Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment developed by Anthony Mannarino, Ph.D.; and Judith Cohen, MD, of AGH’s Center for Traumatic Stress in Children and Adolescents, along with Esther Deblinger, Ph.D. of the New Jersey CARES Institute, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, and is considered the model with the strongest evidence of helping children recover from trauma, including sexual abuse, domestic violence, and traumatic loss.
TF-CBT has already been embraced by child mental health specialists in many locations around the country such as Nevada and Los Angeles County. Earlier this year, Dr. Mannarino presented a two-day conference at the University of Arkansas for Medical Sciences where more than 130 mental health professionals, therapists and counselors learned about TF-CBT.
Now, with funding from the Drexel University College of Medicine, Drs. Cohen and Mannarino are working with the Commonwealth of Pennsylvania to train clinicians in residential treatment facilities across Pennsylvania in TF-CBT and measuring outcomes in children.
“This treatment plan has showed success in a variety of situations and settings,” Dr. Mannarino said. “We are pleased to have the opportunity to reach so many more children and families who need help in overcoming the negative impact of traumatic life events.”
The Center for Traumatic Stress in Children and Adolescents at AGH helps more than 300 new children and families each year to overcome the negative impact of traumatic life events such as child abuse, community or domestic violence, terrorism, war, disasters, accidents and childhood traumatic grief.
Many of these children exhibit symptoms associated with Posttraumatic Stress Disorder such as disordered sleep patterns, nightmares, fear, and anxiety, as well as depression, behavior problems, or difficulties with learning and attention span.
“With TF-CBT, we take a simple, gentle approach to help children ‘make the unspeakable speakable,’” Dr. Mannarino said. “We encourage children to talk about the traumatic events that have affected them, focusing on exposure to the event, not avoidance. They may create a narrative of the trauma, in the form of a small book, poetry, or art work. When they finish retelling the story, they realize it wasn’t so scary to tell.”
“But we also strike a balance between talking about the event and moving forward,” Dr. Mannarino added. “For children who are overwhelmed with anxiety, for example, we teach them relaxation skills such as visualization and deep breathing.”
Parents or other caretakers are deeply involved in TF-CBT. In joint therapy sessions, children share their story of the trauma with their parent, opening the way to an ongoing dialogue. Parents also learn how to help children learn coping skills, and how to deal with immediate concerns such as sleep problems or fighting.
“In the process, parents often see improvement in their own trauma-related symptoms such as stress and anxiety,” Dr. Mannarino said.
With the help of a grant from the federal Substance Abuse and Mental Health Services Administration, Drs. Cohen and Mannarino are also adapting TF-CBT with a focus on enhancing resiliency in military children and in traumatized children ages 8-17 in other residential treatment facilities across the country.
“This intervention has been the subject of eight randomized controlled trials, all of which showed similar successful outcomes,” Dr. Mannarino said.
Dr. Mannarino was named to the American Psychological Association’s Presidential Task Force on Child and Adolescent Posttraumatic Stress Disorder and Trauma in 2008. He is a Professor of Psychiatry at the Drexel University College of Medicine and Vice President, Department of Psychiatry at AGH. He has been providing clinical services to traumatized children and their families for more than 25 years, and has been the principal investigator on several federal grants examining the impact and treatment of child sexual abuse.
Dr. Cohen is a board-certified child and adolescent psychiatrist and Professor of Psychiatry at the Drexel University College of Medicine. She has written and lectured extensively on the evaluation and treatment of children exposed to traumatic events, and has conducted several federally funded research projects on the symptomology and treatment of traumatized children.
Dr. Mannarino and Dr. Cohen, with Esther Deblinger, are the authors of “Treating Trauma and Traumatic Grief in Children and Adolescents,” in which they elaborate on their TF-CBT treatment approach, including how to adapt the model to children of different ages and from diverse cultural backgrounds.