Judith A Cohen

Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

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Publications (74)207.34 Total impact

  • [Show abstract] [Hide abstract]
    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 11/2014; · 2.72 Impact Factor
  • Child and adolescent psychiatric clinics of North America 04/2014; 23(2):xiii-xvi. · 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. · 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. · 6.97 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. · 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; · 1.93 Impact Factor
  • Judith A Cohen
    Journal of the American Academy of Child and Adolescent Psychiatry 04/2013; 52(4):344-5. · 6.97 Impact Factor
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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; · 1.33 Impact Factor
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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.
  • 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. · 2.77 Impact Factor
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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. · 2.34 Impact Factor
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    ABSTRACT: We comment on a recently published article in the Journal of Traumatic Stress that reviewed school-based interventions related to trauma. We point out the recent book published by Guilford Press on the International Society for Traumatic Stress Studies Practice Guildelines (2009), which also provides a thorough review of this literature, and discuss reasons why this review may have been missed.
    Journal of Traumatic Stress 11/2011; 24(6):760-1; discussion 762. · 2.72 Impact Factor
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    ABSTRACT: ABSTRACT: Sexual violence against children is a major global health and human rights problem. In order to address this issue there needs to be a better understanding of the issue and the consequences. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia. The PTSD-RI was adapted through the addition of locally relevant items and validated using local responses to three cross-cultural criterion validity questions. Reliability of the symptoms scale was assessed using Cronbach alpha analyses. Discriminant validity was assessed comparing mean scale scores of cases and non-cases. Concurrent validity was assessed comparing mean scale scores to a traumatic experience index. Sensitivity and specificity analyses were run using receiver operating curves. Analysis of data from 352 youth attending a clinic specializing in sexual abuse showed that this adapted PTSD-RI demonstrated good reliability, with Cronbach alpha scores greater than .90 on all the evaluated scales. The symptom scales were able to statistically significantly discriminate between locally identified cases and non-cases, and higher symptom scale scores were associated with increased numbers of trauma exposures which is an indication of concurrent validity. Sensitivity and specificity analyses resulted in an adequate area under the curve, indicating that this tool was appropriate for case definition. This study has shown that validating mental health assessment tools in a low-resource country is feasible, and that by taking the time to adapt a measure to the local context, a useful and valid Zambian version of the PTSD-RI was developed to detect traumatic stress among youth. This valid tool can now be used to appropriately measure treatment effectiveness, and more effectively and efficiently triage youth to appropriate services.
    International Journal of Mental Health Systems 09/2011; 5(1):24. · 1.06 Impact Factor
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    ABSTRACT: In considering potential revisions for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), describing developmental influences on symptomatic expression is a high priority. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Research conducted in the past 15 years is reviewed that pertains to expressions of posttraumatic stress disorder (PTSD) symptoms in preschool and school age children and in adolescents. This research has attempted to determine the usefulness of the DSM-IV criteria for PTSD in children and adolescents. Based on the studies of preschool children, evidence supports two sets of suggestions: first, we suggest that developmental manifestations are warranted in A-D criteria of PTSD; and second, we suggest that a developmental preschool PTSD subtype is warranted that lowers the C threshold from three to one symptom. For school-age children and young adolescents, the evidence is more limited. Nevertheless, there is also evidence suggesting that modifications in PTSD criteria A-D, including fewer Cluster C symptoms, may facilitate accurate diagnosis in this age group.
    Depression and Anxiety 09/2011; 28(9):770-82. · 4.61 Impact Factor
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    ABSTRACT: Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: (1) enhancing safety early in treatment; (2) effectively engaging parents who experience personal ongoing trauma; and (3) during the trauma narrative and processing component focusing on (a) increasing parental awareness and acceptance of the extent of the youths' ongoing trauma experiences; (b) addressing youths' maladaptive cognitions about ongoing traumas; and (c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas.
    Child abuse & neglect 08/2011; 35(8):637-46. · 2.34 Impact Factor
  • Judith A. Cohen, Anthony P. Mannarino
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    ABSTRACT: Following traumatic deaths children may develop Childhood Traumatic Grief (CTG), a condition in which trauma symptoms interfere with adaptive child grieving. Educators have an important role in supporting children who have CTG. Key contributions that educators can make are to (a) recognize CTG symptoms in school settings; (b) refer children for mental health evaluations when appropriate; (c) recognize reminders that trigger trauma symptoms and identify ways to manage these triggers and responses in school settings; (d) support CTG treatments in school by reinforcing children’s use of stress-management strategies; (e) respect confidentiality; (f) recognize the importance of cultural issues in CTG; and (g) maintain good communication with parents and other helping professionals.
    School Psychology International 04/2011; 32(2):117-131.
  • Anthony P. Mannarino, Judith A. Cohen
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    ABSTRACT: Although different types of childhood trauma have many common characteristics and mental health outcomes, traumatic loss in children and adolescents has a number of distinctive features. Most importantly, youth who experience a traumatic loss may develop childhood traumatic grief (CTG), which is the encroachment of trauma symptoms on the grieving process and prevents the child from negotiating the typical steps associated with normal bereavement. This article discusses the distinctive features of CTG, how it is different from normal bereavement, how this condition is assessed, and promising treatments for children who experience a traumatic loss.
    Journal of Child & Adolescent Trauma 01/2011; 4(1):22-33.
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    ABSTRACT: To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms. Randomized controlled trial conducted using blinded evaluators. Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009. Of 140 consecutively referred 7- to 14-year-old children, 124 participated. Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy). Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems). Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events. Community TF-CBT effectively improves children's IPV-related PTSD and anxiety. clinicaltrials.gov Identifier: NCT00183326.
    JAMA Pediatrics 01/2011; 165(1):16-21. · 4.28 Impact Factor
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    ABSTRACT: Child sexual abuse (CSA) is associated with the development of a variety of mental health disorders, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an established treatment for children who have experienced CSA. However, there are questions about how many TF-CBT sessions should be delivered to achieve clinical efficacy and whether a trauma narrative (TN) component is essential. This study examined the differential effects of TF-CBT with or without the TN component in 8 versus 16 sessions. Two hundred and ten children (aged 4-11 years) referred for CSA and posttraumatic stress disorder symptoms were randomly assigned to one of the four treatment conditions: 8 sessions with no TN, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Mixed-model ANCOVAs demonstrated that significant posttreatment improvements had occurred with respect to 14 outcome measures across all conditions. Significant main and interactive effect differences were found across conditions with respect to specific outcomes. TF-CBT, regardless of the number of sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the children's personal safety skills. The eight session condition that included the TN component seemed to be the most effective and efficient means of ameliorating parents' abuse-specific distress as well as children's abuse-related fear and general anxiety. On the other hand, parents assigned to the 16 session, no narrative condition reported greater increases in effective parenting practices and fewer externalizing child behavioral problems at posttreatment.
    Depression and Anxiety 01/2011; 28(1):67-75. · 4.61 Impact Factor

Publication Stats

2k Citations
207.34 Total Impact Points


  • 2006–2014
    • Drexel University College of Medicine
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
    • Cardiff University
      • Department of Psychological Medicine and Neurology
      Cardiff, WLS, United Kingdom
  • 2000–2014
    • Allegheny General Hospital
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 2012
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2011
    • Rutgers New Jersey Medical School
      Newark, New Jersey, United States
  • 2007–2011
    • Tulane University
      • Department of Psychiatry
      New Orleans, Louisiana, United States
    • Stratford University
      Stratford, Connecticut, United States
  • 2008
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2002
    • University of Pittsburgh
      • School of Social Work
      Pittsburgh, Pennsylvania, United States
    • National Institute of Mental Health (NIMH)
      Maryland, United States