Orientation to TFCBT

Presentation Overview Establish context through some quick facts about trauma in the US Understand the Trauma Response Describe 3 sources of trauma & types of responding Discuss TF-CBT and manualized treatments Review organization of remaining trainings

Establishing Context Everyone has trauma 90% of US adults report being exposed to something notably traumatic1 Unresolved trauma reactions may be at the core of many developmental, relational, or clinical impairments To increase intrapersonal well-being and interpersonal functioning, meaningful and efficacious treatment is an imperative

Sources of Trauma Many possibilities, but also some distinct categories Threats to our body Environmental and disaster-related events Relational trauma

Types of Response Traumatic Experience Natural Recovery Response Persistence of Trauma Symptoms Recovery through treatment Compounding of symptoms through non-treatment

Clinical Symptoms of PTSD From the medical model perspective Exposure to traumatic material (direct or indirect) Intrusion symptoms (flashbacks, nightmares, physio) Negative changes in cognitions and mood Alternations in arousal or activity level Duration- ASD versus PTSD Functional significance

Clinical Symptoms of PTSD From a Wellness, Strength-based Perspective Alterations in positive emotions and happiness Decreased engagement with life activities Affected social relationships Disrupted perceptions of meaning and existential well-being Impediment to activities that promote sense of accomplishment

3 Sources of Trauma Response Biological dysregulation Behavioral explanations of trauma-focused interventions Behavioral theory Cognitive-emotional processing theory Cognitive explanations of trauma-focused interventions Social cognitive theory of PTSD

Biological Dysregulation Neurocircuitry models make reference to some important brain areas Amygdala, medial prefrontal cortex and anterior cingulate, and hippocampus Activity in these areas is markedly different in those with PTSD than without

Behavioral Conceptualizations Mowrer2 provided a framework for development and maintenance of fear responses Classical Conditioning explains on onset/acquisition of fear response Operant Conditioning maintains response through avoidance of fear provoking stimuli

Emotional Processing Theory Foa’s3 practice-based theory integrated meaning into the learned response In response to traumatic experience, we develop meaning structures with stimulus and physiological responses Maintenance and recovery moderated by three factors: Degree of emotional engagement Quality of trauma-related cognitions Degree of narrative articulation

Social Cognitive Theory of PTSD Resick and colleagues4 depicted this model in the treatment of individuals with PTSD. Avoidance of thinking about the event and problematic appraisals of event contribute to non-recovery. Largely moderated through cognitive assimilation Just-world thinking Hindsight bias Happily ever after thinking Assimilation Use traumatic event as proof of negative belief Related to safety, trust, power/control, esteem, and intimacy Over- accommodation Experience natural emotions Correct misappraisals associated with manufactured emotions Keys to Recovery

TF-CBT and Manualized Treatments

Manualized Treatment What is a manualized treatment? How do manualized treatments apply to evidence-based practice? Do I have to do it by the book? How can this help me as a developing practitioner? Our manual is called Treating trauma and traumatic grief in children and adolescents7

TF-CBT Conjoint child-parent therapy approach Use core set of CBT skills to promote coping Include narrative processing component Sequential and components based Flexible and responsive Culturally sensitive

TF-CBT Protocol Psychoeducation Relaxation and Stress Management Training Affective expression Cognitive coping strategies Trauma narrative In vivo mastery of trauma reminders Conjoint kiddo-parent sessions Enhancing future safety

For the Upcoming Weeks Sign up for online modules at https://tfcbt.musc.edu Complete related modules prior to face to face meetings with clients and after planning/supervision Use manual and resources to extend on information presented in online modules and provide opportunity to develop resources and skills for your use at clinic. Review manualized treatment article and Lenz and Hollenbaugh (2015) article

References Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537-547. doi:10.1002/jts.21848 Mowrer, O. H. (1960). Learning and behavior. (Vol. 960). New York, NY: John Wiley & Sons. Foa, E. B., Huppert, , J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In B. O. Rothbaum (Ed.). Pathological anxiety: emotional processing in etiology and treatment (pp.3-24). New York, NY: Guilford Press. Larsen, S. (2012). The neurofeedback solution. Rochester, VT: Healing Art Press. Chapin, T. J., & Russell-Chapin, L. A. (2014). Neurotherapy and neurofeedback: Brain-based treatment for psychological and behavioral problems. New York, NY: Routlede. Monson, C., & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: interventions that work. Washington, DC: American Psychological Association. Cohen, L., Mannarino, A., & Deblinger, E. (2006). Treating trauma and grief in children and adolescents. New York, NY: The Guilford Press. Foa, E. B., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. New York, NY: Oxford University Press. Resick, P. A., Monson, C. M., & Chard, K. M. (2008). Cognitive processing therapy: Veteran/military version. Washington, DC: U.S. Department of Veteran’s Affairs. Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339-376. Thomas, K., Dorrepaal, E., Draijer, N., Jansma, E., Veltman, D., & van Balkom, A. (2013). Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review. Journal of Psychiatric Research, 50, 1-15.