This type of therapy aims to help children, adolescents and adult survivors heal from the effects of trauma. It should also be noted that the present sample only included youth who began the trauma processing (second) phase of TF-CBT. While there were no differences on demographic measures between these youth and those who discontinued therapy before that point, there could be other differences between these groups. In addition, we focused on the trauma processing phase of TF-CBT, where the focus is on the activation and processing of traumatic memories and related content. Important processes of change are also likely to occur in the other phases of TF-CBT, and these should be examined in future studies.
The updated theory (Foa et al., 2006; Foa & McNally, 1996) also incorporates findings on inhibitory learning (e.g., Bouton, 2000; see Craske et al., 2008 for a review), which suggest that new responses learned in treatment do not replace the pathological learning, but rather can inhibit or buffer the old responses. This suggests that it is also important to measure new, more adaptive responses across multiple domains. Another strength of the present study is that the CHANGE coding system (Hayes, Feldman, et al., 2007) allowed for the measurement of multiple types of responses to trauma content in one study and as rated by independent raters. The CHANGE can be useful cognitive behavioral therapy as a single measure that captures multiple domains of pathological and adaptive trauma responses expressed during treatment sessions, in line with EPT’s emphasis on multimodal activation and change (Foa et al., 2006). Future studies could include different types of measures for each of the domains assessed (cognitive, emotional, behavioral, and physiological), including self-reports, lab tasks, behavioral assessments, and psychophysiological measures. In the final three models, the within-person quadratic slope of multimodal negative responses was entered as a predictor of posttreatment internalizing (Model 4), externalizing (Model 5), and PTSD symptoms (Model 6).
Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers
Currently, 25 randomized controlled trials have been conducted in the U.S., Europe and Africa, comparing TF-CBT to other active treatment conditions. All of these studies have documented that TF-CBT was 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 8-25 sessions with the child/adolescent and caregiver.
Such a pattern could be related to low reliability of the predictor variables, which would increase risk of Type I error; however, the intraclass correlations were all in the good to excellent range (.66 to .91; Cicchetti, 1994), and all of the analyses in question produced nonsignificant findings. Further, other models including the same predictors had much smaller standard errors and confidence intervals, suggesting that the problem was not with the predictor variables. It is possible that we were somewhat underpowered to detect https://ecosoberhouse.com/ significant effects, due to the nature of the models (i.e., using within-person slopes as predictors) relative to the sample size. These findings will require replication in a larger sample to assure that null findings were not due to insufficient power. Both parents and children may become able to better process emotions and thoughts relating to a traumatic experience through TF-CBT, which can provide those in therapy with the necessary tools to alleviate the overwhelming thoughts causing stress, anxiety, and depression.
What is Cognitive Behavioral Therapy?
The CHANGE uses verbal and nonverbal information and can assess trauma reactions expressed by clients across the cognitive, emotional, behavioral, and physiological domains of interest in this study. While the constructs that we examined involved multimodal sets of responses, we calculated composite scores rather than conducting network analyses. This was because the density of within-person data and the number of participants were not sufficient for network analyses (Epskamp, Borsboom, & Fried, 2018). With assessments that are daily or more frequent (rather than weekly), network analyses could be used to examine the interconnectivity among the types of responses and to identify those that are most central in predicting outcome (Borsboom, 2017; Epskamp et al., 2018). The present approach still has clinical utility in that findings suggest that clinicians might attend to changes in the breadth of their clients’ responses to trauma-related content rather than focusing on one type of response or another (e.g., cognitive or emotional).
Consistent with the broader framework of emotional processing theory (Foa et al., 2006), we found that an increase and then decrease (a curvilinear pattern) of multimodal pathological responses over the course of the trauma processing phase of TF-CBT predicted improvement in internalizing and PTSD symptoms. In addition, increases in multimodal adaptive responses predicted improvement in externalizing symptoms. Researchers might broaden the measurement of emotional processing and processes of change in PTSD treatments to include pathological and adaptive trauma-related responses across multiple domains, including cognitions, emotions, behaviors, and physiological responses. Our findings also illustrate the importance of examining not only linear, but also nonlinear patterns of change. TF-CBT clinicians might target activation and change in trauma responses across multiple domains, facilitate an increase then a decrease in negative responses during trauma processing, and also help clients to develop new, more positive responses to traumatic experiences. This study examines processes of change in trauma-focused cognitive behavioral therapy (TF-CBT) delivered to a community sample of 81 youth.
Emotional Processing and Nonlinear Change
Due to its trauma focus, this type of therapy is practiced with more sensitivity toward post-traumatic stress and mood disorders that may stem from abuse or grief. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment model designed to assist children, adolescents, and their families in overcoming the negative effects of a traumatic experience. Multilevel modeling was used to account for the hierarchical structure of the data (i.e., sessions nested within participants).
- These are some common forms of trauma that therapy can address; however it’s important to note that trauma can include any event or experience that causes emotional or psychological harm.
- The updated theory (Foa et al., 2006; Foa & McNally, 1996) also incorporates findings on inhibitory learning (e.g., Bouton, 2000; see Craske et al., 2008 for a review), which suggest that new responses learned in treatment do not replace the pathological learning, but rather can inhibit or buffer the old responses.
- The CHANGE coding system (Hayes, Feldman, et al., 2007) was used to code each treatment session in the trauma processing phase of TF-CBT for each participant.
- In the first three models, within-person slopes of multimodal negative and positive response scores were estimated to represent each individual’s linear change in these variables over time.
- It reinforces the survivor’s capacity to manage difficulties and fosters hope and optimism about the future.