Judith A Cohen

Allegheny General Hospital, Pittsburgh, Pennsylvania, United States

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Publications (97)304.46 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS).MethodsA total of 53 children (ages 3–7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. Trial registration: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563.ResultsThere were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT.Conclusions Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.
    Journal of Child Psychology and Psychiatry 10/2015; DOI:10.1111/jcpp.12471 · 6.46 Impact Factor
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    ABSTRACT: Objective: This study explored the feasibility of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) relative to TF-CBT with children (aged 8–12).
    Research on Social Work Practice 09/2015; DOI:10.1177/1049731515601898 · 1.53 Impact Factor
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    Tonje Holt · Judith A Cohen · Anthony Mannarino ·
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    ABSTRACT: Although many children experience violence and abuse each year, there is a lack of instruments measuring parents' emotional reactions to these events. One instrument, the Parent Emotional Reaction Questionnaire (PERQ), allows researchers and clinicians to survey a broad spectrum of parents' feelings directly related to their children's traumatic experiences. The objectives of this study were: (1) to examine the factor structure and the internal consistency of the PERQ; (2) to evaluate the discriminant validity of the instrument; and (3) to measure whether potential subscales are sensitive to change. A Norwegian sample of 120 primary caregivers of a clinical sample of 120 traumatized children and youths (M age=14.7, SD=2.2; 79.8% girls) were asked to report their emotional reactions to their child's self-reported worst trauma. Exploratory factor analysis was used to explore the underlying factor structure of the data. The analysis of the PERQ showed a three-factor structure, conceptualized as PERQdistress, PERQshame, and PERQguilt. The internal consistencies of all three subscales were satisfactory. The correlations between the PERQ subscales and two other parental measurements revealed small to moderate effect sizes, supporting the discriminant validity of the PERQ subscales. The differences in sum scores of the PERQ subscales before and after a therapeutic intervention suggest that all of the subscales were sensitive to change. Study findings support the validity of conceptualizing the PERQ as three separate subscales that capture clinically meaningful features of parents' feelings after their children have experienced trauma. However, the subscales need to be further evaluated using a larger sample size and a confirmatory factor analytic approach.
    European Journal of Psychotraumatology 09/2015; 6:28733. DOI:10.3402/ejpt.v6.28733 · 2.40 Impact Factor
  • Judith A. Cohen · Anthony P. Mannarino ·
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    ABSTRACT: Trauma-focused cognitive behavioral therapy (TF-CBT) is a family-focused treatment in which parents or caregivers participate equally with their traumatized child or adolescent. TF-CBT is a components-based and phase-based treatment that emphasizes proportionality and incorporates gradual exposure into each component. Child and parent receive all TF-CBT components in parallel individual sessions that enhance skills to help the child recognize and regulate trauma responses, express thoughts and feelings about the child's trauma experiences and master avoidance of trauma memories and reminders. Parental participation significantly enhances the beneficial impact of TF-CBT for traumatized children. Copyright © 2015 Elsevier Inc. All rights reserved.
    Child and Adolescent Psychiatric Clinics of North America 04/2015; 24(3). DOI:10.1016/j.chc.2015.02.005 · 2.60 Impact Factor
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    ABSTRACT: Background In order to develop Stepped Care trauma-focused cognitive behavioral therapy (TF-CBT), a definition of early response/non-response is needed to guide decisions about the need for subsequent treatment. Objective The purpose of this article is to (1) establish criterion for defining an early indicator of response/non-response to the first step within Stepped Care TF-CBT, and (2) to explore the preliminary clinical utility of the early response/non-response criterion. Method Data from two studies were used: (1) treatment outcome data from a clinical trial in which 17 young children (ages 3–6 years) received therapist-directed CBT for children with posttraumatic stress symptoms (PTSS) were examined to empirically establish the number of PTSS to define early treatment response/non-response; and (2) three case examples with young children in Stepped Care TF-CBT were used to explore the utility of the treatment response criterion. Results For defining the responder status criterion, an algorithm of either three or fewer PTSS on a clinician-rated measure or being below the clinical cutoff score on a parent-rated measure of childhood PTSS, and being rated as improved, much improved or free of symptoms functioned well for determining whether or not to step up to more intensive treatment. Case examples demonstrated how the criterion were used to guide subsequent treatment, and that responder status criterion after Step One may or may not be aligned with parent preference. Conclusion Although further investigation is needed, the responder status criterion for young children used after Step One of Stepped Care TF-CBT appears promising.
    Child and Youth Care Forum 02/2015; 44(1). DOI:10.1007/s10566-014-9270-1 · 1.25 Impact Factor
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    ABSTRACT: This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic stress and their guardians who participated in this open trial. The TF-CBT for Child Traumatic Grief protocol was adapted for use with a group, resulting in 12 weekly sessions for children and guardians separately with conjoint activities and 3 individual visits with child and guardian. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary child outcomes assessed were symptoms of grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pretreatment, posttreatment, and 3 and 12 months after the end of treatment. Results showed improved scores on all outcomes posttreatment, sustained at 3 and 12 months. Effect sizes (Cohen's d) for baseline to posttreatment were 1.36 for child reported grief symptoms, 1.87 for child-reported PTS, and 1.15 for guardian report of child PTS.
    Journal of Traumatic Stress 12/2014; 27(6). DOI:10.1002/jts.21970 · 2.72 Impact Factor
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    ABSTRACT: This article describes the National Children's Disaster Mental Health Concept of Operations ("CONOPS") model as a method to address discrepancies between research advances that have been made and the typical methods of providing mental health services to children after disasters. Three key CONOPS strategies are described: (1) the PsySTART Disaster Mental Health Triage System, (2) a child-focused Incident Action Plan (IAP), and (3) a continuum of risk stepped-care model that matches the level of evidence-based treatment interventions with the level of identified risk using a stepped-care framework. Together, these strategies provide an integrated "disaster systems of care" method for the needs of children. With the goal to strengthen the resilience of children, the CONOPS provides clear operational strategies to facilitate mental health care addressing the full continuum of risk and resilience in the child population. Adapting this tool to health care systems is a vital step to improving mental health services and resilience outcomes for children after a disaster.
    Clinical Pediatric Emergency Medicine 11/2014; 15(4). DOI:10.1016/j.cpem.2014.09.002
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    ABSTRACT: The purpose of this study was to examine prevalence, correlates and predictors of mental health in children in New Orleans 15 months post-Hurricane Katrina. Analyses were conducted on 195 children who completed self-reports of hurricane and lifetime trauma exposure, social support, post-traumatic stress disorder (PTSD) symptoms, and depression. Teachers completed the Strengths and Difficulties Questionnaire. Children reported high incidence of PTSD symptoms: 36.9% moderate to severe and 23.6% mild. In multiple regression analyses, gender, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted PTSD. Age, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted child depressive symptoms. Teachers reported lower levels of problems and no significant predictors of teacher reports other than age and school. PTSD and depression were significant problems for children 15 months post-Hurricane Katrina. Lifetime trauma exposure was the strongest predictor of both PTSD and depression. Effective and accessible treatment is needed for such children.
    Journal of Child & Adolescent Trauma 09/2014; 6(3):143-156. DOI:10.1080/19361521.2013.812171
  • Stephen J Cozza · Judith A Cohen · Joseph G Dougherty ·

    Child and adolescent psychiatric clinics of North America 04/2014; 23(2):xiii-xvi. DOI:10.1016/j.chc.2014.01.005 · 2.88 Impact Factor
  • Laura K Murray · Amanda Nguyen · Judith A Cohen ·
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    ABSTRACT: This article begins by defining sexual abuse, and reviews the literature on the epidemiology of child sexual abuse (CSA). Clinical outcomes of CSA are described, including health and mental health. An outline is given of all the services often involved after an incident of CSA, and the need for coordination among them. Treatment strategies and evidence-based recommendations are reviewed. Challenges around dissemination and implementation, cultural considerations, and familial dynamics are described. Possible future directions are discussed.
    Child and adolescent psychiatric clinics of North America 04/2014; 23(2):321-337. DOI:10.1016/j.chc.2014.01.003 · 2.88 Impact Factor
  • Judith A Cohen · Jeanette Scheid · Ruth Gerson ·

    Journal of the American Academy of Child and Adolescent Psychiatry 01/2014; 53(1):9-13. DOI:10.1016/j.jaac.2013.10.004 · 7.26 Impact Factor
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    ABSTRACT: The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
    International Journal of Mental Health Systems 10/2013; 7(1):24. DOI:10.1186/1752-4458-7-24 · 1.06 Impact Factor
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    ABSTRACT: This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3-6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy.
    Child Psychiatry and Human Development 04/2013; 45(1). DOI:10.1007/s10578-013-0378-6 · 1.93 Impact Factor
  • Judith A Cohen ·

    Journal of the American Academy of Child and Adolescent Psychiatry 04/2013; 52(4):344-5. DOI:10.1016/j.jaac.2013.01.005 · 7.26 Impact Factor
  • Laura K. Murray · Judith A. Cohen · Anthony P. Mannarino ·
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    ABSTRACT: Many evidence-based treatments are now available for traumatized children and youth, and their families. Although these are typically based on past traumas, a large portion of these youth experience continuous traumas. Trauma-focused cognitive–behavioral therapy (TF-CBT) is an evidence-based treatment that has been used successfully with youth and families who experience ongoing traumas. Within these studies and projects, TF-CBT trainers have worked collaboratively with stakeholders, families, and service providers to develop TF-CBT strategies to best respond to populations with continuous trauma. This article highlights certain projects, presents common conceptualizations of continuous trauma, and describes four practical strategies commonly and successfully utilized with youth/families experiencing continuous trauma. Each strategy is exemplified with case studies. The addition of such strategies helped to assure safety and enhance the uptake of coping skills as traumas arise. Research suggests that even in cases of continuous traumas, youth can be treated with TF-CBT and significantly improve symptoms. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
    Peace and Conflict Journal of Peace Psychology 01/2013; 19(2):180. DOI:10.1037/a0032533
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    ABSTRACT: Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.
    Cognitive and Behavioral Practice 01/2013; 21(1). DOI:10.1016/j.cbpra.2013.07.004 · 1.33 Impact Factor
  • Judith A. Cohen · Lucy Berliner · John S. March ·
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    ABSTRACT: Both psychosocial and medication management have been recommended, alone and in combination, for children and adolescents suffering from posttraumatic stress disorder (PTSD). Empirical evidence favors cognitive-behavioral psychotherapy over other forms of psychotherapy; support for medication management is weak at best. Eye movement desensitization and reprocessing may or may not prove useful, and treatments such as art therapy, psychodynamic psychotherapy, or group therapy, are supported by anecdotal evidence but cannot on this basis be recommended as 1st-line treatments for pediatric PTSD. There currently is no empirical evidence regarding the optimal length of the treatment with psychotherapy or medication. Children and adolescents with PTSD would likely benefit from treatment focused on PTSD symptomatology. Recommendation ratings are presented for several different treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    ABSTRACT: This study presents the findings from 6- and 12-month follow-up assessments of 158 children ages 4-11 years who had experienced sexual abuse and who had been treated with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with or without the inclusion of the trauma narrative (TN) treatment module and in 8 or 16 treatment sessions. Follow-up results indicated that the overall significant improvements across 14 outcome measures that had been reported at posttreatment were sustained 6 and 12 months after treatment and on two of these measures (child self-reported anxiety and parental emotional distress) there were additional improvements at the 12-month follow-up. Higher levels of child internalizing and depressive symptoms at pretreatment were predictive of the small minority of children who continued to meet full criteria for posttraumatic stress disorder at the 12-month follow-up. These results are discussed in the context of the extant TF-CBT treatment literature.
    Child Maltreatment 07/2012; 17(3):231-41. DOI:10.1177/1077559512451787 · 2.77 Impact Factor
  • Monica M. Fitzgerald · Judith A. Cohen ·
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    ABSTRACT: Schools are ideal settings for identifying children and adolescents who have been exposed to traumatic events. They are also ideal for providing evidence-based mental health services, such as trauma-focused cognitive behavioral therapy, to students affected by childhood posttraumatic stress disorder and co-occurring mental health and behavioral problems. Educators and school psychologists are uniquely positioned to educate school staff and families about child trauma and play a crucial role identifying and treating traumatized children in schools. School psychologists can (a) implement trauma informed screening to gain an awareness of child trauma, (b) recognize reminders that trigger trauma symptoms and identify ways to manage these triggers and responses in school settings, (c) facilitate a supportive response for traumatized students and families, and (c) provide trauma-focused cognitive behavioral therapy to children and their nonoffending caregivers in the school setting.
    Journal of Applied School Psychology 07/2012; 28(3):294-315. DOI:10.1080/15377903.2012.696037
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    ABSTRACT: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include (a) dedicating proportionally more of the model to the TF-CBT coping skills phase; (b) implementing the TF-CBT Safety component early and often as needed throughout treatment; (c) titrating gradual exposure more slowly as needed by individual youth; (d) incorporating unifying trauma themes throughout treatment; and (e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma.
    Child abuse & neglect 06/2012; 36(6):528-41. DOI:10.1016/j.chiabu.2012.03.007 · 2.34 Impact Factor

Publication Stats

4k Citations
304.46 Total Impact Points


  • 1996-2015
    • Allegheny General Hospital
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 2006-2014
    • Drexel University College of Medicine
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
  • 2004-2014
    • Drexel University
      Filadelfia, Pennsylvania, United States
  • 2012
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2002
    • National Institute of Mental Health (NIMH)
      • Division of Intramural Research Programs
      Maryland, United States
  • 1986-1994
    • University of Pittsburgh
      • School of Social Work
      Pittsburgh, Pennsylvania, United States