to face and resolve those problems in a safe and therapeutic way 3) to effectively integrate their trauma experiences and help them move on with their lives in a safe and positive manner. What specific emotional issues related to adverse experiences is it designed to treat? Fear, shame, embarrassment, guilt, and self-blame. TF-CBT also improves caregiver support of the child, parenting skills, and parent-child communication. What specific diagnoses related to adverse experiences is it designed to treat? Posttraumatic Stress Disorder (PTSD), trauma-related depression, anxiety, and behavior problems, and common trauma-related cognitive and emotional problems What age range is TF-CBT a best fit for? Children and youth 3-18 years old. What demographic is TF-CBT a best fit for? Children from any racial, ethnic, cultural, or country of origin group living in urban, suburban or rural areas. To date, there is no demographic group of traumatized children or youth for which TF-CBT has been found to be ineffective. Types of Traumatic Events (6) 1) experiencing or witnessing interpersonal violence, such as sexual abuse/assault, physical abuse/assault, intimate partner violence, bullying, shootings, or other forms of violence in the home, school, or community. 2) Unexpected, traumatic death of a loved one 3) Motor vehicle accident 4) Experiencing a natural or man-made disaster such as a tornado, flood, earthquake, or hurricane, chemical spill, train or airplane crash 5) Dog or other animal attack 6) Exposure to war, combat violence, or torture. How many symptoms of PTSD should the child present to be eligible for TF-CBT? 4 or more ***des noted to meet full diagnostic criteria Co-morbid Diagnoses for which TF-CBT is effective (3) ADHD, oppositional defiant disorder, and conduct disorder. Can treatment be conducted without caregiver involvement? TF-CBT can be done with children without a supportive caregiver, substantial parts of the treatment will be lost. Every effort should be made to locate and engage. Who is TF-CBT not for? (3) 1) No history of traumatic events. 2) No trauma-related problems. Some children are highly resilient, possess effective coping skills, and have strong familial and social support systems to help them manage potentially traumatic experiences effectively. Consequently, they may not have clinically significant mental health symptoms related to those experiences. 3) Severe cognitive challenges. TF-CBT can be used with children and youth who have intellectual, cognitive, or other developmental problems if their level of functioning allows them to engage in and benefit from a cognitive therapy. (Diagnoses where cannot be applied - severe intellectual disability, neurocognitive disability, neurodevelopmental disorder, & ASD.) Problems to manage prior to beginning TF-CBT: 1) Imminent safety. 2) Severe disruptive or aggressive behavior problems. 3) A child or youth is exhibiting a high level of disruptive or aggressive behavior that makes it very difficult to focus on trauma treatment. 4)Active suicidal ideation. 5) Active, problematic substance use. What are the Guiding Principles of TF-CBT? CRAFTS What does CRATS stand for? Components based, respectful of cultural values, adaptable and flexible, family focused, therapeutic relationship is central, self-efficacy is emphasized. What is the components basis for the treatment? Each has a specific therapeutic purpose and set of techniques. Each builds on the previous one. No prescribed set of procedures for each session, rather therapist works through the components in the proper order, tailoring the pace to accommodate client need. What makes the treatment adaptable and flexible? 1) Can be adapted to many different clinical settings, situations, and families. 2) The pacing of treatment components and techniques is flexible. 3) therapist creativity in delivery is encouraged as long as fundamental goals and principles of the components are followed. Approximately what portion of the treatment involves conjoint sessions with a supportive caregiver? Close to half of sessions. How does the treatment address self - efficacy? Children completing TF-CBT should develop both a sense of competence because they are no longer overwhelmed by trauma-related problems, and hope for the future because they have learned how to manage other difficulties that may come along. They face and integrate the events rather than internalize, externalizations, or avoid symptoms related to it. Helps build resiliency for future events. What are the nine treatment components? Psychoeducation + parenting skills, relaxation, affective identification and regulation, cognitive coping, trauma narration and processing, in vivo mastery, conjoint child parent sessions, and enhancing safety and future development. What the general benefit of relaxation and coping skills? Managing physiological symptoms fear and anxiety. The physiological reaction reduces the child perceptions of fear and anxiety, encouraging a sense of empowerment and mastery over symptoms. Emotions commonly associated with children who have experienced traumatic events. Incongruency,, sadness, anger, fear, anxiety, guilt, shame, and disgust. How is the cognitive triangle incorporated into the cognitive coping component? 1) Therapist explains the connections between thoughts, feelings, and behavior. 2) Generating alternative thoughts that are more accurate or helpful to alter emotions. 3) May be delved in deeper during parent and family sessions. 4) Lays foundation for later, more complex cognitive processing in treatment. What is the trauma narrative? Children are guided through the creation of a narrative describing the traumatic events with a goal of helping them better manage trauma-related thoughts and feelings. A form of gradual exposure therapy that doses negative feelings associated with the trauma in a safe and controlled environment. In what mediums might a trauma narrative for a child take form? Writing a book, poem, song or drawing pictures. What exposure technique is used in treatment? Gradual exposure What is the ideal session frequency and length? Ideally, delivered in weekly sessions of 60-90 mins. More commonly, therapists see patients for 45-50 minute sessions, and TF-CBT can be adapted to fit into that time frame. TF-CBT sessions can be conducted more frequently, ex. 2x a week but should not be delivered less frequently ex. every 2-3 weeks What is the duration of treatment? Has been found effective in as few as 8 sessions and may extend to as many as 25 sessions. Ideal: be completed within 12-20 treatment sessions. What are the three phases of treatment? 1) Stabilization 2) Trauma Narrative 3) Integration/consolidation What occurs during the stabilization phase of treatment? Psychoeducation, Relaxation, Affective Expression and Regulation, and Cognitive Coping. What occurs during the trauma narrative phase of treatment? Story creation & processing. Gradual exposure is a major component and both children and caregivers process their reactions to the child's narrative. What occurs during the Integration/Consolidation phase of treatment? In Vivo Mastery of trauma reminders, Conjoint Child-Parent Sessions, and Enhancing Future Safety and Development components. What components throughout the whole treatment process? Parenting skills & gradual exposure How are sessions paced? Abut one-third of the sessions should be devoted to the components that make up the Stabilization phase, about one-third to the Trauma Narrative phase, and about one-third to the Integration/Consolidation phase. What are two components of treatment Fidelity? Adherence and competence What are important points of adherence? Use with appropriate cases, supportive of her involvement, frequent treatment sessions, following components at accurate pace and duration. What are important points of competence? Following procedures and techniques correctly. Utilizing supervision. How should treatment fidelity and outcomes be measured? With close attention, particularly with therapists new to this treatment model, and prior, during, and at the end of treatment. How does research support the efficacy of TF-CBT? It has been tested in multiple randomized controlled trial's with ages 3 to 18 with subjects who have experienced many types of traumatic events. Has been applied internationally in diverse cultural and ethnic backgrounds with effective outcomes.