About Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is an evidence-based treatment for traumatized children and adolescents developed by Esther Deblinger, Judith Cohen and Anthony Mannarino. It is a components-based treatment that integrates trauma-sensitive interventions with cognitive-behavioral strategies to reduce negative emotional and behavioral symptoms. The treatment addresses distorted beliefs and attributions related to the trauma, and provides a supportive environment in which children are provided the skills and support to talk about their traumatic experience.
TF-CBT also helps caregivers and other supportive adults (who are valuable participants in the treatment), cope effectively and develop skills that support their children. The treatment is appropriate for children and adolescents who have had a range of traumatic experiences, including sexual abuse, physical abuse, witness to violence, traumatic grief, etc.
Why use TF-CBT with Commercially Sexually Exploited Children?
Those who have experienced commercial sexual exploitation (CSE) are at very high risk for a broad range of negative mental health outcomes including PTSD, anxiety, depression and substance use problems. Risk of PTSD is recognized as particularly high with this population (as high as 80% is some studies) as a result of the high levels of trauma associated with their commercial sexual exploitation and significant histories of trauma (e.g. childhood sexual abuse) prior to their exploitation.
TF-CBT has strong research support (16 RCTs to date) for its effectiveness in addressing PTSD symptoms and trauma related difficulties, including recent research demonstrating its effective use with CSEC victims in Cambodia and the Congo. TF-CBT is effective with youth with single traumas, multiple traumas, and different kinds of traumas, as is often the case with those who have experienced commercial sexual exploitation. Importantly, TF-CBT has been used in an array of settings, including clinics, homes, residential facilities, DJJ facilities, and in-patient units, which are the very settings where commercially sexually exploited children and adolescents are served.
TF-CBT has also been used effectively with children when there is no caregiver involved as well as when there is a parent, foster care parent, group home staff person, or other invested adult involved in the treatment, consistent with the many locales and caregiver circumstances of CSEC victims. Also, TF-CBT is effective with youth from diverse backgrounds, in a variety of languages and different cultures reflecting the range of backgrounds representative of CSEC victims.
A wide range of clinical difficulties can be addressed within the flexible framework of the TF-CBT model. Cognitive problems, relational difficulties, affective problems, family difficulties, traumatic behavior problems, and somatic problems are some of the domains addressed in TF-CBT. In addition to addressing trauma and trauma-related symptoms and difficulties, there are a broad array of common clinical challenges associated with the delivery of therapy with commercially sexually exploited children and adolescents, such as engagement and retention difficulties, runaway risk, and more that can be flexibly addressed within the model. TF-CBT also includes an emphasis on personal safety and supporting caregiver-youth relationships, which are often particular concerns with commercially sexually exploited clients.