Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is a mental health treatment model designed for children ages 3- 18 who are experiencing difficulties after trauma exposure such as sexual abuse, exposure to violence, or a natural disaster. TF-CBT was developed by Judy Cohen, M.D., Anthony Mannarino, Ph.D. and Esther Deblinger, Ph.D.
TF-CBT is an evidenced-based intervention that is a SAMHSA best practice in the treatment of childhood posttraumatic stress disorder (PTSD). Features of TF-CBT:
- Treatment is short-term. On average, TF-CBT is completed over 18-24 weekly sessions.
- TF-CBT is skills–based. Families are taught many skills in sessions, such as relaxation, to reduce trauma-related distress. In order for treatment to be effective, therapists will also ask children and caregivers to practice and use these skills at home and other places where stress may occur.
- TF-CBT involves the family. Caregivers are actively included in treatment with their child and are key to successful outcomes. Typically, therapists in each TF-CBT session will spend individual time with the child, check in separately with the caregiver, and include combined family time. However, when a child does not have a caregiver who can be involved in treatment, TF-CBT treatment can still be effective in reducing childhood trauma symptoms.
- Sessions will be structured. TF-CBT therapists will have a planned focus for each session to cover skills and activities known to be important for reducing distress related to trauma.
- Treatment will be engaging to the family! TF-CBT therapists will strive to be creative and tailor activities to engage children and provide an enjoyable and safe treatment experience.
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.