Trauma-Focused Cognitive Behavioral Therapy for PTSD

Trauma-Focused Cognitive Behavioral Therapy for PTSD
Abstract
Post-Traumatic Stress Disorder could arise after a harrowing and distressing event which threatens a person’s safety or makes him or her to feel helpless. A lot of youngsters around the globe experience events that are traumatizing. It is notable that if exposure to trauma is not treated on time, it could bring about a range of mental health problems. Trauma-Focused Cognitive Behavioral Therapy is a components-based treatment model incorporating trauma-sensitive interventions with family, cognitive behavioral, in addition to humanistic techniques and principles. It can be used to treat posttraumatic stress disorder in youngsters. The research question for this study is: How effective is Trauma-Focused Cognitive Behavioral Therapy in the treatment of young people with Posttraumatic Stress Disorder? There is persuasive evidence base for TF-CBT in the treatment of PSTD. Nevertheless, few controlled trials have been carried out on very young children and are limited mainly to victims of sexual abuse. This study will fill this gap in existing knowledge. The participants include 46 trauma-exposed children aged 4-9. They are randomized to either the Trauma-Focused Cognitive Behavioral Therapy treatment group (n=23) or the Treatment as Usual group (n=23). Approval would be obtained from the appropriate Institutional Review Board.
Trauma-Focused Cognitive Behavioral Therapy for PTSD
It is normal, following a traumatic experience, for a person to feel disconnected, anxious, sad and frightened. However, if the distress does not fade and the individual feels stuck with a continuous sense of danger as well as harmful memories, then that person might in fact be suffering from Post-Traumatic Stress Disorder (PTSD). PSTD could develop after a traumatic incident which threatens one’s safety or makes one to feel helpless (Dalgleish, 2010). Coping with traumatic events could be very difficult, but confronting one’s feelings and seeking professional assistance is usually the only way to properly treat PSTD (Dalgleish, 2010). Many children and adolescents worldwide experience events that are traumatizing. If exposure to trauma is not treated, it could lead to various mental health problems (Kameoka et al., 2015). Researchers have reported a connection between traumatization and increases in mood and anxiety disorders, but the most frequently reported symptoms of psychological distress are post-traumatic stress symptoms (Cohen, Mannarino & Iyengar, 2011).
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is basically a conjoint parent and child psychotherapy approach for children and teenagers who are undergoing significant behavioral and emotional difficulties pertaining to traumatic life events (Jensen, Holt, Ormhaug, Egeland, Granly, Hoaas, Hukkelbergm & Indregard, 2014). In essence, it is a components-based treatment model incorporating trauma-sensitive interventions with family, cognitive behavioral, as well as humanistic techniques and principles. Parents and children learn new skills to help in processing feelings and thoughts relating to traumatic events in life; resolve and manage distressing behaviors, feelings, and thoughts that are related to traumatic events in life; and enhance growth, safety, family communication and parenting skills (Scheeringa et al., 2011).
TF-CBT treatment is generally designed to be a rather short-term treatment, characteristically lasting twelve to sixteen sessions. More than 80% of traumatized children who get Trauma-Focused Cognitive Behavioral Therapy experience considerable improvement following 12 to 16 weeks of treatment (Dalgleish et al., 2014). Depending on the needs of the individual child and family, treatment might be offered for longer episodes. It is worth mentioning that Trauma-Focused Cognitive Behavioral Therapy could be utilized as part of a larger treatment plan for kids who have complex difficulties. For young people who have PSTD, TF-CBT is usually recommended.
Research question
How effective is Trauma-Focused Cognitive Behavioral Therapy in the treatment of young people with Posttraumatic Stress Disorder?
This research paper will present research that supports the effectiveness of TF-CBT in the treatment of young persons who have post-traumatic stress disorder. The findings of various empirical research studies performed in the past few years on the subject matter are analyzed exhaustively and compared. The studies chosen focus on the use of TF-CBT in treating PTSD in young persons who are aged from 3 to 17 years in the United States, Africa, Europe and Asia. Dalgleish et al. (2014) reported that after life-threatening or horrific events, an estimated 10-15 percent of young kids usually develop PSTD. PSTD symptoms are distressing – anger outbursts, flashbacks, nightmares in addition to disturbed play. Such symptoms result in significant disruption to the functioning of a child and, if not treated, could continue for a number of years. Until now, there is no recognized empirically-validated treatment for post-traumatic stress disorder in young children.
There is compelling evidence base for TF-CBT in the treatment of PSTD. Even so, few controlled trials have been carried out on very young children and are limited mainly to victims of sexual abuse. In their study, Scheeringa et al. (2011) examined the effectiveness and feasibility of TF-CBT for treating PTSD in children aged 3-6 years who had been exposed to various kinds of traumas. In selecting the participants, three inclusion criteria were utilized: first, the subject has undergone a life-threatening traumatic event; secondly, the subject was aged between 36 months to 83 months at the time of the latest trauma; and thirdly, the subject had at least 4 symptoms of PSTD (Scheeringa et al., 2011).
The findings of their randomized design revealed that the intervention group (compared to the wait-list group) improved considerably more on PSTD symptoms, although not on oppositional defiant, separation anxiety, attention deficit/hyperactivity disorders, or depression. There were large effect sizes for PSTD, oppositional defiant, separation anxiety and depression although not attention-deficit/hyperactivity disorder (Scheeringa et al., 2011). At the 6-month follow-ups, the effect size for PSTD increased, whereas for the comorbid disorders it remained somewhat constant. Scheeringa et al. (2011) concluded that Trauma-Focused Cognitive Behavioral Therapy is actually feasible and more effectual compared to a wait list condition for symptoms of PSTD, and the effect is long-lasting. Participants in the wait list group did not show considerable mean reduction in PSTD symptoms, and this brings up an ethical concern that future usage of wait list control groups might be needless (Scheeringa et al., 2011).
In another study, O’Callaghan et al. (2013) performed a randomized controlled trial of TF-CBT for war-affected, sexually abused girls. The aim of their study was to evaluate the efficacy of this form of treatment provided by non-clinical facilitators in decreasing post-traumatic stress, anxiety and depression and behavior problems, and increasing prosocial behavior in a grouping that comprised sexually exploited, war-affected girls in a randomized, parallel-design, single-blind, controlled trial. A total of 52 girls aged from 12 years to 17 years who had been exposed to inappropriate sexual touch as well as rape in the African country of Democratic Republic of Congo were screened for prosocial behavior, conduct problems, anxiety and depression, and trauma. Next, O’Callaghan et al. (2013) randomly assigned these girls to a wait-list control group (n=28) or a 15 session, culturally-modified, group-based TF-CBT (n=24). Primary analysis involving all the study subjects took place at pre-intervention and post-intervention and at three-month follow-up only for the intervention group.
The findings revealed that in comparison to the wait list control group, the Trauma-Focused Cognitive Behavioral Therapy group experienced considerably greater drops in symptoms of trauma. Additionally, the Trauma-Focused Cognitive Behavioral Therapy group exhibited a very considerable improvement in symptoms of anxiety and depression, prosocial behavior, as well as conduct problems (O’Callaghan et al., 2013). The authors concluded that a culturally modified, group-based, TF-CBT intervention provided by non-clinically trained Congolese facilitators brought about a statistically significant, large decrease in PSTD symptoms and psychosocial difficulties amongst war-affected girls who had been exposed to sexual violence and rape (O’Callaghan et al., 2013).
According to Dalgleish et al. (2014), TF-CBT is a psychological intervention which is effectual in the treatment of PSTD in older kids aged from eight to twelve years, teens, and adults. In their study, they examined TF-CBT designed for kids aged from three to eight years (Dalgleish et al., 2014). The findings of their study demonstrated superiority of TF-CBT to treatment as usual. This implies that TF-CBT for young children could be utilized as the treatment of choice for young kids who have post-traumatic stress disorder. When used in treating young children, this treatment approach could bring benefits not just to them, but also to the health system in general (Dalgleish et al., 2014).
Jensen et al. (2014) noted that the effectiveness of TF-CBT has actually been established in many randomized control trials. Even so, none has been performed outside of America, few trials have utilized therapy as usual (TAU) as a comparison group and few have been carried out in community clinics. In their study, Jensen et al. (2014) evaluated the efficacy of TF-CBT in regular community settings in comparison to treatment as usual. A total of 156 traumatized young people were assigned randomly to TAU or TF-CBT. Jensen et al. (2014) tested whether TF-CBT was better than TAU, in eight community clinics for teens and kids who have symptoms of trauma in Norway. Given that young people who are referred to community clinics in most cases present with various symptoms, the authors assessed a number of different disorders, which included anxiety, depression, post-traumatic stress symptoms, and general mental health. They also carried out clinical evaluations of PSTD (Jensen et al., 2014).
Intention-to-treat analysis with the use of mixed effects models demonstrated that the youth who received TF-CBT reported considerably lower levels of general mental health symptoms and post-traumatic stress symptoms compared to the young people in the therapy as usual group (Jensen et al., 2014). Moreover, considerably fewer young persons in the TF-CBT condition were diagnosed with PTSD in comparison to young persons in the TAU condition. In general, post-treatment, the number of young persons diagnosed with post-traumatic stress disorder was very much lower in the TF-CBT group than in the TAU group. They concluded that TF-CBT is actually effectual in the treatment of traumatized young persons within community mental health clinics. They also concluded that the program might as well be executed successfully in nations outside America (Jensen et al., 2014).
Kameoka et al. (2015) reported that the efficacy of TF-CBT has been confirmed in quite a few randomized controlled studies, and added that these studies have mostly been ...