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

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

Education and Training

Prerequisite/Minimum Provider Qualifications

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

Education and Training Resources

There is a manual that describes how to deliver this program, and there is training available for this program.

Training Contacts:
Training is obtained:

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 not been conducted on how to implement Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).

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 12 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 comparison groups, outcomes, measures, notable limitations)
The study evaluated 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 posttraumatic stress disorder (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 indicated 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 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 comparison groups, outcomes, measures, notable limitations)
The purpose of this 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 Cognitive Behavioral Therapy (CBT-SAP) or Nondirective Supportive Therapy (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 at posttest the CBT-SAP group had improved significantly in comparison with the NST on the CSBI, the WBR total score, and on the Behavior Profile-Total and Internalizing subscales of the CBCL. Limitations include small sample size, reliance on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

Stauffer, L. B. & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 1, 65-76. https://doi.org/10.1177/1077559596001001007

Type of Study: One-group pretest-posttest
Number of Participants: 19

Population:

  • Age — Children: 2.3-6.5 years (Mean=3.46 years), Parents: 23-65 years (Mean=34.61 years)
  • Race/Ethnicity — Children: 84% Caucasian and 16% African American, Parents: 89% Caucasian and 11% African American
  • Gender — Children: 84% Caucasian and 16% African American, Parents: 89% Caucasian and 11% African American
  • Status — Participants were clients at the Center for Children’s Support, a resource for the medical and psychological evaluation and treatment of childhood sexual abuse victims and their nonoffending parents.

Location/Institution: New Jersey

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this 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)] with nonoffending mothers and young children with documented sexual abuse behaviors. Measures utilized included the Child Behavior Checklist for Ages 2-3 (CBCL/2-3), the Child Behavior Checklist for Ages 4-18 (CBCL/4-18), and the Child Sexual Behavior Inventory (CSBI). Results indicate that maternal reports of sexualized behaviors as measured by the CSBI showed no change between baseline and pretreatment, significant improvements between pretreatment and posttreatment, and maintenance of the improvements at a 3-month follow-up. Limitations include lack of randomization of participants, small sample size, and length of follow-up.

Length of postintervention follow-up: 3 months.

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 children

Population:

  • Age — 3-6 years at baseline
  • 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 comparison groups, outcomes, measures, notable limitations)
This study used the same sample as Cohen & Mannarino (1996). The purpose of this 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 included the Child Behavior Checklist for Ages 2-3 (CBCL/2-3) or the Child Behavior Checklist for Ages 4-18 (CBCL/4-18); and the Child Sexual Behavior Inventory (CSBI) and the Weekly Behavior Report (WBR). Scores on all measures improved significantly and were maintained over time for the CBT group. The CBT group also scored significantly better than the NST group on the Total Behavior Profile, the Internalizing and Externalizing subscales of the CBCL, and the WBRs. Limitations include small sample size and reliance on self-reported measures.

Length of 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 comparison groups, outcomes, measures, notable limitations)
This study used the same sample as Deblinger et al. (1996). The present study sought to determine whether the efficacy of Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) [now called Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)] and therapeutic gains were maintained for sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms 2 years after treatment. 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 indicated 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 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 children

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 comparison groups, outcomes, measures, notable limitations)
The study evaluated 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) 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 indicated that children in the treatment group showed fewer signs of PTSD symptoms, improvements on self-reported fear and anxiety, parent ratings on the CBCL, and general functioning. Limitations include a small sample size, that therapists were not blinded to family treatment condition, and length of follow-up.

Length of postintervention follow-up: 3 months.

Cohen, J. A., Mannarino, A. P., & Knudsen K. (2005). Treating sexually abused children: One year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 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 Females and 26 Males
  • Status — Participants were mothers and children with histories of sexual abuse trauma and posttraumatic stress disorder.

Location/Institution: Allegheny, Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated 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 included 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 among treatment completers, TF-CBT resulted in significantly greater improvement in anxiety, depression, sexual problems, and dissociation at 6-month follow-up and in PTSD and dissociation at 12-month follow-up. Intent-to-treat analysis indicated group X time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Limitations include small sample size, that the measure used for PTSD was less than optimal, and relatively high dropout rate, particularly in the NST group.

Length of 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, 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 comparison groups, outcomes, measures, 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 study evaluated 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 indicated 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 that the brief follow-up period is another significant limitation of this investigation.

Length of 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, 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, 7% Hispanic, and 14% Other
  • 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 comparison groups, outcomes, measures, notable limitations)
The study evaluated 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). Children were randomly assigned to one of the four treatment conditions: 8 sessions with no trauma narrative (TN) component, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Measures utilized included 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 indicated 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 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 comparison groups, outcomes, measures, notable limitations)
This study evaluated 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 indicated superior outcomes for TF-CBT on the child and parent self-report of PTSD symptoms, as well as hyperarousal, avoidance, and anxiety. Limitations included 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 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 — 35.1% White, 59.5% Black/African-American, and 5.4% Other
  • Gender — 66.2% 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 comparison groups, outcomes, measures, notable limitations)
This study examined 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. Children were assigned in Phase 2 to either 12-session manualized TF-CBT or a 12-week wait list. Measures included the Preschool Age Psychiatric Assessment (PAPA), the Adverse Events Checklist (AEC), the Treatment Fidelity Checklist (TFC), and the Adaptability Checklist–Child (ACC). Results indicated 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 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 comparison groups, outcomes, measures, notable limitations)
This study assessed 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. War-affected girls exposed to rape and inappropriate sexual touch were screened for trauma, depression, anxiety, and conduct problems, and prosocial behavior. They were then 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 generalizability to other populations.

Length of 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 Follette, V.M. & Ruzek, J. (Eds.) Cognitive behavioral therapies for trauma (2nd ed., pp.405-432). Guilford Press.

Contact Information

Judith Cohen, MD
Agency/Affiliation: Allegheny General Hospital, Drexel University College of Medicine
Email:
Phone: (412) 330-4321
Fax: (412) 330-4377
Esther Deblinger, PhD
Agency/Affiliation: CARES Institute
Department: Rowan School of Osteopathic Medicine
Email:
Phone: (856) 566-7036
Fax: (856) 566-2778

Date Research Evidence Last Reviewed by CEBC: June 2019

Date Program Content Last Reviewed by Program Staff: June 2019

Date Program Originally Loaded onto CEBC: May 2006