1. Orientation to TFCBT

2. 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

3. 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

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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. TF-CBT and Manualized Treatments

14. 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

15. 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

16. 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

17. For the Upcoming Weeks
Sign up for online modules at
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

18. 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, doi: /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,
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.