A Review of Trauma-Informed Treatment for Adolescents

Abstract

Experiencing trauma as a child or youth often has a variety of serious repercussions that have the potential to follow an individual into adulthood. These may include experiencing difficulties in key areas of functioning such as academic achievement and social interactions, the development of posttraumatic stress disorder (PTSD), or coming into contact with the criminal justice system. Unfortunately, it is estimated that approximately 1 in 4 youth will experience some type of substantive trauma during his or her developmental years (Duke, Pettingell, McMorris, & Borowsky, 2010). The current article provides a summary of the main trauma-informed therapies that are currently available for treating adolescents with PTSD or trauma-related symptoms, as well as the therapeutic techniques that are common to all of these main treatments. Further, recommendations are provided concerning trauma-informed therapies that might be most beneficial to employ with adolescents. Implementing therapies that specifically consider a youth's potential exposure to trauma will facilitate a reduction of negative trauma-related symptoms as well as an improvement in life functioning.

Full text

A Review of Trauma-Informed Treatment for Adolescents
Pamela J. Black and Michael Woodworth
University of British Columbia
Moreen Tremblay
Youth Forensic Psychiatric Services, Kelowna, British Columbia
Tara Carpenter
University of British Columbia
Experiencing trauma as a child or youth often has a variety of serious repercussions that have the
potential to follow an individual into adulthood. These may include experiencing difficulties in key areas
of functioning such as academic achievement and social interactions, the development of posttraumatic
stress disorder (PTSD), or coming into contact with the criminal justice system. Unfortunately, it is
estimated that approximately 1 in 4 youth will experience some type of substantive trauma during his or
her developmental years (Duke, Pettingell, McMorris, & Borowsky, 2010). The current article provides
a summary of the main trauma-informed therapies that are currently available for treating adolescents
with PTSD or trauma-related symptoms, as well as the therapeutic techniques that are common to all of
these main treatments. Further, recommendations are provided concerning trauma-informed therapies
that might be most beneficial to employ with adolescents. Implementing therapies that specifically
consider a youth’s potential exposure to trauma will facilitate a reduction of negative trauma-related
symptoms as well as an improvement in life functioning.
Keywords: trauma, adolescents, trauma-informed treatment, PTSD, trauma-focused cognitive behav-
ioural therapy (TF-CBT)
Traumatic events are typically defined as incidents that are
perceived as terrifying, shocking, sudden, or that potentially pose
a threat to one’s life, safety, or personal integrity (Buffington,
Dierkhising, & Marsh, 2010; Cohen, Mannarino, & Deblinger,
2010). Examples of traumatic events include being the victim of
physical, sexual, or emotional abuse; being a victim of crime;
witnessing a crime or abuse in the household; and surviving a
natural disaster or a school shooting (Anthony, Lonigan, & Hecht,
1999). While these are some types of trauma, because the experi-
ence of trauma is subjective, it would be extremely difficult to
delineate the full spectrum of potentially traumatic events. What
one individual finds traumatic may not be traumatic to another, but
as long as the individual is genuinely traumatized by the experi-
ence, he or she may experience the negative effects associated with
trauma (Perry, 2001).
Studies in the area of trauma have revealed that many human
beings are quite resilient when faced with a traumatic event and do
not experience any further aversive effects as a result of the
already-aversive experience (Amaya-Jackson et al., 2003). How-
ever, the subset of individuals who do experience the effects of
trauma can be detrimentally impacted in a number of ways (Anda
et al., 2006; Feeny, Foa, Treadwell, & March, 2004). Factors such
as the length of time an individual experienced a particular trauma,
as well as its severity, lead to an increased likelihood that the
individual will suffer from long-lasting difficulties (Perry, 2001,
2009). As an example, Elklit (2002) determined that the traumatic
experiences of physical and sexual abuse, rape, childhood neglect,
and attempted suicide were the most likely to result in trauma-
related symptoms. While some individuals may experience mild
trauma-related effects, or only a small number of symptoms, others
may develop posttraumatic stress disorder (PTSD), a chronic and
potentially debilitating condition (Amaya-Jackson et al., 2003).
PTSD was originally studied among war veterans and victims of
rape, and for a period of time, it was unclear whether children and
adolescents were also able to experience symptoms of PTSD or if
it would necessarily be equivalent to the experience of adults
(Saigh, 1988). A number of studies conducted on trauma-related
effects among children and adolescents have now demonstrated
that children and adolescents do in fact suffer from PTSD that is
consistent with symptomology in adults (Amaya-Jackson &
DeRosa, 2007; Anthony et al., 1999; Feeny et al., 2004). For
example, Anthony et al. (1999) conducted a study with 5,664 child
and adolescent survivors of a natural disaster and found that PTSD
was expressed similarly across childhood, adolescence, and adult-
hood. It should be noted that while full-blown symptoms of PTSD
are relatively rare among adolescents, subclinical expressions of
PTSD are common among adolescents who have experienced
trauma (Copeland, Keeler, Angold, & Costello, 2007; Perry,
2001). Some have suggested that adolescents who have subclinical
This article was published Online First July 9, 2012.
Pamela J. Black, Michael Woodworth, and Tara Carpenter, Department
of Psychology, University of British Columbia, Kelowna, British Colum-
bia, Canada; Moreen Tremblay, Project Manager Training and Develop-
ment, Youth Forensic Psychiatric Services, Kelowna, British Columbia,
Canada.
This project was supported by IRCS Part D Funding from Justice
Canada.
Correspondence concerning this article should be addressed to Michael
Woodworth, Department of Psychology, University of British Columbia,
ASC II, ASC 205, 3333 University Way, Kelowna, BC, V1V 1V7. E-mail:
michael.woodworth@ubc.ca
Canadian Psychology / Psychologie canadienne © 2012 Canadian Psychological Association
2012, Vol. 53, No. 3, 192–203 0708-5591/12/$12.00 DOI: 10.1037/a0028441
192

expressions of PTSD are just as likely to experience some of the
deleterious effects of trauma as those who have a formal diagnosis
(Stathis et al., 2008). Further, some individuals may suffer from a
construct similar to PTSD, known as complex PTSD. Complex
PTSD shares many symptoms with PTSD but is a distinct con-
struct characterised by developmental difficulties such as struc-
tural dissociation, somatic dysregulation, and disorganized attach-
ment patterns (Roth, Newman, Pelcovitz, van der Kolk, & Mandel,
1997; van der Kolk, 2005). Complex PTSD is specifically associ-
ated with prolonged trauma at a young age by important individ-
uals in the child’s life, such as their caregivers (Ford & Courtois,
2009; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005).
While PTSD certainly has detrimental effects on adults, children
and adolescents are a particularly sensitive population, and expe-
riencing a trauma at a young age may also stunt or permanently
alter brain development, arguably affecting them for the rest of
their lives (Anda et al., 2006; De Bellis, 2001). For example, Perry
(2001) suggests that the area of the brain that is affected by trauma
is dependent on the time (both chronological and development-
related) that the traumatic experience occurs. He further speculates
that the brain may overcompensate for trauma in a particular area
of the brain (such as the limbic system) and then develop in a way
that is conducive to surviving in a traumatic environment, poten-
tially altering neuronal connections and brain patterns for an
extended period of the youth’s life (see also Cohen, Perel, De
Bellis, Friedman, & Putnam, 2002). Recent mounting evidence
suggests that PTSD causes physiological changes in the brain,
affecting areas like the amygdala, which plays a role in emotional
memories (Francati, Vermetten, & Bremner, 2007), and regulating
neurotransmitters, such as serotonin, which is thought to play a
role in externalized symptoms such as aggression (Cohen et al.,
2002; De Bellis, Hooper, Woolley, & Shenk, 2010). For example,
a study conducted by De Bellis (2001) with adolescents who had
been neglected as children revealed that these individuals had
increased levels of cortisol, a hormone that plays an integral role
in the body’s stress system, as well as dysregulation of serotonin
levels (see also Cohen et al., 2002). Similar research has revealed
that children who have experienced trauma early in life are found
to have a dysregulation of cortisol, a neurotransmitter that this is
associated with less prosocial behaviour and more aggressive
behaviour (Alink, Cicchetti, Kim, & Rogosch, 2012; Dozier,
Peloso, Lewis, Laurenceau, & Levine, 2008).
Indeed, traumatic experiences can affect both psychological and
physical development, which, in turn, may impact an individual’s
social interactions and academic achievement (Boney-McCoy &
Finkelhor, 1995; Margolin & Gordis, 2000; Pfefferbaum, 1997).
For example, a study by Beers and De Bellis (2002) with children
who were maltreated during their formative years and met diag-
nostic criteria for PTSD found that the children performed more
poorly on attention tasks and had lower levels of executive func-
tioning, were more impulsive, and had poorer long-term memory
for verbal information when compared with children who had not
been mistreated. Greenfield and Marks (2010) examined a sample
of 2,939 noninstitutionalized English-speaking U.S. adults be-
tween the ages of 25 and 74 years. Their results indicated that
individuals who had suffered psychological violence from either
parent had more negative affect and less psychological well-being
in adulthood (see also Arata, Langhinrichsen-Rohling, Bowers, &
O’Farrill-Swails, 2005). Anda et al. (2006) also conducted a study
examining adverse childhood experiences (ACE) with an adult
sample (17,337 participants). Results indicated that adults who had
experienced a traumatic event in childhood were much more likely
to experience affective disturbances (such as panic reactions and
anxiety), somatic disturbances (such as sleep disturbances and
obesity), as well as substance abuse, sexual disturbances, high
stress, difficulty controlling anger, and intimate partner violence in
adulthood (see also Borum, 2003). Trauma-related symptoms may
also contribute to overall health problems and habit disorders, such
as alcohol or drug addiction (Mulvihill, 2005).
Experiencing a traumatic event and trauma-related effects dur-
ing childhood has also been associated with delinquent and anti-
social behaviour in adolescence and adulthood (Anda et al., 2006;
Duke, Pettingell, McMorris, & Borowsky, 2010; Felitti et al.,
1998; Grella, Stein, & Greenwell, 2005; Margolin & Gordis, 2000;
Mueser, Rosenberg, & Rosenberg, 2009; Yexley, Borowsky, &
Ireland, 2002). For example, a study conducted by Duke et al.
(2010) found that high-school youth in their large sample who had
suffered multiple traumas had a substantially increased risk of
violence perpetration. There is also evidence to support the link
between experiencing abuse and maltreatment as a child or youth
and an increased risk of engaging in self-harm (e.g., Kaplan et al.,
1999).
Unfortunately, exposure to trauma among young people is quite
common (Cauffman, Feldman, Waterman, & Steiner, 1998).
Costello, Erkanli, Fairbank, and Angold (2002) conducted a lon-
gitudinal study of mental health with 1,420 children and adoles-
cents aged 9, 11, and 13 years. One out of every four adolescent
participants had experienced at least one high magnitude (or ex-
treme) stressor, such as being the victim of abuse or being the
cause of harm done to someone else, at some point in their lives.
A more detailed examination revealed that 72% of these partici-
pants had experienced one extreme stressor, 18% had experienced
two extreme stressors, and the remaining 10% had experienced
three or more extreme stressors. Interestingly, this study revealed
that exposure to one traumatic stressor increased a participant’s
likelihood of being exposed to another stressor. There have been
no epidemiological studies of the prevalence of traumatic experi-
ences and adolescents diagnosed with PTSD in Canada. However,
American studies have confirmed that approximately 25% of
youth experience some type of extreme adverse event (see also
Duke et al., 2010). Both the type and effects of trauma suffered by
adolescents may also vary depending on a variety of factors. For
example, a study conducted by Elklit (2002) with a sample of 390
Danish 13- to 15-year-olds, revealed that adolescents were more
likely to experience indirect trauma (23%), such as learning of
the death of a loved one, than direct trauma (17%), such as being
the victim of violence. Females (12.3%) were more likely to be
diagnosed with PTSD than males (5.6%), and with subclinical
PTSD (17.4% vs. 11.2%).
In summary, it is imperative that juveniles who have suffered a
trauma and exhibit trauma-related symptoms be treated as quickly
and efficiently as possible to reduce the likelihood of any perma-
nent harm (Perry, 2001, 2009). Notably, the full extent of symp-
toms of trauma may occur immediately after the traumatic event or
may lay dormant for years, emerging later on in adolescence or
even in adult life (Greenfield & Marks, 2010; Margolin & Gordis,
2000). The purpose of the current article is to provide a compre-
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hensive discussion of the trauma-informed treatments currently
available for treating adolescents with symptoms of trauma.
Method
An extensive review of the literature was conducted to gather all
of the relevant information for this review. The authors primarily
used the online databases PsycInfo, PubMed, Academic Search
Complete, and Cochrane Reviews, as well as search engines such
as Google Scholar and Google. The keywords used to search for
articles pertinent to this review of trauma-informed therapy in-
clude all possible combinations of the following words: juvenile,
child, youth, adolescent, trauma, traumatic stress, trauma-
informed treatment, treatment, therapy, and intervention. The fol-
lowing inclusion criteria were then used to narrow the focus of
study: fully developed therapy programs created specifically for
treating trauma-related symptoms, that is, not treatments that sim-
ply expanded on general treatment practices and do not address
symptoms of trauma as a by-product of another treatment issue;
treatments that had the treatment model and instructional guide
available; treatments that are specifically designed for use with
adolescents (individuals between the age of 12 and 18 years)
suffering from PTSD or symptoms of trauma; treatments that had
at least one study that had examined the effectiveness of the
treatment with adolescents who had experienced at least one
traumatic stressor and was experiencing trauma-related symptoms
at the time that the treatment was provided; treatments that had at
least one study had examined the effectiveness of treatments for
both males and females; and lastly, the articles had to be written in
English.
These stringent criteria significantly reduced the number of
articles to be reviewed by the authors. The abstracts that remained
after the initial cut, based on the criteria outlined here, were
reviewed by the first and second authors of this article to determine
whether the articles should be read in full. If either of the authors
believed the abstract to be potentially relevant, the article was read
in full. The authors conducted several rounds of review before
deciding on the most pertinent trauma-focused treatments and
articles. This extensive search resulted in the inclusion of five main
trauma-informed therapies.
Treatments for the Effects of Trauma
There is a vast amount of research conducted on the treatment of
trauma-related symptoms for adolescents (Amaya-Jackson et al.,
2003; Amstadter, McCart, & Ruggiero, 2007; Farrell, Hains, &
Davies, 1998; Feather & Ronan, 2009). However, research into the
treatment of PTSD among adolescents is relatively new compared
with the research conducted on the symptoms of PTSD and effec-
tive treatments for this disorder among adults. Variations of cog-
nitive behavioural therapies (CBT) are the most commonly used
treatment methods for PTSD because they have greater empirical
support than treatments based on psychodynamic theory and med-
ication (Feeny et al., 2004; Follette & Ruzek, 2006; March,
Amaya-Jackson, Murray, & Schulte, 1998; Rosenberg, Jankowski,
Fortuna, Rosenberg, & Mueser, 2011). The primary goal of the
therapist who implements CBT is to change thoughts and behav-
iours in an attempt to lessen or eliminate negative psychological
symptoms (Follette & Ruzek, 2006; Taylor, 2006). In relation to
treating trauma-related symptoms, there are a number of CBT-like
treatments that involve most aspects of the therapy but do not
actually present themselves specifically as CBT, such as multi-
modal trauma treatment (MMTT), as well as different variations of
CBT, such as trauma-focused cognitive behavioural therapy
(TF-CBT). CBT has been administered to both adults and adoles-
cents (Amstadter et al., 2007; Farrell et al., 1998), whereas MMTT
and TF-CBT are trauma-informed treatments developed specifi-
cally for use with children and adolescents (Cohen et al., 2010; see
Table 1).
Multimodal Trauma Treatment
A treatment that falls under CBT is MMTT, a therapy that
claims to adapt CBT strategies that are effective with adults and
adjust them for adolescents that experience anxiety and have
disruptive behavioural disorders (Amaya-Jackson et al., 2003).
This therapy is grounded in the theory that experiencing trauma at
a young age disrupts development, and it attempts to use age-
appropriate CBT techniques to help the children/adolescents over-
come trauma. MMTT is a 14-session group therapy that is most often
conducted in a school setting (March, Amaya-Jackson, Murray, &
Schulte, 1998). This treatment, based on CBT techniques, includes
the use of psychoeducation, narrative (writing in a journal about
the trauma), exposure to memories of the trauma, relaxation tech-
niques, and cognitive restructuring (Amaya-Jackson et al., 2003;
March et al., 1998). A study conducted by Amaya-Jackson et al.
(2003) revealed that 57% of adolescents who underwent this
treatment, after experiencing a traumatic event in the form of a
community disaster, experienced reduced symptoms of PTSD im-
mediately after treatment and 86% no longer had symptoms of
PTSD at 6-month follow up. This treatment demonstrated similar
results for depression, anxiety, and anger—all trauma-related
symptoms. MMTT has been successfully implemented with ado-
lescents who have experienced many different types of trauma,
including sexual abuse. A recent meta-analysis (19 studies; N ⫽
4,655) of the effectiveness of school-based trauma-informed treat-
ments conducted by Rolfsnes and Idsoe (2011) did not include
MMTT specifically but revealed that school-based CBT treatments
similar to MMTT were the most successful in reducing symptoms
of trauma when compared with other types of treatments, including
play/art therapy, eye movement desensitization and reprocessing
(EMDR), and mind– body skills (d ⫽ .68). Specifically, school-
based CBT programs reduced symptoms of trauma with an effect
size in the medium to large range. The advantages of MMTT are
that it is a therapy developed specifically for adolescents who are
experiencing trauma-related symptoms and that it is effective with
a wide range of traumas (Amaya-Jackson et al., 2003). Further, it
is a group therapy that can treat many individuals concurrently,
and it is flexible, so that specific focuses can be included for
adolescents who have experienced specific traumas. The disadvan-
tage of MMTT is that it has mainly been tested with adolescents
who have experienced only one incident of trauma.
Trauma-Focused Cognitive Behavioural Therapy
TF-CBT, created by Cohen and colleagues in 2006 (Cohen,
Mannarino, Murray, & Igelman, 2006), addresses symptoms of
PTSD among children and adolescents, as well as other trauma-
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Table 1
A Summary of Trauma-Informed Treatment Models Currently Available
Treatment name
Description/Goals
of treatment
Individual vs.
Group treatment
Availability of
treatment Techniques used Results
Multimodal trauma
therapy (MMTT;
Amaya-Jackson et al.,
2003)
–Often conducted within school
systems
–Has only been extensively
studied with adolescents who
experienced a single
traumatic event
–Effective with males and
females
–Conducted in a group
setting
–Manuals are available at
no charge by contacting
the owner of the
copyright
–14 sessions in length
–Uses CBT strategies, like
narrative and relaxation
techniques
–Significantly reduced the symptoms of
PTSD immediately after treatment and at
6-month follow-up assessment (N ⫽ 7)
–Reduced anger, anxiety and depression
(Amaya-Jackson et al., 2003)
–No effect size available for MMTT
specifically
Trauma-focused cognitive
behavioral therapy
(TF-CBT; Cohen et al.,
2010)
–Aims to reduce symptoms of
PTSD as well as other
trauma-related symptoms
(i.e., anger or depression)
–Effective with males and
females
–Conducted on an
individual basis
with adolescents
and with parents
–Occasionally
conducts sessions
with the parent and
child together
–Manual is available online
and in a hard-copy
format
–Conducted over 8 to 20
sessions
–Based on CBT strategies
–Teaches clients the skills
to master trauma-related
cues that incite stress
–A review revealed that TF-CBT reduces
trauma-related symptoms most effectively
(Little & Akin-Little, 2009)
–Meta-analysis (N ⫽ 881) revealed TF-CBT
reduces PTSD symptoms with effect size
of .40 (Cary & McMillen, 2012)
Stanford cue-centered
therapy (SCCT;
Carrion & Hull, 2010)
–Focuses on the cognitive,
behavioral, affective, and
physical effects of trauma
–Effective with males and
females
–Conducted on an
individual basis
–Manual is available in a
short form online
–Extended manual is
available through the
Stanford School of
Medicine
–CBT strategies and an
emphasis on expression
of emotions
–Emphasis on skill
building and
empowerment of the
youth
–Case studies (N ⫽ 2) using this method
reveal that this treatment effectively
teaches adolescents the skills they require
to decrease the stress resulting from
trauma-related symptoms (Carrion &
Hull, 2010) -No effect size available
Seeking Safety (Najavits
et al., 2006)
–Addresses trauma-related
symptoms as well as
substance abuse disorder
–Effective with adolescents and
adults
–Effective with males and
females
–Conducted in a group
or individual setting
–Relevant training and
implementation
information is available
on the internet
–25 topics must be
covered over the course
of treatment
–The order of the topics
does not matter
–The length of treatment
is determined by the
therapist
–Effectively reduced symptoms of PTSD (d
⫽ 1.26), anxiety (d ⫽ .61), and
depression (d ⫽ .65) in adolescent girls
(N ⫽ 59) (Ford et al., 2012)
TARGET (Ford et al.,
2005)
–Enhances self-regulation and
decrease trauma-related
symptoms
–Studies have been conducted
specifically with juvenile
offenders
–This trauma-informed model
is currently being used with
juvenile offenders in
Connecticut and Florida
–Effective with males and
females
–Conducted in a group
or individual setting
–Available through ATS
–May be costly
–Training is required
–Ongoing collaboration
with ATS is required
–FREEDOM model
–Explaining how trauma
can change the brain
and stress response
–How to regulate stress
response and
externalized behaviors
Note. CBT ⫽ cognitive behavioural therapy; PTSD ⫽ posttraumatic stress disorder.
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TREATING TRAUMATIZED ADOLESCENTS

related outcomes (Cohen et al., 2010). TF-CBT was developed for
children between the ages of 3 and 18 years, with specific consid-
eration for the child’s developmental level. TF-CBT is comprised
of 8 to 20 individual sessions conducted with the child or their
parent/caregiver, as well as joint sessions with both the child and
the parent/caregiver (Cohen et al., 2010). It is important to note,
though, that adolescents can also effectively receive TF-CBT
without the involvement of a parent/caregiver. TF-CBT has been
adapted for Native American children and is available in a number
of languages, including German and Chinese (Cohen et al., 2010).
Consistent with the primary theories informing CBT, TF-CBT
posits that adolescents who experience a traumatic event are likely
to experience disturbances in affect as well as in behavioural and
cognitive aspects of functioning (Little & Akin-Little, 2009). The
goal of TF-CBT is to help adolescents learn the skills that they will
need to master the stress that is brought on by traumatic memories.
Further, the goal of this therapy is to help these youth in mastering
their reaction to things that may remind them of the trauma and
ultimately move them beyond victimization. TF-CBT is a
component-based model and can be summarised using the acro-
nym “PRACTICE.” During treatment, the traumatized child is
provided with psychoeducation, taught relaxation skills, affective
expression and modulation, and cognitive coping skills. In addi-
tion, they are encouraged to use trauma narration and cognitively
process the trauma, use in vivo exposure to master trauma remind-
ers, have conjoint parent– child sessions, and enhance safety and
the trajectory of development (Cohen et al., 2010).
This method of treatment was originally developed for use with
victims of sexual abuse but has been shown to effectively reduce
the symptoms of trauma caused by a wide variety of traumatic
experiences, including being traumatized on multiple occasions
(Feather & Ronan, 2009; Little, Akin-Little, & Gutierrez, 2009). In
fact, TF-CBT is labelled as an empirically validated treatment for
trauma-related symptoms, and, in 2007, was the only trauma-
informed treatment fully supported by the California Evidence-
Based Clearinghouse for Child Welfare. Further, a comprehensive
Cochrane review of TF-CBT, conducted in 2010, revealed that
TF-CBT is effective at reducing trauma-related symptoms and
recommended the use of this specific trauma-informed treatment
(Roberts, Kitchiner, Kenardy, & Bisson, 2010).
The use of TF-CBT has been studied extensively with a variety
of other populations. A small single-case design study conducted
by Feather and Ronan (2009), with a sample of adolescents from
New Zealand, revealed that TF-CBT was effective at reducing
trauma-related symptoms and increasing the adolescents’ ability to
cope with trauma-related stressors. A study conducted by Weiner,
Schneider, and Lyons (2009) revealed that both Caucasian and
African American adolescents experienced a significant reduction
in trauma-related symptoms and emotional and behavioural needs
following TF-CBT. A recent meta-analysis of the effectiveness of
TF-CBT examined 10 studies (N ⫽ 881) that used at least four to
five of the “PRACTICE” components characteristic of TF-CBT
revealed very positive results (Cary & McMillen, 2012). When
compared with other treatments of trauma-related symptoms, TF-
CBT significantly reduced PTSD, depression, and behavioural
problems immediately after treatment (effect sizes are d ⫽ .40,
d ⫽ .37, and d ⫽ .20, respectively). The significant reduction in
PTSD symptoms was also present at the 12-month follow-up,
although the effect size was slightly smaller (Cary & McMillen,
2012). The conclusion drawn from this meta-analysis is that TF-
CBT does significantly reduce trauma-related symptoms among
children and adolescents. In summary, TF-CBT is effective across
different cultures and races and takes into account the adolescent’s
unique developmental needs. TF-CBT is a flexible and individu-
alized treatment method that has been shown to effectively reduce
symptoms of trauma (see also Little & Akin-Little, 2009).
Stanford Cue-Centered Therapy (SCCT)
A relatively new trauma-informed treatment is the SCCT, a
short integrative therapy for adolescents that combines a number
of methods of treatment from other empirically supported thera-
pies (Carrion & Hull, 2010). This type of treatment is one of the
only therapies to solely focus on the treatment of trauma within an
individual context. SCCT is designed to address the four main
areas of functioning thought to be affected by trauma: cognitive,
emotional, behavioural, and physical. It is conducted using a
combination of cognitive– behavioural techniques, such as cogni-
tive restructuring, as well as psychoeducation, relaxation, methods
of expression, narrative use, and parental coaching (Stanford
School of Medicine, 2010). The goal of SCCT is to decrease an
individual’s negative cognitions and sensitivity to traumatic mem-
ory while increasing the use of positive emotional expressions and
adaptive coping methods. SCCT treatment is typically 15 to 18
sessions long and is a unique form of treatment focusing on
building skills, such as effective methods of relaxation and em-
powerment. This is primarily achieved through helping the child to
understand how and why the trauma affects them, as well as being
able to control their responses to trauma stimuli (Carrion & Hull,
2010). Although there has been little empirical research completed
on the effectiveness of SCCT, limited preliminary findings using
case studies are promising (Carrion & Hull, 2010). The advantages
of SCCT are that it is effective across races and cultures, and
appears to be effective with both genders. This treatment is also
reported to be effective with high-risk youth. The disadvantages of
SCCT are that it requires a significant amount of caretaker
involvement and that it has not been rigorously tested with large
samples (in fact, thus far, findings have been isolated to case
studies of the treatment methods effectiveness). Further, it only
reduced a subset of the symptoms of PTSD, and treatment time
may have to be extended for severely traumatized individuals
(Cohen et al., 2006).
Seeking Safety
Seeking Safety is a present-focused therapy that addresses both
trauma-related symptoms as well as substance abuse disorder in
adults and adolescents (Brown et al., 2007; Najavits, Gallop, &
Weiss, 2006). The Seeking Safety treatment is based on five basic
principles: personal safety as a priority, the integrated treatment of
both disorders, a focus on the client’s needs, attention to the
therapeutic process, and, lastly, a focus on four specific content
areas— cognitions, behaviours, interpersonal interactions, and case
management (Najavits et al., 2006). Similar to the other trauma-
focused treatments, Seeking Safety involves the use of psychoe-
ducation, coping skills such as relaxation techniques and trigger
identification, trauma narrative use, and cognitive restructuring.
Seeking Safety has been specifically adapted for adolescents.
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Some examples of this adaptation include the therapist taking
into account the reading level of the adolescent, as well as using
displacement to discuss traumatic events. Displacement is a
technique used to distance the client from the trauma narrative;
it is usually done by allowing the client to recount the trauma
narrative as if the experience happened to a friend (Najavits et
al., 2006). A study conducted by Brown et al. (2007) examined
Seeking Safety as a treatment method for adults and revealed
reduced symptoms of PTSD as well as reduced symptoms of
substance use disorder. The participants in this study responded
well to the treatment and reportedly provided positive feedback,
remarking that they appreciated how the treatment plan was
reflective of their specific needs. Further, a study conducted by
Najavits and colleagues (2006) using a small sample size (N ⫽
33) found Seeking Safety to significantly reduce some trauma-
related symptoms, such as sexual concerns (d ⫽ .5) and sexual
distress (d ⫽ .71), as well as symptoms associated with sub-
stance abuse disorder, with effect sizes ranging from d ⫽ .37 to
d ⫽ 1.17. The advantages of the Seeking Safety therapy method
are that it has been adapted specifically for adolescents, it
requires the involvement of parents in only one session, it is
flexible, and it is culturally sensitive. Relevant training and
implementation information is available online (http://
www.seekingsafety.org) and this therapeutic method has been
shown empirically to be effective with adolescents (Najavits et
al., 2006). A further advantage of Seeking Safety is that it
combines the treatment for two disorders, PTSD and substance
use disorder.
Trauma Affect Regulation: A Guide for Education
and Therapy (TARGET)
TARGET is a trauma-informed treatment that has been used and
tested specifically on juvenile offender samples (Advanced
Trauma Solutions, 2001–2010). TARGET can be effectively em-
ployed in either a group therapy setting or in individual sessions
and is largely based on cognitive– behavioural strategies (Ford,
Steinberg, Hawke, Levine, & Zhang, 2012). The goal of TARGET
is to enhance self-regulation capacities and functioning in adoles-
cents who may have been negatively affected by psychological
trauma experienced in childhood. TARGET also trains survivors
of trauma to better understand how trauma changes the brain’s
normal stress response into an alarm response, which can develop
into PTSD (Advanced Trauma Solutions, 2001–2010). Adoles-
cents undergoing TARGET are taught a sequence of practical
self-regulation skills through creative exercises that are designed
to boost self-esteem and belief in ability. They also are taught how
to properly manage and control anger, impulsivity, and feelings of
grief, guilt, and shame. TARGET implements a FREEDOM treat-
ment model, an acronym for focus, recognize triggers, emotion
self-check, evaluate thoughts, define goals, options, and make a
contribution (Advanced Trauma Solutions, 2001–2010; Ford,
Courtois, van de Hart, Nijenhuis, & Steele, 2005). There are only
two treatment methods that differentiate TARGET from TF-CBT,
the first being that those receiving TARGET are not required to
create a trauma narrative, and second, the parents of adolescents
receiving TARGET are not involved in the treatment (Ford et al.,
2012).
The use of TARGET treatment in juvenile detention centers has
been thoroughly evaluated in both male and female samples.
Studies have previously demonstrated that young offenders who
are provided with TARGET are less likely to be aggressive toward
prison staff and other inmates (Ford et al., 2005). Further, a similar
study of a fairly large sample of juvenile delinquents revealed that
each TARGET session within the first 7 days of confinement
resulted in 54% fewer disciplinary incidents, 72 fewer minutes in
disciplinary seclusion, and increased prosocial behaviour over a
14-day stay at the institution (Ford & Hawke, in review). A second
study conducted with female juvenile delinquents revealed that
TARGET significantly reduced the severity of PTSD and trauma-
related symptoms such as anxiety, disturbed cognitions, and affect
regulation, with an effect size in the low to medium range (Ford et
al., 2012). Another advantage of TARGET is that it can be used in
conjunction with TF-CBT, and previous research has shown that
when these two treatment methods are combined, they reduce
aggression among adolescents in contact with the juvenile justice
system (Ford et al., 2005). Potential disadvantages of TARGET are
that it may not be effective across different races and cultures.
Further, there is a lack of overall empirical research examining its
effectiveness with adolescents not involved with the juvenile jus-
tice system (see Table 1 for a summary of the five main trauma-
informed treatments).
Finally, it should be noted that there are a variety of other
alternative treatments for trauma, such as imaginal and in vivo
exposure therapy (Saigh, 1987) and art therapy (e.g., Krantz &
Pennebaker, 2007). Further, EMDR has also been used to treat
PTSD (e.g., Greenwald, 2007; Shapiro, 1995). A meta-analysis of
the effectiveness of EMDR in children demonstrated that this
therapeutic method does significantly reduce trauma-related symp-
toms among children (Rodenburg, Benjamin, de Roos, Meijer, &
Stams, 2009). However, when compared with children who were
simultaneously receiving CBT for trauma-related symptoms, the
effectiveness of the EMDR treatment was subsumed by the effect
of CBT. That is, it did not effectively reduce symptoms of trauma
over and above the effect of CBT. Further, the exact mechanism
behind EMDR therapy that instigates change in functioning is still
relatively unknown, making this type of therapy potentially more
problematic among youth. While these therapies have been used to
treat trauma-related symptoms with positive results, these types of
therapy were not described in more detail because they are not
independent trauma treatments and are often used in conjunction
with other trauma-focused therapies such as TF-CBT.
Interestingly, treatments for PTSD and other trauma-related
symptoms do not appear to aid in the reduction of symptoms for
one gender more than the other (Carrion & Hull, 2010; Cohen et
al., 2010; Ford et al., 2005). Further, there has been little research
conducted on the effectiveness of these therapies among different
races and cultures. While differences between genders and cultures
may exist for effectiveness of treatment, there is currently not
enough research to determine where these differences may lie.
Summary of Techniques Used Within Trauma-
Informed Treatments
A qualitative review of the trauma-focused therapies described
revealed five common therapeutic techniques. The five therapeutic
techniques that are included in most or all of the established
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TREATING TRAUMATIZED ADOLESCENTS

trauma-informed treatment programs are psychoeducation, coping
skills, creating a trauma narrative, cognitive restructuring, and
creating a posttreatment plan (see Table 2 for a summary of these
techniques). The proceeding section will consider each of these
five most salient components of effective treatment.
One of the most standard practices among the trauma-informed
treatment programs is providing the client with psychoeducation.
Psychoeducation is used in most CBT-based treatments and has
been shown to effectively reduce symptoms among patients with
varying disorders, including, for example, schizophrenia
(Rummel-Kluge & Kissling, 2008). This practice, used in all of the
trauma-informed treatment programs, is often the first step of
treatment (Cohen et al., 2010). The purpose of psychoeducation is
to help the adolescent understand what a traumatic event is, how
experiencing trauma affects an individual, and how trauma-related
symptoms are perpetuated long after the trauma has occurred
(Carrion & Hull, 2010). Psychoeducation may range from explain-
ing the way that trauma affects specific areas of the brain (using
age-appropriate terms, as in the TARGET treatment) to how
trauma-related symptoms are perpetuated by classical conditioning
(SCCT and Seeking Safety; Carrion & Hull, 2010; Ford et al.,
2012; Najavits et al., 2006).
After the psychoeducation component of therapy, many trauma-
specific treatment programs employ a module of treatment that
facilitates both learning about and improving coping skills. Coping
skills consist of a variety of techniques, including relaxation skills,
identifying triggers, and methods of expression (Amaya-Jackson et
al., 2003; Carrion & Hull, 2010; Cohen et al., 2010; Ford, 2010).
While there is some variation amongst programs regarding which
types of coping skills they will primarily focus on, all of the
current trauma-informed treatment programs consistently teach
participants a variety of relaxation skills (Cohen et al., 2010; Ford,
2010). There is a wide array of methods that can be taught to aid
in relaxation, such as controlling breathing, using meditation, and
using progressive muscle relaxation (Amaya-Jackson et al., 2003;
Ford, 2010; Lee, Gavriel, Drummond, Richards, & Greenwald,
2002; Taylor, 2006). These techniques allow the adolescent to
become more cognizant of their own bodies and have greater
control over their stress response systems. Relaxation techniques
are used in a number of CBT-based treatments, including treatment
for physical problems such as chronic back pain (Lebovits, 2007).
In addition to teaching individual skills to aid in relaxation, CBT-
based therapies may also use anxiety management training (AMT),
an intervention that is used to teach adolescents to manage anxiety
using specific techniques such as stress inoculation training, cog-
nitive restructuring, and relaxation exercises (Farrell et al., 1998).
Stress inoculation training is a technique commonly used in CBT
that helps a traumatized individual to deal with past traumas as
well as to prepare him/her for dealing with future stressors (Lee et
al., 2002; Meichenbaum, 2009). Methods of relaxation are often
taught to the adolescent early on in therapy, for two reasons. First,
the adolescent can start to use the relaxation techniques outside of
therapy immediately to relieve anxiety, and second, he or she
should learn methods of relaxation before confronting painful and
anxiety-inducing memories of trauma during treatment.
In relation to relaxation skills, adolescents in most of the
trauma-informed treatment programs are taught to identify their
stressors. After experiencing a trauma, there may be certain peo-
ple, places, noises, and/or smells that can trigger flashbacks to the
trauma, an anxiety attack, or just cause general anxiety (Ford,
2010). For successful treatment, it is imperative that clients learn
to identify their triggers and to apply their newfound relaxation
techniques when these triggers cause them stress (Cohen et al.,
2010; Lee et al., 2002; Ford, 2010). This leads to the third most
common coping skill—affect regulation and methods of expres-
sion. Proper affect regulation is integral to emotional well-being,
and emotion regulation and expression is addressed in a number of
different treatment strategies (Ginot, 2012). This can be accom-
plished by using the relaxation skills typically taught earlier in
therapy, by calming oneself before reacting, and by encouraging
other methods of expression such as writing in a journal or through
art (Amaya-Jackson et al., 2003; Carrion & Hull, 2010; Krantz &
Pennebaker, 2007). Adolescents who have experienced trauma
often tend to focus on negative emotions more often than positive
ones, and are taught in treatment to identify the benefits of positive
emotional expression in and outside of therapy (Carrion & Hull,
2010; Ford, 2010).
As previously discussed, adolescents who have experienced
trauma early on in life may suffer from poor social functioning and
may have difficulty understanding and identifying their own emo-
tions, as well as the emotions and facial expressions of others
(Margolin & Gordis, 2000). The TARGET treatment dedicates a
specific section of the therapy to “emotion self-check” to help the
adolescent identify the emotions that he or she is feeling as well as
helping him/her to recognise emotions in others (Ford, 2010).
While this is not a typical component of trauma-specific therapies,
this appears to be a beneficial method for helping adolescents in
the program to better identify and understand emotions and how
these may act as potential triggers.
In the majority of the trauma-informed therapies, once the
adolescent has received psychoeducation and has learned effective
coping skills, he or she is encouraged to form a trauma narrative
(Amaya-Jackson et al., 2003; Cohen et al., 2010; Farrell et al.,
1998; Najavits et al., 2006). A trauma narrative encourages the
adolescent to recount his or her traumatic experience in detail,
either orally or in written form (Amaya-Jackson et al., 2003;
Deblinger, Mannarino, Cohen, Runyon, & Steer, 2011). TF-
CBT, MMTT, AMT, Seeking Safety, and SCCT all involve
creating a trauma narrative and support the belief that having
the adolescent face his or her traumatic event is crucial to the
success of the treatment.
Most trauma-informed treatments also include a specific section
of therapy (typically after the trauma narrative has been addressed)
devoted to cognitive restructuring (Amaya-Jackson et al., 2003;
Cohen et al., 2010). Cognitive restructuring, as it pertains specif-
ically to trauma-informed treatment, is similar to some of the
coping skills considered here, but it more specifically addresses
disturbed cognitions and beliefs. The goal of cognitive restructur-
ing is to bring awareness to the individual’s own thoughts, so that
these thought processes can be altered to correct maladaptive
thinking and beliefs about the trauma itself and trauma-related
cues (Hassija & Gray, 2010). Research has demonstrated that
the use of cognitive restructuring significantly reduces trauma-related
symptoms in adolescents diagnosed with PTSD (Rosenberg et al.,
2011). Finally, most of the trauma-informed therapies involve
creating a plan for the adolescent for after he or she has finished
therapy (Amaya-Jackson et al., 2003; Cohen et al., 2010; Ford,
2010). Specifically, the therapist and the adolescent work together
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Table 2
A Summary of Therapeutic Techniques Currently Used in Trauma-Informed Treatment Models
Therapeutic practices Implementation Goal Addresses Examples
Psychoeducation –All trauma-informed
therapies
–To provide the client with knowledge
about the organic cause of trauma-
related symptoms
–To ensure that the adolescent
understands the reasons that
symptoms are perpetuated
–Organic causes of trauma-related symptoms
(physiological changes to the brain)
–Classical conditioning and how it perpetuates
stress reactions to triggers
–The TARGET treatment explains (at a
developmental age appropriate level) how
trauma affects different areas of the brain
(alarm center, filing center, etc) and how this
change causes stress reactions
Coping skills:
Relaxation
techniques
–All trauma-informed
therapies
–To teach the adolescent how to calm
themselves when experiencing stress
from a trigger or a flashback
–Physiological symptoms such as stress,
anxiety, and fear
–How to control these responses using
relaxation
–SCCT teaches relaxation through meditation,
breathing exercises, and progressive muscle
relaxation
Coping skills:
Identify triggers
–All trauma-informed
therapies
–To identify the triggers that cause the
adolescent to experience stress,
anxiety, fear, and flashbacks
–Triggers are unique to the individual and can
range from sounds to smells, people and
places
–Triggers, such as loud sounds, can occur in
daily life and it is important for the
individual to know their trigger so they can
use relaxation techniques to calm themselves
to avoid stress and fear
–AMT uses stress inoculation training (SIT;
Meichenbaum, 2009) to identify triggers and
cope with the emotions that they induce
Coping skills:
Affect regulation
and expression
–TF-CBT, TARGET,
and SCCT
–To teach adolescents how to regulate
and properly express emotion
–To help adolescents identify emotions
within themselves and others express
–To help adolescents experience more
positive emotions
–Because of the brain being on constant alert
for a threat, those with trauma-related
symptoms experience more negative
emotions than positiv; this helps adolescents
to experience and express positive emotions
as well
–Adolescents who were traumatized at a young
age may have difficulty with areas of social
functioning, particularly identifying emotions
in others
–Helps to reduce externalized symptoms such
as aggression by encouraging proper
expression of emotions
–TARGET treatment helps adolescents to identify
the emotions of others through activities where
they look at pictures of faces and must state
what emotion the person in the picture is
expressing
–Other therapies encourage expression through
writing or other forms of art
Trauma Narrative –All trauma-informed
therapies except
for TARGET
–To have the adolescent relive the
trauma in detail, orally or in written
form
–This therapeutic practice can only be done
after the adolescent has mastered their
coping skills
–Allows the adolescent to relive the memory
while applying their newfound relaxation
skills to ease fear and stress
–MMTT requires the adolescent to create a
trauma narrative
Cognitive
Restructuring
–All CBT-based
trauma-informed
therapies
–To address and adjust schemas or
thought patterns that may be having a
negative effect on the adolescent
–To identify and adjust schemas that
perpetuate trauma-related symptoms
–Negative thought patterns that perpetuate
fearful thinking or constant reminders of the
trauma must be eradicated so that the
individual can reduce their trauma-related
symptoms
–TF-CBT includes a section on cognitive
restructuring and cognitive coping skills
Planning for the
Future
–All trauma-informed
therapies
–To ensure that the adolescent continues
to use the coping skills taught in
therapy to reduce trauma-related
symptoms
–If a plan is not made to help the adolescent
cope on their own after therapy, it is
possible that trauma-related symptoms may
return
–Seeking Safety encourages adolescents to
continue to use the resources that they learned
during therapy in their daily life
Note. AMT ⫽ anxiety management training; CBT ⫽ cognitive behavioural therapy; MMTT ⫽ multimodal trauma therapy; SCCT ⫽ Stanford cue-centered therapy; TARGET ⫽ Trauma Affect
Regulation: Guide for Education and Therapy; TF-CBT ⫽ trauma-focused cognitive behavioural therapy.
199
TREATING TRAUMATIZED ADOLESCENTS

to create a plan to maintain the benefits of treatment. For example,
adolescents are encouraged to implement their relaxation skills
during social interactions when they may feel overwhelmed or feel
the need to be aggressive. A final technique used in creating a
post-trauma-informed therapy plan is, if possible, including the
adolescent’s parents as a source of encouragement.
Finally, it would also appear that understanding the time, in
relation to development, that the trauma was experienced is
crucial to determining the developmental issues that a trauma-
tized child may have (e.g., Perry, 2009). Further, when choos-
ing a trauma-informed treatment, it is important to keep in mind
that the client’s age may be significantly different from his or
her developmental stage, both cognitively and socially (De
Bellis et al., 2010). The goal of all of the established trauma-
informed therapies should be to help the adolescent face his or
her traumatic experiences gradually, so as not to traumatize him
or her further.
Summary and Suggestions
While the authors would prefer that childhood trauma be pre-
vented before it occurs, it is inevitable that some children will
experience traumatic events and require treatment. The purpose of
the current article was to conduct a thorough examination and
review of the available treatments for trauma-related symptoms,
and to provide recommendations as to the most effective treatment.
The authors acknowledge that some of these suggestions are based
on a relatively scant amount of empirical enquiry. While some
treatments, such as TF-CBT and TARGET, are currently being
studied with positive results, because of an overall paucity of
empirical support, it is difficult to delineate the full efficacy of
these treatments. We would like to encourage researchers and
clinicians to conduct more studies in the area of trauma-focused
therapy for youth, with the aim of creating a similar review based
on additional empirical enquiry for available trauma-focused treat-
ments. Specifically, a detailed examination of the levels of evi-
dence supporting the therapeutic techniques used within trauma-
focused treatments would be extremely useful.
It is important to note, before beginning trauma-focused treat-
ment of any kind, that there may be barriers to successful treatment
that do not exist for other childhood issues. Specifically, the
child’s safety may be at risk if they continue to live in a household
with an abusive or neglectful parent, as the trauma may be ongoing
(Cohen, Mannarino, & Murray, 2011; Ford & Cloitre, 2009; van
der Kolk, 2005). In addition, children who have been traumatized
at a young age have difficulty trusting others and this may result in
a poor bond, or a lack of rapport, between the treatment provider
and the child, which is often detrimental to the success of the
treatment (Ford & Cloitre, 2009). Therapists treating children with
trauma-related symptoms must be aware of these issues if they
wish to successfully treat traumatized children.
TF-CBT is the most studied, and the most endorsed, of all of the
treatments for trauma-related symptoms among children and ado-
lescents (Ford & Cloitre, 2009; Silverman et al., 2008). It is well
established and research has demonstrated that it effectively re-
duces symptoms of trauma (Deblinger, Behl, & Glickman, 2012).
The authors of this article strongly encourage the use of TF-CBT
to help reduce trauma-related symptoms among children and ad-
olescents.
Additionally, if a practitioner were attempting to treat trauma-
tized adolescents with behavioural or aggression problems, the
authors of this article suggest that TARGET training be used.
TARGET treatment has been shown to effectively reduce both
internal and external trauma-related symptoms, as well as external
aggression, and is effective with both males and females (Ford et
al., 2005).
While TARGET can be implemented as either an individual or
group treatment method, some of the other specific group therapies
outlined here also appear quite promising. Indeed, group therapies
can be cost- and time-effective, allowing the therapist to treat
many individuals suffering from trauma-related symptoms at once.
Group therapy may also enable adolescents to share their traumatic
experience with others who have also been traumatized, and to
learn from others who are overcoming trauma-related symptoms
(Pfefferbaum, 1997). Both MMTT and TF-CBT are group thera-
pies that could effectively address trauma-related symptoms in
adolescents. Both of these therapies are grounded in CBT and have
been effective in reducing trauma-related symptoms such as de-
pression, anxiety, and avoidance behaviours among adolescents.
Both MMTT and TF-CBT were designed specifically for use with
youth, are effective across different races and cultures, and are
effective at treating a wide array of traumas (Follette & Ruzek,
2006).
Regardless of the specific treatment protocol that is ultimately
adhered to, it is important to keep in mind that psychoeducation,
coping skills, trauma narratives, cognitive restructuring, and cre-
ating an action plan for after the cessation of therapy are all
typically integral practices of the trauma-informed treatment pro-
grams. By implementing some or all of these key practices, it
should be possible to reduce trauma-related symptoms among
adolescents.
In conclusion, PTSD (and trauma-related symptoms) is
present in a substantial proportion of adolescents (Giaconia,
Reinherz, Silverman, & Pakiz, 1995; Grella et al., 2005). Trau-
matic experiences can disrupt and disturb a child’s develop-
ment, which, if left untreated, has been linked to experiencing
a host of emotional and behavioural issues in adulthood as well.
It is clearly important to address issues of trauma, and the
current article has made a number of observations and sugges-
tions with the intent to enhance the treatment of trauma-related
symptoms among adolescents.
Re´sume´
Les traumatismes ve´cus pendant l’enfance ou la jeunesse ont
diverses conse´quences se´rieuses, qui peuvent se poursuivre a` l’aˆge
adulte. Ces conse´quences peuvent inclure des difficulte´s dans des
domaines cle´s, comme a` l’e´cole ou dans les interactions sociales,
le syndrome de stress post-traumatique (SSPT), ou encore des
proble`mes d’ordre criminel. Malheureusement, on estime
qu’environ 1 jeune sur 4 connaıˆtra un quelconque traumatisme
se´rieux durant son enfance (Duke, Pettingell, McMorris &
Borowsky, 2010). Le pre´sent article fournit un sommaire des
principales the´rapies sensibles aux traumatismes qui sont actuel-
lement offertes aux adolescents aux prises avec le SSPT ou des
symptoˆmes relie´s a` un traumatisme, ainsi que les techniques
the´rapeutiques qui sont communes a` toutes ces the´rapies. En outre
sont formule´es des recommandations sur les the´rapies sensibles
200
BLACK, WOODWORTH, TREMBLAY, AND CARPENTER

aux traumatismes qui seraient les plus utiles pour le traitement des
adolescents. Le recours a` des the´rapies qui tiennent spe´cifiquement
compte du risque potentiel d’un jeune de vivre un traumatisme
facilitera la re´duction des symptoˆmes ne´gatifs ainsi qu’une ame´-
lioration du fonctionnement du client.
Mots-cle´s : traumatisme, adolescent, traitement sensible aux trau-
matismes, SSPT, the´rapie cognitivo-comportementale sensible aux
traumatismes.
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Received May 16, 2011
Revision received March 27, 2012
Accepted March 27, 2012 䡲
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