Trauma Treatment – Client-Level Interventions (Child & Adolescent)

EMDR therapy is an 8-phase psychotherapy treatment that was originally designed to alleviate the symptoms of trauma. During the EMDR trauma processing phases, guided by standardized procedures, the client attends to emotionally disturbing material in brief sequential doses that include the client's beliefs, emotions, and body sensations associated with the traumatic event while simultaneously focusing on an external stimulus. Therapist directed bilateral eye movements are the most commonly used external stimulus, but a variety of other stimuli including hand-tapping and audio bilateral stimulation are often used. EMDR is also highlighted on the CEBC website in the Trauma Treatment (Adult) topic area, click here to go to that entry.

KIDNET is a specific type of Narrative Exposure Therapy program aimed at treating refugee children suffering from posttraumatic stress disorder (PTSD). The treatment consists of eight individual therapy sessions, 90 to 120 minutes in length, conducted weekly by trained clinical psychologists. Focused on refugee children suffering from PTSD primarily related to war and other types of organized violence, the program is designed around the therapist helping the child build a chronological narrative of their entire life, with an emphasis on traumatic experiences. Children are asked to describe sensory information, emotions, physical reactions, and thoughts, which are thoroughly recorded by the therapist; this written documentation is given to the child at the end of therapy. Certain illustrative and creative tasks are also completed during the treatment program to aid the child in organizing their memories. Prior to constructing the narrative, children participate in the lifeline exercise, during which they take different flowers and stones, representing positive and negative events, and place them along a rope to illustrate each of the most significant events in their lives. Another exercise is re-enacting body positioning, during which children show therapists the ways they physically positioned their body during a traumatic experience (e.g., hiding in a crouched position during a bombing). Drawings are also used to portray scenes and objects from traumatic experiences. Each of these latter two exercises is utilized with the purpose of helping to bring about descriptions and language tied to these events.

PE-A is a therapeutic treatment where clients are encouraged to repeatedly approach situations or activities they are avoiding because they remind them of their trauma (in vivo exposure) as well as to revisit the traumatic memory several times through retelling it (imaginal exposure). Psychoeducation about common reactions to trauma as well as breathing retraining exercises are also included in the treatment. The aim of in vivo and imaginal exposure is to help clients emotionally process their traumatic memories through imaginal and in vivo exposure. Through these procedures, they learn that they can safely remember the trauma and experience trauma reminders, that the distress that initially results from confrontations with these reminders decreases over time, and that they are capable of tolerating this distress. Prolonged Exposure Therapy for PTSD for Adults (PE) is also highlighted on the CEBC website in the Trauma Treatment (Adult) topic area.

TF-CBT is a conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles.

CPP is a treatment for young children aged 0-5 who have experienced a traumatic event and/or are experiencing mental health, attachment, and/or behavioral challenges. Typically, the child is seen with their primary caregiver in a dyadic format. CPP examines ways that the caregiver-child relationship and the child’s developmental trajectory may be affected by: 1) the child’s trauma history, 2) caregiver’s trauma history, 3) caregiver’s relational history, 4) contextual factors including culture, socioeconomic status, sociocultural trauma, and immigration experience. Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other along with interactions and behaviors that interfere with the child’s mental health and the emotion regulation capacities of both child and caregiver. For children exposed to trauma, caregiver and child are guided to create a joint narrative of the traumatic event and to identify and address traumatic triggers that generate dysregulated behaviors and affect.

Fostering Healthy Futures - Preteen (FHF-P) is a mentoring and skills group program for preadolescent children (ages 9–11) who have current or previous child welfare involvement due to one or more adverse childhood experiences (ACEs). These ACEs may include the experience of maltreatment; out-of-home placement; instability in housing, caregivers, or schools; and/or parental substance use, mental illness, or incarceration.

Skills Groups: Children attend skills groups which meet for 1.5 hours/week for 30 weeks. The groups follow a manualized curriculum that combines cognitive-behavioral strategies with activities designed to help children process experiences related ACEs. For example, topics include: emotion recognition, problem solving, anger management, cultural identity, change and loss, and peer pressure. Multicultural stories and activities are integrated throughout.

Mentoring: Children receive 30 weeks of 1:1 mentoring (2-4 hours per week). Mentors work to: 1) create relationships with children that serve as positive examples for future relationships, 2) advocate for needed services, 3) help children generalize and practice skills learned in group, 4) engage children in educational, social, cultural, and recreational activities, and 5) promote positive future outlooks.

FHF-P targets risk and protective factors that have been identified as strong predictors of adolescent mental health problems, risk behaviors and associated outcomes.

Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) is designed to be a comprehensive approach for reducing or preventing the effects of exposure to child or family anger, aggression, and/or child physical abuse. Accordingly, it seeks to reduce many of the known risks for physical abuse/violence while also helping families to recover from the effects of exposure to these conditions. AF-CBT (originally named Abuse-Focused Cognitive-Behavioral Therapy) teaches parents and children intrapersonal and interpersonal skills to enhance self-control, promote positive family relations, and reduce violent behavior. These skills include anger and anxiety management, how to challenge misattributions to support flexible thinking, child social skills, effective and safe discipline strategies, and healthy family communication and problem-solving skills. These skills seek to improve self-control, help families get along better, and maintain a safe and secure home environment. AF-CBT seeks to improve the relationships between children and their parents/caregivers who experience any of the following clinical concerns:

• Family conflict/arguments
• Anger and verbal aggression, including emotional abuse
• Child behavior problems, including physical aggression
• Threats or use of harsh/punitive/ineffective physical discipline or punishment
• Child physical abuse

AF-CBT is a treatment based on principles derived from learning and behavioral theory, family systems, cognitive therapy, developmental victimology, and the psychology of aggression.

Developed as an adaptation to the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program. Bounce Back is a cognitive-behavioral, skills-based group intervention aimed at relieving symptoms of child posttraumatic stress disorder (PTSD), anxiety, depression, and functional impairment among elementary school children (ages 5-11) who have been exposed to traumatic events. It is used most commonly for children who experienced or witnessed community, family, or school violence, or who have been involved in natural disasters, or traumatic separation from a loved one due to death, incarceration, deportation, or child welfare detainment. It includes 10 group sessions where children learn and practice feelings identification, relaxation, courage thoughts, problem solving and conflict resolution, and build positive activities and social support. It is designed to be used in schools with children from a variety of ethnic and socio-economic backgrounds and acculturation levels. It also includes 2-3 individual sessions in which children complete a trauma narrative to process their traumatic memory and share it with a parent/caregiver. Bounce Back also includes materials for parent education sessions.

CFTSI is a brief early intervention model for children and adolescents 7-18 that is implemented soon after exposure to a potentially traumatic event, or in the wake of disclosure of physical and sexual abuse. Developed at the Yale Child Study Center, CFTSI fills a gap between acute responses/crisis intervention and evidence-based, longer-term treatments designed to address traumatic stress symptoms and disorders that have become established. The goal of this family-strengthening model is to improve the caregiver's ability to respond to, and support, a child who has endorsed at least one posttraumatic symptom. By raising awareness of the child's symptoms, increasing communication and providing skills to help master trauma reactions, CFTSI aims to reduce symptoms and prevent onset of posttraumatic stress disorder (PTSD). In addition, CFTSI offers an opportunity to assess which children and families need longer-term treatment. CFTSI is provided by master's-level clinicians who have been trained by CFTSI master trainers.

CBITS is a school-based, group and individual intervention designed to reduce symptoms of posttraumatic stress disorder (PTSD), depression, and behavioral problems among students exposed to traumatic life events, such as exposure to community and school violence, accidents, physical abuse, and domestic violence. It is designed for students, who have experienced a traumatic event and have current distress related to that event. The goals of the intervention are to reduce symptoms and behavior problems and improve functioning, improve peer and parent support, and enhance coping skills. The program includes 10 student group sessions, 1-3 student individual sessions, 2 parent sessions, and a teacher educational session. Developed for the school setting in close collaboration with school personnel, the program is well suited to the school environment.

CPC-CBT: Empowering Families Who Are at Risk for Physical Abuse is a short-term (16-20 sessions), strength-based therapy program for children ages 3-17 and their parents (or caregivers) in families where parents engage in a continuum of coercive parenting strategies. These families can include those who have been substantiated for physical abuse, those who have had multiple unsubstantiated referrals, and those who fear they may lose control with their child. Children may present with PTSD symptoms, depression, externalizing behaviors and a host of difficulties that are targeted within CPC-CBT. The program is grounded in cognitive behavioral theory and incorporates elements (e.g., trauma narrative and processing, positive reinforcement, timeout, behavioral contracting) from CBT models for families who have experienced sexual abuse, physical abuse, and/or domestic violence, as well as elements from motivational, family systems, trauma, and developmental theories. CPC-CBT helps the child heal from the trauma of the physical abuse, empowers and motivates parents to modulate their emotions and use effective non-coercive parenting strategies, and strengthens parent-child relationships while helping families stop the cycle of violence.

CCT is a manualized protocol consisting of 15 sessions. It is an integrative approach combining elements from cognitive, behavioral, psychodynamic, expressive, and family therapies to address four core domains: cognition, behavior, emotions, and physiology. The primary goal of CCT is to build strength and resilience by empowering the child through knowledge regarding the relationship between their history of trauma exposure and current affective, cognitive, behavioral, or physiological responses. Children and parents learn about the significance of traumatic stress, how adaptive responses become maladaptive, how to cope with rather than avoid ongoing stress, and the importance of verbalizing their life experiences. The treatment process is designed to help build overall competence, reduce physical symptoms of anxiety, modify cognitive distortions, and facilitate emotional expression. In CCT, youth and caregivers are taught how to recognize and effectively manage maladaptive responses that occur in response to traumatic reminders (cues).

EEG Neurofeedback is a type of biofeedback therapy (also known as EEG Biofeedback) that involves monitoring and regulating brain activity to improve cognitive function, emotional regulation, and overall well-being. It is a noninvasive therapy that helps individuals train their brain to function more efficiently. EEG Neurofeedback is based on the principle that the human brain can adapt and change, a concept known as neuroplasticity. By using technology that provides real-time visual and auditory feedback, individuals ideally learn to regulate their brain activity.

The Fairy Tale Model is a model of trauma-informed psychotherapy and is so named because it is taught with the telling of a fairy tale, in which each element of the story corresponds to one of the phases in treatment. Following the treatment manual, Treating Problem Behaviors: A Trauma-Informed Approach, this phase model of trauma-informed treatment calls for a given phase of treatment to be pursued until the client outcome specified for that phase has been achieved. The treatment manual has scripted interventions for working with teens individually.

GTI is designed for children ages 7 to 12 with posttraumatic stress due to witnessing or being a direct victim of one or more types of violence or a disaster, or due to experiencing or witnessing the death of a loved one, including death by homicide. The purpose of the intervention is to improve symptoms of posttraumatic stress, depression, and traumatic grief. The intervention is conducted with children in a group or individual format in 10 sessions of approximately 1 hour with at least one session with the parent. The techniques used in the sessions are grounded in cognitive-behavioral therapy (CBT) and narrative therapy and include narrative exposure to the trauma (through drawing, discussing, and writing), development of an in-depth, coherent narrative while eliciting the child's thoughts and feelings, development of positive coping strategies, and making meaning of losses.

PPT is a manualized, 12-session cognitive-behavioral therapy protocol to treat very young children with posttraumatic stress disorder (PTSD) and trauma-related symptoms. The sessions are either with the therapist working individually with the child (with the parent observing via a video feed) or with the parent and child together.

RRFT is an integrative, ecologically informed, and exposure-based approach to addressing co-occurring symptoms of PTSD (and other mental health problems), substance use problems, and other risk behaviors often experienced by trauma-exposed adolescents. RRFT is novel in its integration of these components, given that standard care for trauma-exposed youth often entails treatment of substance use problems separate from treatment of other trauma-related psychopathology. RRFT is individualized to the needs, strengths, developmental factors, and cultural background of each adolescent and family. The pacing and ordering of RRFT components are flexible and determined by the needs of each family and symptom severity in each domain. Substance use (as relevant) and posttraumatic stress (PTS) symptoms are monitored throughout treatment to help track progress and guide clinical decision making. The average frequency and duration of RRFT depends on the symptom level of each youth, but typically involves 18-24 weekly, 60-90 minute sessions with periodic check-ins between scheduled appointments.

The SITCAP-ART program is a comprehensive trauma intervention program, modified from the original Structured Sensory Intervention for Traumatized Children, Adolescents and Parents (SITCAP) program initially researched in 2001. SITCAP-ART is designed specifically for at-risk and adjudicated youth. SITCAP-ART integrates cognitive strategies with sensory/implicit strategies. When memory cannot be linked linguistically in a contextual framework, it remains at the symbolic level for which there are no words to describe. To retrieve that memory so it can be encoded, given a language, and then integrated into consciousness, it must be retrieved and externalized in its symbolic perceptual (iconic) form. SITCAP-ART, which is followed by cognitive or explicit strategies, supports moving from victim to survivor thinking allowing changes in negative behaviors (aggressive and rule-breaking behavior) and making adolescents more resilient to future traumas.

Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format for adolescents (both females, and males) in various settings (e.g., outpatient, inpatient, residential, home care, and schools). Seeking Safety consists of 25 topics that can be conducted in any order and number. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety has been also rated by the CEBC in the areas of Substance Abuse Treatment (Adult) and Trauma Treatment (Adult), click here to see that entry.

The primary objective of Stepped Care CBT for Children after Trauma (SC-CBT-CT) [formerly called, Stepped Care TF-CBT] is to decrease posttraumatic stress symptoms in children. SC-CBT-CT aims to improve the accessibility, efficiency, and cost of delivering treatment to children after trauma. SC-CBT-CT consists of two steps: Step One, Stepping Together for Children after Trauma (Stepping Together-CT) includes brief cognitive-behavioral therapy (CBT) (3 therapist–parent–child sessions over 6 weeks) and 11 parent–child meetings that take place in the home without the therapist, where the parent works with the child using a parent-child activity book. Step Two, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), provides therapist-led TF-CBT as a “step up” for children needing more intensive care.

Designed for implementation by school teachers or counselors, SSET is a cognitive-behavioral and skills-based 10-session support group for middle school children (ages 10-16) who have been exposed to traumatic events (such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or injured) and who are experiencing moderate to severe levels of posttraumatic stress disorder (PTSD) symptoms. Its aim is to relieve symptoms of child traumatic stress, anxiety, depression, and functional impairment. It is designed to be used in schools with children from a variety of ethnic and socioeconomic backgrounds and acculturation levels. Delivery of mental health programs through schools can overcome logistical barriers (transportation, scheduling) as well as reduce stigma and reach disadvantaged and minority youth who have limited access to mental health care. Developed as an adaptation of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program, SSET contains many of the same therapeutic elements but is designed to be implemented by school staff members without clinical training.

The Center for Mind–Body Medicine (CMBM) Small Group Model for Children and Adolescents is an approach for healing psychological trauma, relieving stress, reducing symptoms of chronic illness, and increasing resilience. Working in small groups of 8–10 children, facilitators teach a variety of techniques drawn from the world’s healing traditions as well as modern medicine, to help participants learn to move through emotions and experience their own capacity for self-healing. Trained facilitators guide the experience, helping participants discover their own answers.

The CMBM Small Group Model for Children and Adolescents helps young people understand how their mind and bodies operate under stress and in the aftermath of trauma. This knowledge is then used to teach self-regulation and reduce shame around negative coping adaptations. The CMBM also offers parallel group learning processes and individual coaching for parents whose children are targeted by their approach.

TARGET-A is an educational and therapeutic intervention designed to prevent and treat traumatic stress disorders (including PTSD, severe anxiety disorders, depression, and dissociative disorders), co-occurring addictive, personality, or psychotic disorders, and adjustment disorders related to other types of stressors.

TARGET-A teaches a seven-step sequence of skills, the FREEDOM Steps, designed to enable participants to recognize, understand, and gain control of stress reactions by enhancing their strengths/abilities for mental focusing, mindfulness, emotion regulation, executive function, and interpersonal engagement/interaction. TARGET-A provides a systematic approach to processing traumatic and other critical memories that does not require memory processing.

TARGET-A provides a manualized protocol for brief (4-session), time-limited (10-14 sessions), and extended (26+ sessions) individual, group, or couple/family education and therapy. TARGET-A can be delivered in community, outpatient, inpatient, residential treatment, shelter, workplace, correctional, or healthcare settings.

TARGET-A has been adapted to be gender-specific, culturally responsive, and attuned to the unique needs of adults who have experienced (or are currently experiencing) childhood trauma, sexual trauma, domestic violence, community violence, traumatic losses, disaster trauma, medical trauma, racism-related trauma, sexual identity-related trauma, or military trauma.

TARGET for Adults is highlighted in the Trauma Treatment (Adults) topic area on the CEBC as well.

TFC targets the internalizing effects of exposure to trauma in children and adolescents, with an emphasis on treating posttraumatic stress disorder (PTSD) and the collateral symptoms of depression, anxiety, anger, and an external locus of control [i.e., tendency to attribute one's experiences to fate, chance, or luck]. The intervention utilizes social learning theory and a skills-oriented cognitive-behavioral approach that is carried out in 14-week sessions of gradual exposure, moving from psycho-education, anxiety management skill building, and cognitive coping training to finally trauma narrative and cognitive restructuring activities.

TGCT-A is a manualized, assessment-driven group or individual treatment program for trauma-exposed or traumatically bereaved older children and adolescents. It is designed to address the complex needs of youth who must content with the interplay of trauma and grief. Its modular design, with workbook and detailed instructions, enables it to be customized for specific youth needs and varying lengths of treatment. It is organized into four modules that can be used in multiple configurations. Module I provides psychoeducation regarding traumatic stress and grief reactions, and training in core skills for emotion regulation, dealing with trauma and loss reminders, accessing social support, etc. Module II provides guidelines for facilitating narrative construction and sharing of trauma-/loss experiences. Module III provides a customized approach to grief based on the assessment of a youth's multidimensional grief profile. Specific skill training and therapeutic experiences are provided depending on the mix of separation distress, existential/identity distress, or circumstance-related distress (traumatic circumstances of death). Module IV promotes developmental progression, planning for upcoming stressors, and consolidates treatment gains.