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Trauma-Focused Cognitive Behavioral Therapy: A Guide for Teens and Parents

Trauma-focused cognitive behavioral therapy - a guide for teens and parents

When an adolescent experience some level of trauma, whether that is sexual abuse, traumatic loss, or maltreatment, the repercussions from the experience can be dire. Due to the trauma experienced, the teen can have both behavioral and emotional negative responses, distorted beliefs or perceptions, and even difficulty dealing with normal life stressors.

Trauma-focused cognitive behavioral therapy (TF-CBT) is a therapeutic approach that has been shown to help adolescents, as well as their parents or caregivers, work through some of the challenges that stem from prior trauma.

What is trauma-focused cognitive behavioral therapy (TF-CBT)?

TF-CBT is a form of therapy that combines several elements of other formerly used approaches and ideas, such as cognitive therapy, behavioral therapy, family therapy, and the attachment theory. The therapy is designed to help a teen face the negative emotions and thoughts they have due to the trauma.

For example, teens can experience recurring memories of the traumatic event that triggers problems with their thought processes and behavior patterns. As an added component, which can be unique to TF-CBT, parents or caregivers are involved in specific levels of treatment, and are taught skills to further aid the teen.

The exact numbers of people under 18 who have experienced trauma are hard to pin down. However, a research has speculated that as much as two-thirds of American children experience an adverse childhood event (ACE) or some type of trauma by the age of 16. The Centers for Disease Control and Prevention have put forth an effort to raise awareness of childhood trauma and the adverse effects to reduce how many children experience ACEs. Individuals who do experience these events do typically need some level of therapy like TF-CBT.

Therapist leading a Trauma-focused cognitive behavioral therapy or TF-CBT

Key Components of TF-CBT – The PRACTICE Protocol

Usually, TF-CBT is provided by a licensed therapist in a series of weekly sessions. Initially, both the teen and parent will spend time with the therapist separately, but later in treatment, the teen and parent may have conjoined treatment sessions. The protocol of trauma-focused cognitive behavioral therapy are easy to remember with the “PRACTICE” acronym.

P – Psychoeducation

Psychoeducation is done to teach the foundation of trauma. For example, a teen may be educated on how sexual abuse can bring about certain future beliefs or reactions. At this point, parent sessions are also focused on providing insight into things like effective communication and positive parenting.

R – Relaxation techniques

The child and parent are taught specific relaxation techniques that may be helpful in overcoming intense emotions. Some of those techniques can include progressive muscle relaxation or using focused breathing.

A – Affective expression and regulation

Affective expression and regulation revolve around helping the teen and caregiver better manage their reactions to any reminders of the trauma experienced. During this part of treatment, the goal is to help individuals identify what emotions occur and when, and then learn how to self-soothe at the moment.

C – Cognitive coping and processing

Cognitive coping and processing involve getting to know the seemingly unavoidable connection that exists between certain behaviors or thoughts and how that information should be processed in a healthier way. Inaccurate, unhelpful, or inappropriate thoughts, feelings, and behaviors that may be related to abuse or trauma but directed at everyday situations may also be explored.

T –  Trauma narration and processing

Verbal or written recounting exercises of the traumatic event gently force the individual to look closer at the trauma that occurred, or to bring it out into the open in a way. Through this process, the trauma is explored, but also the negative feelings and emotions that come up.

I – In vivo exposure

In vivo exposure is primarily designed to create gradual exposure to situations or elements that may be reminding of past trauma. For example, a teen that experienced abuse in the dark may be exposed to the dark in a safe setting. This gradual exposure helps the teen learn how to identify and then use taught self-soothing techniques to better handle their reactions to the stimuli that would normally provoke a negative reaction.

C – Conjoint parent/child sessions

Enhancing communication between the parent and child is an integral component of family therapy, and is valuable as a component in TF-CBT just the same. These joint sessions encourage the much-needed open dialogue between the teen and their caregiver or vice versa.

E – Enhancing personal safety and future growth

The teen is given training on objectives like developing personal skills for staying safe, developing a healthy way to manage stressors that occur in the future, and more. This final component of therapy is created to help the teen set forth with and apply the new skills learned during treatment.

Why would a teen need a TF-CBT

Why would a teen need TF-CBT?

Teens may need trauma-focused cognitive behavioral therapy if they have experienced at least one ACE, and they are showing signs that the event is interfering with their healthy state of outlook or emotional well-being. According to the Child Welfare Information Gateway, a child may need TF-CBT if any of the following has taken place:

  • The teen was exposed to at least one type of traumatic event
  • The teen is experiencing symptoms of PTSD, such as panic attacks, anxiety, or sudden periods of stress
  • The teen has issues with anxiety, guilt or shame, depression, or developing logical beliefs and thoughts
  • The teen is experiencing behavioral problems stemming from the trauma, such as inappropriate sexual behavior

TF-CBT is not only designed to help teens; the therapy can also be beneficial for the parents or caregivers of the teen as well. Through treatment of the whole family unit, teens gain a more equipped support system at home, and parents better understand how to cope with a traumatized teen and their own stress.

The Proven Benefits of TF-CBT

A growing number of studies have examined the effectiveness of TF-CBT and found quite a few benefits to both the child and the child’s caregivers. Some of the benefits for teens include:

  • Decreased symptoms of PTSD
  • Fewer relationship difficulties
  • Fewer instances of behavior problems
  • Less depression and anxiety
  • Lowered cognitive distortions
  • Sustained improvements over time

Parents also benefit from trauma-focused cognitive behavioral therapy. Most parents see reduced distress and fewer feelings of depression, both of which can be substantial if a child is dealing with ramifications after a traumatic experience.

Is Past Trauma Causing Problems in Present Life?

Do you need advice about teen trauma, either as a parent or as a teen? If so, feel free to reach out to us or take the free Teen Trauma Assessment to determine if your teen needs help.

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