Trauma-focused CBT for youth who experience ongoing traumas

ArticleinChild abuse & neglect 35(8):637-46 · August 2011with30 Reads
DOI: 10.1016/j.chiabu.2011.05.002 · Source: PubMed
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.
    • "The present study results suggest that it is important to specify hallucinatory experience as it relates to dissociation and peer victimization. It is possible that psychosocial interventions (e.g., trauma-focused cognitive behavioral therapy for youth (Cohen et al., 2011), cognitive–behavioral intervention for trauma in school; Stein et al., 2003) rather than antipsychotic medication could be effective in managing hallucinatory experiences associated with peer victimization in early adolescence. For appropriate intervention strategies, assessing dissociation and peer victimization as they affect hallucinatory experiences is necessary. "
    [Show abstract] [Hide abstract] ABSTRACT: Peer victimization increases the risk of experiencing psychotic symptoms among clinical and general populations, but the mechanism underlying this association remains unclear. Dissociation, which is related to peer victimization and hallucinatory experiences, has been demonstrated as a significant mediator in the relation between childhood victimization and hallucinatory experience among adult patients with psychosis. However, no studies have examined the mediating effect of dissociation in a general early adolescent population. We examined whether dissociation mediates the relationship between peer victimization and hallucinatory experiences among 10-year-old adolescents using a population-based cross-sectional survey of early adolescents and their main parent (Tokyo Early Adolescence Survey; N=4478). We examined the mediating effect of dissociation, as well as external locus of control and depressive symptoms, on the relationship between peer victimization and hallucinatory experiences using path analysis. The model assuming mediation effects indicated good model fit (comparative fit index = .999; root mean square error of approximation = .015). The mediation effect between peer victimization and hallucination via dissociation (standardized indirect effect = .038, p<.001) was statistically significant, whereas the mediation effects of depressive symptoms (standardized indirect effect =−.0066, p=0.318) and external locus of control (standardized indirect effect = .0024, p=0.321) were not significant. These results suggest that dissociation is a mediator in the relation between peer victimization and hallucinatory experiences in early adolescence. For appropriate intervention strategies, assessing dissociation and peer victimization as they affect hallucinatory experiences is necessary.
    Full-text · Article · Jun 2016
    • "An important protective factor for children in the aftermath of IPV exposure is the parent-child relation (Afifi & MacMillan, 2011). For children to process difficult and even traumatic life events, it is important to form a coherent narrative of the events (Cohen, Mannarino, & Murray, 2011). Parent-child relations in which children feel safe to give meaning to the traumatic events may enhance their recovery (Fivush, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: This cross-sectional study examined the hypothesis that parent–child emotion dialogues among interparental violence (IPV) exposed dyads (n = 30; 4–12 years) show less quality than dialogues among nonexposed dyads (n = 30; 4–12 years). Second, we examined whether parental posttraumatic stress symptoms and parental adverse childhood experiences (ACEs) were associated with the quality of the dialogues. As expected, in the IPV-exposed group, quality of mother-child emotion dialogues was of lesser quality; dyads often showed a lack of elaboration in their dialogue; mothers showed less sensitive guidance; and children showed less cooperation and exploration, compared to dialogues, dyads, mothers, and children in the nonexposed group. Although maternal posttraumatic stress symptoms and maternal history of ACEs were significantly higher in the IPV-exposed families than in the nonexposed families, these variables were not associated with the quality of emotion dialogues. Clinical implications and study limitations are discussed.
    Article · Feb 2016
    • "The limited number of evidencebased interventions is attributable in part to challenges of assessment of mental health problems with regard to developmental differences of PTSD symptoms and underidentification across childhood and adolescence (Kerig, Fedorowicz, Brown, & Warren, 2000). Many evidence-based interventions focus on addressing behavioral and cognitive problems related to PTSD and focus on emotional awareness and expression, increasing feelings of emotional security, improving parent– child interactions, psychoeducation , exposure, and learning specific coping strategies (Cohen et al., 2011). These largely individual-level interventions can be improved by adding elements to strengthen community cohesion , as the results of this review suggests. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Adolescents living in Israel and the Palestinian authority are exposed to political violence. This review examines psychosocial risk factors for posttraumatic stress disorder (PTSD) organized within an ecological framework. Method: Relevant articles were identified through PubMed and PsycINFO. Studies measuring risk and/or protective factors for PTSD in the Palestinian and/or Israeli adolescent populations because of conflict exposure from 1990 to present were included. Results: A total of 20 studies met inclusion criteria. Greater violence exposure, poor economic resources, living in rural compared with urban areas, poor family and peer relations, and poor coping skills were associated with PTSD symptoms. Conclusions: The ecological framework is a useful approach to understanding factors affecting adolescent PTSD. Future research should focus on socioecological levels that have received limited attention. (PsycINFO Database Record
    Full-text · Article · Jan 2016
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