1. Presented By: Lorien Holman, LPC-S, CEO
TF-CBT Basics
Presented By: Lorien Holman, LPC-S, CEO

2. TF-CBT The History
TF- CBT was developed by Drs. Anthony Mannarino PhD, Judith Cohen MD, and Esther Deblinger MD.
TF-CBT is an evidence-based treatment that has been evaluated and refined during the past 25 years
Was developed to treat children and adolescents who were sexually abused and has now been expanded to treat impacts of trauma as well such as affective (e.g., depressive, anxiety), cognitive and behavioral problems, and improving the participating caregiver’s personal distress about the child’s traumatic experience, effective parenting skills, and supportive interactions with the child.
Is now recognized by SAMSHA as a Model Program due to extensive research efforts to include 21 randomized controlled trials which have been conducted in the U.S., Europe and Africa, comparing TF-CBT to other active treatments and have documented TFCBT is superior for improving children’s trauma symptoms and responses.
TF-CBT is a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in sessions with the child/adolescent and caregiver.

3. Overview: Core Concepts
Assessments
Engagement
Psychoeducation
Parenting
Relaxation
Affective Modulation
Cognitive Coping
Trauma Narrative
Cognitive Processing
In-Vivo Exposure
Family Sessions
Enhancing Safety

4. Assessments Identify the history of trauma Assessment Tools:
Identify PTSD symptoms
Establish a baseline
Observe client and family during assessment process (clinical observations)
Assessment Tools:
CATS- Child and Adolescent Trauma Screen
the only trauma screen paid for by Medicaid
TESI-Traumatic Events Screening Inventory
TSCYC- Trauma screen checklist for young children
TSCC- Trauma Screen Checklist for Children
BRIEF-C- Behavior Rating Inventory of Executive Function
ASQ-Ages and Stages Questionnaire
Child Sexual Behavior Inventory
Child PTSD Symptom Scale
What are you anchored to?
Trauma Exposure and symptoms-TESI, CATS
PTSD Symptoms- TSCYC, TSCC, CSBI, Child PTSD
Other areas that might be affected- Brief, ASQ

5. Methods of assessment for Children
Standardized measures
Telling the story
Reading a book
“A Terrible thing Happened”
“The Right Touch”
“I said No”
Interview with caregiver
Getting their perspective on the event, child’s symptoms and behaviors
Assessing context by exploring environment, development, and social protective factors
Clinical observations

6. Understanding PTSD and Similar Diagnoses
ADHD

8. Engagement Getting parental and client involvement
Setting the foundation and expectations for treatment
Establish goals of treatment
This should be done collaboratively
Sometime can be split between parent session and child session
Reduce resistance as much as possible

9. Engagement
Refer back to assessment results and problems that have been identified by family and/or client
Explore and link the child and caregivers goals and explore PACEs with family, as well as progress and successes made as treatment progresses
Explore rewards or incentives that can be used to increase motivation

10. Psychoeducation Teach, normalize, and validate symptoms of PTSD
Normalize the trauma exposure
Statistics
Groups
Reduce or eliminate self blame
Outline TF-CBT process and how it helps
Components and structure
Clarify the importance of consistent efforts in treatment

11. PsychoEducation Books Games Youtube
Taking Action: Support for Families with Children with Problematic Behaviors By: Jane F. Silovsky, Ph. D
Games
Youtube
(young children sexual abuse)
Worksheets or Workbook (it’s free! Own-TF-CBT-Workbook-Final.pdf)
Fun and Creative activities

12. Working with Parent or Caregiver
Understand family system and relationships within it
Learn skills to manage difficult or inappropriate behaviors
Skills covered should include:
Appropriate and timeliness of praise and rewards
One on One or Special Time
Understanding selective attention and ignoring
Power struggles
Consequences

13. Parenting Tools Worksheets Role playing Modeling
%20CBT/pages/7%20Trauma%20Focused%20CBT/General%20Questions%20for%20Psychoeducatio n.pdf
Role playing
Especially helpful when working in the Trauma Narrative
Modeling
Observing parent child interactions and practicing skills as well as coaching
Independent reading

14. Relaxation Skills that the child can use in any setting
Feelings First Aid Kit or a “Toolbox”
Use activities the child already enjoys (drawing, music, reading, watching youtube)
Yoga, mindfulness, guided imagery, controlled breathing
Can be used when working with the trauma narrative
Differentiate between relaxation and distress tolerance skills
Know when to use each
Relaxation techniques are deep breathing guided meditation
Distress tolerance skills are radical acceptance, self soothing with senses and distraction

15. Affective Modulation
Develop feeling language and be able to label feelings
Begin to understand feelings and normalize multiple, uncomfortable or competing feelings
(anxiety and depression)
Cognitive Triangle – Thoughts, feelings, behavior
TF-CBT Triangle of Life app available from Allegheny Health Network IOS Based
Understand intensity of feelings- In the workbook there is a thermometer
Explore feelings related to trauma
Learn Emotion Regulation Skills

16. Cognitive Coping Cognitive triangle
Explore automatic thoughts that may be causing distress
Distress can be caused from both traumatic reminders and non traumatic experiences
Explore ways to understand our feelings and ways to change them and out behavior by becoming more aware of and changing unhelpful thoughts
Thoughts, feelings, behavior games
Don’t Go Bananas

17. Cognitive processing Identify unhelpful and inaccurate thoughts
Explore with both the caregiver/client ways that the traumatic event may have changed their view of themselves, the world, their family, and their future
Explore helpful and more accurate ways to think about trauma exposure and replace old thoughts with new ones
“Damaged goods” more positive view “It’s not my fault”

18. Bottom-Up Interventions
What is it?
Working with the body/going through the body to change the brain
Sensory awareness or exposure techniques
Give me 5
Close your eyes and touch and describe objects
Introspective Awareness
Yoga
Diaphragmatic breathing
Exercise
Progressive Relaxation

19. Top-Down Interventions
What is it?
It’s working with trauma using cognitions to affect the body
Cognitive Restructuring/reappraisal
Acceptance and Commitment cognitive exercise
Transcendental Meditation
Focus Meditations
Empty Chair Technique
Assertiveness training
Talk therapy

20. Horizontal Interventions
What is it?
It’s going across hemispheres of the brain
Processing across modalities
Cross hemispheric processing
Art Therapy
Sensory Integration

21. Trauma Narrative What is it?
Telling the story of the trauma experience and should be done for each experience
Use media that the child likes, clay, paint, crayons, pencils
Comic Strips
Collage
Doll house
Puppet show

22. Trauma Narrative Cont. Provide exposure to trauma related memories
Explore unhelpful and inaccurate cognitions that need to be processed
Identify thoughts related to altered world view of self, related to trauma exposure or context of trauma
Put traumatic exposure into context (there are good things, future hopes and dreams)

23. In- Vivo Exposure
Learn how to differentiate between trauma reminders or fear response triggers (fear of spiders)
Identify triggers and explore causation- (use a fear ladder)
In session practice of distress tolerance skills during progressive exposure (as needed)
Create support with caregivers and client through use of praise and rewards
Exploring previous coping skills
Helps to reduce the avoidant responses that interfere with daily functioning

24. Family Sessions
Family sessions should happen regularly to provide support, praise and encouragement from their trusted adults
Learn what the child has done so far
Allows trusted adult to hear the child’s perspective
Provides a higher level of exposure with trusted adult
Provide space for parent to ask questions and process feelings about traumatic event as well as provide a place to role play showing support, praise and encouragement (parent only session)
Helpful in reducing shame

25. Building Safety Develop safety plan with both the child and family
Builds structure for family which in turns supports client after treatment
May go back to a video they liked
Usually toward the end of treatment however can be done anywhere
Include self harm or suicidal thoughts safety plan
Identify risk factors, triggers, “red flag warnings”
Explore appropriate boundaries with others

26. References
Tfcbt.org
Youtube
Feldman and Dorsey UW 2010
Nueroscience for Clinicians Jennifer Sweeton Ph.D M. S., M.A.