Childhood Trauma and Trauma Focused Cognitive Behavioral Therapy

 

In the society we live in trauma is unfortunately a large contributor to childhood mental health conditions like depression, anxiety, panic attacks, post-traumatic stress disorder (PTSD), and substance use. The effects of trauma can be long lasting and puts children at greater risk of developing both mental health and physical health problems as adults.

How is trauma defined?

An event that either poses a threat or causes harm to an individual.

An individual’s response to a traumatic event often depends on how the events are interpreted. The effects of the event on the person can dramatically affect social, occupational, and physical functioning.

Examples of Trauma

There are many different types of trauma including but not limited to:

  • Domestic violence
  • Physical abuse
  • Sexual abuse
  • Bullying
  • Suicide
  • Abandonment
  • Natural disaster
  • Car accident
  • Kidnapping
  • Terrorism
  • Cancer treatment

Types of Trauma

  1. Acute – a single and time limited event
  2. Chronic – multiple exposures to traumatic events
  3. Complex- chronic exposure to trauma (often in early childhood) which impacts long-term functioning in areas like relationships, behavior, emotional regulation, and learning
  4. Systems induced – ie. traumatic removal of a child from a home, multiple foster care placements, parental abandonment, medical trauma, etc.

What does trauma look like in kids?

Common emotional and behavioral symptoms are:

  • Anger
  • Irritability
  • Anxiety
  • Emotional dysregulation
  • Problems with concentration
  • Poor sleep
  • Anger outbursts
  • Risk taking behavior
  • Substance use
  • Self-injurious behavior
  • Sexual acting out
  • Bullying/fighting
  • Running away

How do I know whether a child has experienced trauma?

The likelihood of a child disclosing trauma without being asked is very unlikely.

This is the reason that providers and caregivers should be asking if any events have occurred especially in the context of behavioral, academic, mood, and personality changes. Asking this question allows for early referral for treatment if trauma has occurred.

What happens after referral to a mental health provider?

An integral part of trauma informed care is a clinical interview with the caregiver and the child. There are several evidence-based instruments that can be used by clinicians in the office. The choice of measure used often depends on the child’s age. After the interview is complete the treatment provider/treatment team can start building an individualized plan designed to meet the needs of the child.

How is trauma treated?
Trauma focused cognitive behavioral therapy (TF-CBT) is a useful treatment for children 3-18 years old with a known history of trauma. TF-CBT primarily addresses symptoms of trauma ie. depression, anxiety, PTSD, and behavioral problems.

Involvement of a non-offending caregiver is optimal, but symptoms often improve if caregivers are not physically present or cannot participate due to safety concerns. Sometimes a support person may not be in the form of a parent. It could be a grandparent, aunt, probation officer, pastor, etc.

TF-CBT includes individual sessions with both the parent/caregiver/support person and also individual sessions with the child. The treating therapist will see both the adult and the child, and about the same amount of time is spent with both. The average length of treatment is 12-25 sessions.

During these sessions treatment consists of education about trauma, the effects it has on children and caregivers. There is also a strong focus on parenting skills and helping parents learn to cope with their own difficulty raising a traumatized child.

There is also significant work on relaxation, regulation of emotion, cognitive processing of the trauma, and writing a trauma narrative (which helps the child conceptualize the trauma), and mastery of coping skills. There is also caregiver-child work in conjoint sessions and a focus on safety and appropriate/safe social skills.

What TF-CBT is NOT?

TF-CBT does not retraumatize the child.

 

Of course, gradual exposure to the traumatic even can bring up feelings of distress, but this is not retraumatization, this is a sign that treatment is occurring.

Evidence Based Treatment

There have been 20 randomized controlled trials in multiple countries throughout the world showing that TF-CBT is an effective treatment for children with trauma. Studies have shown an improvement in PTSD, depression, anxiety, behavioral problems, and parental distress. TF-CBT has also been shown to improve resiliency in children and adolescents and decrease trauma related shame/guilt behaviors.

 

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