TIMBER (Trauma Interventions using Mindfulness Based Extinction and Re-consolidation)
The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been reviewed by the CEBC in the following Topic Areas:
About This Program
Target Population: Children and adolescents with trauma or anxiety or depression related symptoms; intervention also used with adults
For children/adolescents ages: 8 – 17
TIMBER is a translational mindfulness-based cognitive-behavioral therapy (CBT) for PTSD and uses elements of Yoga, CBT, and Mindfulness-Based Graded Exposure Therapy, and integrates them in a self-help format with the more recent neurobiological understanding of trauma learning and trauma memories. TIMBER uses a balanced combination of both extinction (i.e., gradual diminishing of a conditioned response over time as a person learns to uncouple a response from a stimulus) and re-consolidation of memory approaches (i.e., retrieval of memories to strengthen, add, or remove information, and then update them). These are 2 fundamental learning methods that play crucial role in maintenance of trauma memories. It has been used both as a standalone therapy as well as in combination with psychotropic medications. TIMBER is designed to not cause over-flooding and retraumatization for patients that is seen in some other treatment approaches.
The goals of TIMBER (Trauma Interventions using Mindfulness Based Extinction and Re-consolidation) are:
- Improvement in core symptoms and associated symptoms of PTSD & comorbid panic and depression symptoms
- Improvement in avoidance behaviors related to PTSD
- Improvement of dysfunctions arising from symptoms of PTSD
- Improvements in Quality of Life in population with PTSD
The essential components of TIMBER (Trauma Interventions using Mind-fulness Based Extinction and Re-consolidation) include:
- Uses both extinction and re-consolidation processes, whereas most contemporary trauma treatments use extinction-only approach which has limitations in form of context-dependency and just suppressing the memories rather than updating them
- Uses controlled reactivation (rather than over-flooding) of trauma memories using:
- A standardized scale (Arousal Response to Trauma Memory Reactivation, [ART-MR])
- Brief narrative of the index trauma
- The methodology of Mindfulness-Based Graded Exposure Therapy (MB-GET)
- Individualized by use of scores on ASMI (Assessment Scale for Mindfulness Interventions)
- 2 versions:
- Full TIMBER: The longer 40-45-minute version
- Memory extinction
- Therapist assisted MB-GET interventions
- Mini-TIMBER: The shorter (5-minute) version
- Memory re-consolidation format
- Ideally suited for home practice
- Helps subjects to quickly de-escalate the arousal symptoms of PTSD as they arise in their daily life situations in response to trauma-related cues
- Ideally, subsequent calm and detached reappraisal of expres-sion of trauma memories is achieved and thus new learning becomes possible
- Clients are initially trained on full TIMBER and mini-TIMBER in a therapist-assisted manner in therapist’s office. Mini-TIMBER is typically suitable for self-help for quickly controlling the PTSD, panic and depression symptoms manifesting in the client’s daily life situations whereas full-TIMBER is meant for planned and graded exposure to the dysfunctional and anxiety provoking clinical situations, first in therapist assisted manner using imaginative exposure followed by daily home practice and real-life exposure. Typically after 2 training sessions, clients are able to use both mini-TIMBER and full-TIMBER. This combined and targeted approach is designed to prevent restoration or re-expression of the trauma memories and the associated reactivity that lie at the core of the pathology and dysfunctions in PTSD.
TIMBER (Trauma Interventions using Mindfulness Based Extinction and Re-consolidation) directly provides services to children/adolescents and addresses the following:
- Symptoms and resulting dysfunctions of posttraumatic stress disorder (PTSD) and co-morbid panic and depression symptoms
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Parents/caregivers, if available, are used as co-therapists to enhance better adherence to home practice sessions of TIMBER and enhance generalization of therapeutic gains.
30-45 minute sessions at varying intervals
8-12 sessions over 24 weeks (first 2 training sessions are once a week followed by the next 3-4 sessions once every 2 weeks, then the next 2 sessions every 3 weeks, and finally 2 sessions are booster sessions carried out at once a month frequency)
This program is typically conducted in a(n):
- Outpatient Clinic
TIMBER (Trauma Interventions using Mindfulness Based Extinction and Re-consolidation) includes a homework component:
Home practice sessions are usually 2 types: Routine practice twice daily (in the morning and evening, usually 2 hours before sleep time) and as needed practice 3-4 times a day using standardized home practice log. As needed, practice is done as soon as an outburst of anxiety episode begins so that mini-TIMBER can be applied quickly before it escalates.
TIMBER (Trauma Interventions using Mindfulness Based Extinction and Re-consolidation) does not have materials available in a language other than English.
Resources Needed to Run Program
The typical resources for implementing the program are:
Just a regular office set up is all that is necessary.
Minimum Provider Qualifications
Providers need to have a bachelor-level education and some understanding about mindfulness and cognitive-behavioral therapy.
Education and Training Resources
There is a manual that describes how to implement this program, and there is training available for this program.
- Basant Pradhan, MD, Assistant Professor of Psychiatry and Pediatrics
Cooper University Hospital,
dept.: Department of Psychiatry
Training is obtained:
Onsite for a fee
Number of days/hours:
Six hours over a period of 2 days
Relevant Published, Peer-Reviewed Research
This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.
Pradhan, B. K., Gray, R. M., Parikh, T, Akkireddi, P., & Pumariega, A. (2015). Trauma Interventions using Mindfulness Based Extinction and Re-consolidation (TIMBER©) as mono-therapy for chronic PTSD in adolescents: A pilot study. Adolescent Psychiatry, 5(2), 125–131. doi:10.2174/221067660502150430155038
Type of Study: One group pretest-posttest study
Number of Participants: 4
- Age — 14-19 years
- Race/Ethnicity — 2 White, 1 Black, and 1 Hispanic
- Gender — 2 Male and 2 Female
- Status — Participants who were diagnosed with post-traumatic stress disorder (PTSD).
Location/Institution: Not specified
Summary: (To include comparison groups, outcomes, measures, notable limitations)
This paper examines the Trauma Interventions using Mindfulness Based Extinction/Re-consolidation (TIMBER) program in the treatment in adolescent patients with posttraumatic stress disorder (PTSD). Measures utilized include the Post Traumatic Stress Disorder Symptom Check List (PCLC), the Assessment Scale for Mindful Interventions (ASMI), and the Arousal Response during Trauma Memory Reactivation (ART-MR). Results indicate that treatment resulted in remission of PTSD symptoms and associated dysfunction as evidenced by reduction in the scores of PTSD Symptom Check List-Civilian Version (PCLC) as well as in distress and avoidance behavior in daily life. In addition, there were clinically observable improvements in depression, panic symptoms, insomnia, and level of general attentiveness. Limitations nonrandomization of participants, lack of control group, small sample size, and lack of follow-up.
Length of postintervention follow-up: 8 months.
Pradhan, B. K. (2014). Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT): A clinical guide. Springer International Publishing, Switzerland
Pradhan, B. K., Wainer, I. W., Moaddel, R., Torjman, M.C., Goldberg, M., Sabia, M., … Pumariega, A. J. (2017). Trauma Interventions using Mindful-ness Based Extinction and Reconsolidation (TIMBER) psychotherapy prolong the therapeutic effects of single ketamine infusion on posttraumatic stress disorder and co-morbid depression: a pilot randomized, placebo-controlled, crossover clinical trial. Asia Pacific Journal of Clinical Trials: Nervous System Diseases, 2(2), 80-91. doi:10.4103/2542-3932.211589
- Basant Pradhan, MD
- Title: Assistant Professor of Psychiatry and Pediatrics
- Agency/Affiliation: Cooper University Hospital
- Department: Department of Psychiatry
- Email: Pradhan-Basant@Cooperhealth.edu
Date Research Evidence Last Reviewed by CEBC: August 2017
Date Program Content Last Reviewed by Program Staff: August 2017
Date Program Originally Loaded onto CEBC: June 2016