Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)

About This Program

Target Population: Children with a known trauma history who are experiencing significant posttraumatic stress disorder (PTSD) symptoms, whether or not they meet full diagnostic criteria. In addition, children with depression, anxiety, and/or shame related to their traumatic exposure. Children experiencing childhood traumatic grief can also benefit from the treatment.

For children/adolescents ages: 3 – 18

For parents/caregivers of children ages: 3 – 18

Program Overview

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.


Program Goals

The goals of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) are:

  • Improving child PTSD, depressive and anxiety symptoms
  • Improving child externalizing behavior problems (including sexual behavior problems if related to trauma)
  • 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

Logic Model

The program representative did not provide information about a Logic Model for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).

Essential Components

The essential components of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) include:

  • Gradual exposure is included in all components to help children gain mastery in how to use skills when trauma reminders or cues occur.
  • The program components are:
    • P – Psycho-education and parenting skills
    • R – Relaxation techniques: Focused breathing, progressive muscle relaxation, and teaching the child to control their thoughts (thought stopping).
    • A – Affective expression and regulation: To help the child and parent learn to control their emotional reaction to reminders by expanding their emotional vocabulary, enhancing their skills in identification and expression of emotions, and encouraging self-soothing activities
    • C – Cognitive coping: Through this component, the child learns to understand the relationships between thoughts, feelings and behaviors and think in new and healthier ways.
    • T – Trauma narrative and processing: Gradual exposure exercises including verbal, written and/or symbolic recounting (i.e., utilizing dolls, art, puppets, etc.) of traumatic event(s) so the child learns to be able to discuss the events when they choose in ways that do not produce overwhelming emotions. Following the completion of the narrative, clients are supported in identifying, challenging and correcting cognitive distortions and dysfunctional beliefs.
    • I – In vivo exposure: Encourage the gradual exposure to innocuous (harmless) trauma reminders in child's environment (e.g., basement, darkness, school, etc.) so the child learns they can control their emotional reactions to things that remind them of the trauma, starting with non-threatening examples of reminders.
    • C – Conjoint parent/child sessions: Held typically toward the end of the treatment, but maybe initiated earlier when children have significant behavior problems so parents can be coached in the use of behavior management skills. Sessions generally deal with psycho-education, sharing the trauma narrative, anxiety management, and correction of cognitive distortions. The family works to enhance communication and create opportunities for therapeutic discussion regarding the trauma.
    • E – Enhancing personal safety and future growth: Provide training and education with respect to personal safety skills and healthy sexuality/ interpersonal relationships; encourage the utilization of skills learned in managing future stressors and/or trauma reminders.

Program Delivery

Child/Adolescent Services

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) directly provides services to children/adolescents and addresses the following:

  • Feelings of shame, distorted beliefs about self and others, acting out behavior problems, and PTSD and related symptoms

Parent/Caregiver Services

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) directly provides services to parents/caregivers and addresses the following:

  • Inappropriate parenting practices and parental trauma-related emotional distress

Recommended Intensity:

Weekly 30- to 45-minute sessions for the child and parent separately until the end of treatment nears; then conjoint sessions of 30-45 minutes are included

Recommended Duration:

12-18 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Daily Living Setting
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) includes a homework component:

Parents are given weekly assignments to practice the treatment components at home, both alone and to reinforce and practice these with their children. Children are also given homework during certain sessions to reinforce and practice skills learned in therapy sessions.

Languages

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) has materials available in languages other than English:

Dutch, German, Japanese, Korean, Mandarin, Polish, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Private space to conduct sessions
  • Waiting area for children when parents are being seen
  • Therapeutic books and materials

Manuals and Training

Prerequisite/Minimum Provider Qualifications

  • Master's degree and training in the treatment model
  • Experience working with children and families

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contacts:
Training Type/Location:

National Conferences; CARES Institute, Allegheny General Hospital and onsite by request

Number of days/hours:
  • Introductory Overview: 11 hour web-based course, TF-CBTWeb 2.0, available at: http://tfcbt2.musc.edu
  • Basic Training: 2–3 days from an approved national TF-CBT trainer
  • Ongoing Phone Consultation (twice monthly for 6-12 months): groups of 5-12 clinicians receive ongoing case consultation from an approved national TF-CBT trainer or consultant to implement TF-CBT for patients in their setting
  • Advanced Training: 1–3 days on selected topics relevant to the organization

More information is available at hhttp://tfcbt.org.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as listed below:

The TF-CBT Implementation Manual describes the organizational readiness process. It is available from the program representative listed at the end of the entry.

Formal Support for Implementation

There is formal support available for implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as listed below:

There is a formal structure for therapists to become certified in TF-CBT (www.tfcbt.org) as well as a structure for official training of TF-CBT trainers, organizational supervisors, and consultants to support large implementation programs.

Fidelity Measures

There are fidelity measures for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as listed below:

The TF-CBT Brief Practice Checklist is a self-report form that is available in Appendix 4 of the TF-CBT Implementation Manual. The manual is available from the program representative listed at the end of the entry.

Implementation Guides or Manuals

There are implementation guides or manuals for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as listed below:

The TF-CBT Implementation Manual describes the implementation process. It is available from the program representative listed at the end of the entry.

Research on How to Implement the Program

Research has been conducted on how to implement Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) as listed below:

Orengo-Aguayo, R., Stewart, R. W., Villalobos, B. T., Hernandez Rodriguez, J., Dueweke, A. R., de Arellano, M. A., & Young, J. (2020). Listen, don't tell: Partnership and adaptation to implement trauma-focused cognitive behavioral therapy in low-resourced settings. American Psychologist, 75(8), 1158–1174. https://doi.org/10.1037/amp0000691

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) are summarized below:

Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310–321. https://doi.org/10.1177/1077559596001004003

Type of Study: Randomized controlled trial
Number of Participants: 90

Population:

  • Age — 7-13 years
  • Race/Ethnicity — 70% Caucasian, 21% African American, 7% Hispanic, and 2% Other
  • Gender — 83% Female and 17% Male
  • Status — Participants were children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD) who were referred by the Department for Youth and Family Services, prosecutor's office, or other community agency.

Location/Institution: New Jersey

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the use of a cognitive-behavioral intervention designed to treat posttraumatic stress disorder (PTSD) and other behavioral and emotional difficulties [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)] in a sample of children with histories of sexual abuse trauma and PTSD. Participants were randomly assigned to child-only, mother-only, or mother and child treatment conditions, or to a standard community care control condition. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-E), the State Trait Anxiety Inventory for Children (STAIC), the Child Depression Inventory (CDI), the Child Behavior Checklist for Ages 4-18 (CBCL/4-18) and the Parenting Practices Questionnaire (PPQ). Results indicate that children assigned to either treatment condition showed fewer PTSD symptoms after treatment than those assigned to parent-only treatment or community conditions. Mothers in either treatment condition reported more effective parenting behaviors on the PPQ and reported fewer externalizing behaviors for their children. Limitations include the large variation in treatment received by the community care control condition, small sample size, and lack of a postintervention follow up.

Length of controlled postintervention follow-up: None.

Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35(1), 42–50. https://doi.org/10.1097/00004583-199601000-00011

Type of Study: Randomized controlled trial
Number of Participants: 67

Population:

  • Age — 3-6 years
  • Race/Ethnicity — 54% Caucasian, 42% African American, and 4% other
  • Gender — 58% Female and 42% Male
  • Status — Participants were families and children with histories of sexual abuse trauma who were recruited from rape crisis centers, Child Protective Services, pediatricians, psychologists, community mental health agencies, police, or judicial system.

Location/Institution: Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the relative efficacy of a short-term individual cognitive-behavioral treatment model (CBT-SAP) [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)] compared to a nonspecific alternative treatment, nondirective supportive therapy (NST) for nonoffending parents and children with documented sexual abuse. Participants were randomly assigned to CBT-SAP or NST. Measures utilized include the Preschool Symptom Self-report (PRESS), the Child Behavior Checklist for Ages 2-3 (CBCL/2-3), the Child Behavior Checklist for Ages 4-18 (CBCL/4-18), the Child Sexual Behavior Inventory (CSBI), and the Weekly Behavior Report (WBR), which was developed for this research project. Results indicate that at comparison of pretreatment and posttreatment outcome measures demonstrated that while the NST group did not change significantly with regard to symptomatology, the CBT-SAP group had highly significant symptomatic improvement on most outcome measures. Repeated-measures analyses of variance demonstrated group x time interactions on some variables as well. Clinical findings also supported the effectiveness of the CBT-SAP intervention over NST. Limitations include small sample size, reliance on self-reported measures, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Cohen, J. A., & Mannarino, A. P. (1997). A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36(9), 1228-1235. https://doi.org/10.1097/00004583-199709000-00015

Type of Study: Randomized controlled trial
Number of Participants: 43

Population:

  • Age — 3-6 years
  • Race/Ethnicity — 56% Caucasian and 44% African American
  • Gender — 56% Female and 44% Male
  • Status — Participants were children with substantiated cases of sexual abuse.

Location/Institution: Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
This study used a subset of the sample from Cohen & Mannarino (1996). The purpose of the study was to determine the efficacy of Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)]. Participants were randomly assigned to receive either CBT-SAP or nondirective supportive therapy (NST). Measures utilized include the Child Behavior Checklist for Ages 2-3 (CBCL/2-3) or the Child Behavior Checklist for Ages 4-18 (CBCL/4-18); the Child Sexual Behavior Inventory (CSBI); and the Weekly Behavior Report (WBR). Results indicate that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. Limitations include small sample size and reliance on self-reported measures. 

Length of controlled postintervention follow-up: 1 year.

Deblinger, E., Steer, R. A., & Lippmann, J. (1999). Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering from post-traumatic stress symptoms. Child Abuse & Neglect, 23(12), 1371–1378. https://doi.org/10.1016/S0145-2134(99)00091-5

Type of Study: Randomized controlled trial
Number of Participants: 75

Population:

  • Age — 7-13 years
  • Race/Ethnicity — 70% White, 21% Black, 7% Hispanic and 2% Other
  • Gender — 83% Female and 17% Male
  • Status — Participants were children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD).

Location/Institution: New Jersey

Summary: (To include basic study design, measures, results, and notable limitations)
This study used a subset of the sample from Deblinger, Lippmann, & Steer (1996). The purpose of the study was to determine whether the therapeutic gains previously found would be sustained 2 years after treatment with Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)] Participants were randomly assigned to one of three cognitive-behavioral treatment conditions: child only, mother only, or mother and child, or a community comparison condition. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-E), the Child Depression Inventory (CDI), the Child Behavior Checklist for Ages 4-18 (CBCL/4-18), and the Parenting Practices Questionnaire (PPQ). Results indicate that at the 2-year follow-up, scores on the measures of PTSD symptoms, depression and externalizing behaviors remained comparable to scores at the original posttreatment assessment. Limitations include small sample size, missing data, and the tremendous variability in the experiences of participants who were encouraged to seek therapy in their communities.

Length of controlled postintervention follow-up: 2 years.

King, N. J., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., Martin, R., & Ollendick, T. H. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11), 1347-1355. https://doi.org/10.1097/00004583-200011000-00008

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

  • Age — 5-17 years
  • Race/Ethnicity — Not specified
  • Gender — 69% Female and 31% Male
  • Status — Participants were children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD) who were referred from sexual assault centers, Department of Disability, Housing and Community Services (DHCS), mental health professionals, medical practitioners, or school authorities.

Location/Institution: Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of child and caregiver participation through the use of Family Cognitive-Behavioral Therapy (CBT) [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)] in a sample of children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD). Participants were randomly assigned to 1 of 3 groups: (1) Waiting-list control (WLC), (2) Child CBT, or (3) Family CBT. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV (ADIS), the Fear Thermometer for Sexually Abused Children, the Coping Questionnaire for Sexually Abused Children, the Revised Children’s Manifest Anxiety Scale (R-CMAS), the Children’s Depression Inventory, the Global Assessment Functioning Scale (GAF), and the Child Behavior Checklist for Ages 4-18 (CBCL/4-18). Results indicate that compared with controls, children who received treatment exhibited significant improvements in posttraumatic stress disorder symptoms and self-reports of fear and anxiety. Significant improvements also occurred in relation to parent-completed measures and clinician ratings of global functioning. In general, parental involvement did not improve the efficacy of cognitive-behavioral therapy. Maintenance of improvement was evident at a 12-week follow-up assessment. Limitations include a small sample size, that therapists were not blinded to family treatment condition, and length of follow-up.

Length of controlled postintervention follow-up: 3 months.

Cohen, J. A., Mannarino, A. P., & Knudsen K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135–146. https://doi.org/10.1016/j.chiabu.2004.12.005

Type of Study: Randomized controlled trial
Number of Participants: 82

Population:

  • Age — 8-15 years
  • Race/Ethnicity — 60% Caucasian, 37% African American, 2% Biracial, and 1% Hispanic
  • Gender — 56 Female and 26 Male
  • Status — Participants were mothers and children with histories of sexual abuse trauma and posttraumatic stress disorder.

Location/Institution: Allegheny, Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in a sample of children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD). Participants were randomly assigned to one of two treatment groups: TF-CBT or nondirective supportive therapy (NST). Measures utilized include the Children's Depression Inventory (CDI), Trauma Symptom Checklist for Children (TSCC), State-Trait Anxiety Inventory for Children (STAIC), Child Sexual Behavior Inventory (CSBI), and the Child Behavior Checklist for Ages 6-18 (CBCL/6-18). Results indicate that significant group × time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems were found. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. Limitations include small sample size, that the measure used for PTSD was less than optimal, and a relatively high dropout rate, particularly in the NST group.

Length of controlled postintervention follow-up: 1 year.

Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 45(12), 1474-1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb

Type of Study: Randomized controlled trial
Number of Participants: 183

Population:

  • Age — 8-14 years
  • Race/Ethnicity — 60% Caucasian, 28% African American, 9% Hispanic, 7% Biracial, and 1% Other
  • Gender — 79% Female and 21% Male
  • Status — Participants were mothers and children with histories of sexual abuse trauma and posttraumatic stress disorder.

Location/Institution: Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
Note: Posttreatment results are available in Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393-402. The purpose of the study was to evaluate the efficacy of child and caregiver participation through the use of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in a sample of children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD). Participants were randomly assigned to receive TF-CBT or child-centered therapy (CCT). Measures utilized include the Kiddie Schedule for Affective Disorders for School-age Children-Present and Lifetime Version (K-SADS-PL-PTSD) PTSD subscale, the Children’s Depression Inventory (CDI), the State-Trait Anxiety Inventory for Children (STAIC), the Children’s Attributions and Perceptions Scale (CAPS), the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), the Child Sexual Behavior Inventory (CSBI), the Beck Depression Inventory (BDI), the Parent’s Emotional Reaction Questionnaire (PERQ), and the Parenting Practices Questionnaire (PPQ). Results indicate that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to CCT only. Limitations include that the sample is not representative of all children who have experienced sexual abuse, and  the brief follow-up period.

Length of controlled postintervention follow-up: 12 months.

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-Focused Cognitive Behavioral Therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28(1), 67–75. https://doi.org/10.1002/da.20744

Type of Study: Randomized controlled trial
Number of Participants: 210

Population:

  • Age — 4-11 years
  • Race/Ethnicity — 65% Caucasian, 14% African-American, 14% Other, and 7% Hispanic
  • Gender — 61% Female and 39% Male
  • Status — Participants were mothers and children with histories of sexual abuse trauma and posttraumatic stress disorder.

Location/Institution: Pittsburgh, PA and Stratford, NJ

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the differential effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with or without the trauma narrative (TN) component in 8 versus 16 sessions in a sample of children with histories of sexual abuse trauma and posttraumatic stress disorder (PTSD). Participants were randomly assigned to one of four treatment conditions: 8 sessions with no TN component, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS), Beck Depression Inventory (BDI), Child Behavior Checklist (CBCL) for Ages 1.5-5 (CBCL/1.5-5) or Child Behavior Checklist for Ages 6-18 (CBCL/6-18), and the Children’s Depression Inventory (CDI). Results indicate that TF-CBT, regardless of the number of sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the children’s personal safety skills. The eight-session condition that included the TN component seemed to be the most effective and efficient means of reducing parents’ abuse-specific distress as well as children’s abuse-related fear and general anxiety. On the other hand, parents assigned to the 16-session, no TN component condition reported greater increases in effective parenting practices and fewer externalizing child behavioral problems at posttreatment. Limitations include the lack of a postintervention follow-up.

Length of controlled postintervention follow-up: None.

Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence. Archives of Pediatrics & Adolescent Medicine, 165(1), 16–21. https://doi.org/10.1001/archpediatrics.2010.247

Type of Study: Randomized controlled trial
Number of Participants: 124

Population:

  • Age — 7-14 years
  • Race/Ethnicity — 56% Caucasian, 33% African American, and 11% Biracial
  • Gender — 51% Female and 49% Male
  • Status — Participants were children with mental health symptoms whose mothers had been referred to an intimate partner violence center.

Location/Institution: Pittsburgh, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate community-provided Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)–related posttraumatic stress disorder (PTSD) symptoms. Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy). Measures utilized included the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]), University of California at Los Angeles PTSD Reaction Index (RI), Screen for Child Anxiety Related Emotional Disorders (SCARED), Children's Depression Inventory (CDI), Kaufman Brief Intelligence Test, and the Child Behavior Checklist for Ages 6-18 (CBCL/6-18). Results indicate that there were superior outcomes for TF-CBT on the child and parent self-report of PTSD symptoms, as well as hyperarousal, avoidance, and anxiety. Limitations include a high dropout rate and the inability to generalize the effectiveness of TF-CBT to settings that lack the ancillary services offered at the Women's Center and Shelter of Greater Pittsburgh (WCS).

Length of controlled postintervention follow-up: None.

Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya–Jackson, L., & Guthrie, D. (2011). Trauma–Focused Cognitive–Behavioral Therapy for posttraumatic stress disorder in three- through six-year–old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860. https://doi.org/10.1111/j.1469-7610.2010.02354.x

Type of Study: Randomized controlled trial
Number of Participants: 64

Population:

  • Age — 3-6 years
  • Race/Ethnicity — 60% Black/African-American, 35% White, and 5% Other
  • Gender — 66% Male
  • Status — Participants were children who suffered acute single blow trauma, chronic repeated events, or were victims of the Hurricane Katrina disaster.

Location/Institution: New Orleans, Louisiana

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy and feasibility of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for treating posttraumatic stress disorder (PTSD) in three- through six-year-old children exposed to heterogeneous types of traumas. Participants were assigned in Phase 2 to either 12-session manualized TF-CBT or a 12-week wait list. Measures utilized include the Preschool Age Psychiatric Assessment (PAPA), the Adverse Events Checklist (AEC), the Treatment Fidelity Checklist (TFC), and the Adaptability Checklist–Child (ACC). Results indicate that the intervention group improved significantly more on symptoms of PTSD, but not on depression, separation anxiety, oppositional defiant, or attention deficit/hyperactivity disorders. After the waiting period, all participants were offered treatment. Effect sizes were large for PTSD, depression, separation anxiety, and oppositional defiant disorders, but not attention-deficit/hyperactivity disorder. Limitations include high attrition and small sample size.

Length of controlled postintervention follow-up: 6 months.

O'Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of Trauma-Focused Cognitive Behavioral Therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359–369. https://doi.org/10.1016/j.jaac.2013.01.013

Type of Study: Randomized controlled trial
Number of Participants: 52

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 100% Congolese
  • Gender — 100% Female
  • Status — Participants were sexually exploited adolescent girls.

Location/Institution: Democratic Republic of Congo

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the efficacy of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) delivered by social worker facilitators in reducing posttraumatic stress, depression, anxiety, and conduct problems and increasing prosocial behavior in a group of war-affected, sexually exploited girls. Participants were randomized to a 15-session, group-based, culturally modified TF-CBT group or a waitlist control group. Measures included the University of California–Los Angeles Posttraumatic Stress Disorder Reaction Index [UCLA-PTSD RI] and the African Youth Psychosocial Assessment Instrument (AYPA). Results indicated that, compared to the waitlist control, the TF-CBT group experienced significantly greater reductions in trauma symptoms. In addition, the TF-CBT group showed significant improvement in symptoms of depression, anxiety, conduct problems, and prosocial behavior. Limitations include small sample size, reliance on self-reported outcome measures, and lack of generalizability to other populations

Length of controlled postintervention follow-up: 3 months.

Additional References

Cohen, J. A., & Mannarino, A. P. (2004). Treating childhood traumatic grief. Journal of Clinical Child and Adolescent Psychology, 33, 820-233. https://doi.org/10.1097/01.chi.0000135620.15522.38

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. Guilford Press.

Deblinger, E., Thakkar-Kolar, R., & Ryan, E. (2006). Trauma in childhood. In V. M. Follette, & J. Ruzek, (Eds.) Cognitive behavioral therapies for trauma (2nd ed., pp. 405-432). Guilford Press.

Contact Information

Judith Cohen, MD
Agency/Affiliation: Allegheny Health Network
Email:
Phone: (412) 330-4321
Esther Deblinger, PhD
Agency/Affiliation: CARES Institute
Department: Rowan School of Osteopathic Medicine
Email:
Phone: (856) 566-7036

Date Research Evidence Last Reviewed by CEBC: September 2021

Date Program Content Last Reviewed by Program Staff: May 2024

Date Program Originally Loaded onto CEBC: June 2006