©20061 UCLA Trauma-Grief Focused Treatment Program for Adolescents (TGFT) Christopher M. Layne William R. Saltzman Robert S. Pynoos

©20062 Implementation Sites to Date Armenia (massive earthquake) Post-War Bosnia (war) Inglewood, California (school shooting) Pasadena, California (community violence) Columbine/Santee High Schools (school shootings) World Trade Center (terrorist attack, community & domestic violence) Florida (selected components; hurricane)

©20063 Empirical Evidence (Layne et al., 2001) Significant pre-post reductions in: –PTSD symptoms –complicated grief symptoms –depression symptoms Reliable improvement rates (RCI’s): –49% in PTSD scores –51.4% in complicated grief scores –35.2% in depression scores

©20064 Program Characteristics Ages: years old Focus: Trauma (single or multiple exposure) & traumatic death/loss. Setting: School or community clinic Assessment-driven Length of Treatment: sessions (modular design – varied length depending on which parts are used).

©20065 Overview of Trauma/Grief-Focused Group Psychotherapy Module I (6 sessions) Module II (8-12 sessions) Module III (8 sessions) Module IV (4 sessions) Group Phase OpeningWorking ThroughTermination Module Title Group Cohesion, Psychoeducation, and Basic Coping Skills Working Through Traumatic Experiences Coping with Traumatic Loss and Grief Re-Focusing on the Present and Looking to the Future Therape -utic Tasks  1: Welcome and introduction (program overview, barriers, group contract, posttraumatic stress, depression, and grief reactions)  2: Learning about trauma and loss reminders (how I react to, and cope with, reminders)  3: Learning coping skills  4: The event-thought- feeling link  5: Identifying and challenging distressing thoughts (“Three Steps to Taking Charge of Your Feelings”)  6: Support seeking (“Five Steps to Getting Support”)  First: Preparing for trauma narrative work (constructing the group narrative, constructing my personal trauma timeline)  Middle: Constructing the trauma narrative (prolonged therapeutic exposure; develop a vocabulary for communicating about the trauma)  Final: Exploring the worst moments (prolonged therapeutic exposure; using trauma reminders to understand the nature and personal meaning of traumatic experiences; cognitive restructuring cognitions associated with guilt and shame; exploring intervention fantasies)  1: Learning about grief (grief reactions, loss reminders, and grief processes / tasks)  2: Understanding grief reactions: Focus on anger  3: Understanding grief reactions: Focus on guilt  4: Remembering and reminiscing  5: Guided imagery: Retrieving a non-traumatic image of the deceased  6: Adjusting to a world in which the deceased is absent  7: Planning for difficult days (relapse prevention)  8: Saying goodbye in a good way  1: Resuming developmental progression  2: Problem-solving current life (“Three Steps to Solving a Problem”)  3: Dealing with problems that are not my job to fix  4: Saying goodbye in a good way

©20066 Trauma/Grief Focused Psychotherapy: Five Therapeutic Foci 1)Traumatic Experiences 2)Trauma & Loss Reminders 3)Post-Trauma Stresses & Adversities 4)Bereavement and the Interplay of Trauma & Grief Reactions 5)Developmental Impact

©20067 Intervention Strategies Psychoeducation Skills Training Cognitive Interventions Prolonged Therapeutic Exposure Grief Processing/Facilitation Social Network Interventions Relapse Prevention

©20068

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10 My Timeline What was happening outside of me: What was happening inside of me: (thoughts, feelings, bodily sensations)

© SituationsThoughts BehaviorsFeelings Trauma Narrative Construction Algorithm

© Practice Exercise: Parts of my life I want or need to change to adjust to the loss Overall Change I Want/Need First Steps I need to Take Living situation and finances Mealtimes/ time spent with family School, homework, preparation for college Choice of friends/ time spent with friends Daily interactions with people Favorite activities and hobbies Chores and Responsibilities Other (describe)____________