Are you struggling with depression, anxiety, fears, phobias or post traumatic stress disorder (PTSD)?  Are you having trouble getting past your grief or loss?  Orlando Trauma Focused Cognitive Behavioral Therapy (TF CBT) is an evidenced based treat model that has been clinically researched.  The TF-CBT treatment model is comprised of eight components; Psychoeducation and parenting skills, Relaxation, Affective expression and modulation, Cognitive coping and processing I, Trauma narrative, In vivo mastery of trauma reminders, Conjoint child-parent sessions, and Enhancing future safety and development. Each component forms the acronym PRACTICE. TF CBT also has a grief component which includes; Grief psychoeducation, Grieving the loss and resolving, Preserving positive memories, and Redefining the relationship. The ultimate goal of TF-CBT is in providing a safe environment where the person can talk and process the trauma, address identified trauma symptoms, improve child/adolescent functioning and quality of life.

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What ages can benefit from Trauma Focused Cognitive Behavioral Therapy?

TF CBT has been found to be effective in addressing multiple trauma symptoms in children and teens, typically 3 – 18 years old, and adults which include depression and anxiety.

How long does it take to complete treatment? 

TF CBT is considered short-term, 12 to 16 sessions depending on treatment needs.

What type of Trauma or Anxiety does TF CBT help? 

According to the American Psychiatric Association, “features that distinguish traumatic events include the following; death or threat to life or bodily integrity; and/or the subjective feeling of intense terror, horror, or helplessness.” TF-CBT interventions address a range of trauma symptoms which can include depression, anxiety, behavioral symptoms, self-injury, impaired relationships, the inability to trust, and difficulty regulating intense emotions. Cognitive Behavioral Therapy emphasizes the connection between one’s thoughts (cognitions), how thoughts impact feelings (emotions), and finally how our thoughts, and feelings determine behavior. Through therapeutic interventions CBT can identify and address inaccurate thinking leading to maladaptive behavior, and present alternative more adaptive thinking which in turn will influence feelings and behavior.

What does TF-CBT look like or How does it work?

An example of this dynamic might look like this;

  1. Event: You (older sibling) get blamed for breaking your mother’s vase which wasn’t your fault.
  2. Maladaptive Thought: It isn’t fair, I always get blamed being the oldest.
  3. Feeling: Sad, Mad, Frustrated
  4. Behavior: Yell, it’s not fair and go to your room slamming your bedroom door.
  5. Result: You get punished.

A more appropriate response would look like the following:

  1. Event: You (older sibling) get blamed for breaking your mother’s vase which wasn’t your fault.
  2. Positive Thought: If I calmly explain what happened, tell the truth, it will work out.
  3. Feeling: Hopeful
  4. Behavior: Without yelling, explain what happened and that you didn’t break the vase and offer to will help pick up the pieces.
  5. Result: Mother listens, understands what happened and apologizes.

The PRACTICE components build upon each other in a sequential order of skill building. Briefly each component includes;

  1. Psychoeducation | Supplying educational resources and information, normalizing the responses to the traumatic event as being expected and not unusual, validating feelings, providing strategies for managing current symptoms (irritability, sleeplessness, anger outburst, problems with concentration, etc.), challenges, and providing hope.
  2. Parenting Skills | Encouraging the maintenance of normal routines and expectations regarding discipline.
    • Using praise, positive affirmations, consistency and predictability – “I like how you made your bed without being told.”
  3. Relaxation | Presenting relaxation techniques to help reduce levels of stress and serve as helpful coping strategies, especially when encountering a stressful event or thought.
    • Deep breathing
    • Progressive muscle relaxation
    • Journaling are just a few of the relaxation strategies introduced having psychological and biological benefits.
  4. Affective expression and modulation | Focuses on the identification and appropriate expression of feelings
    • Child, teen or adults sense of safety
    • Positive self-talk
    • Problem-solving skills
    • Assertiveness
    • How to cope with difficult feelings.
  5. Cognitive coping and processing | Entails the exploration of the child’s thoughts concerning the traumatic event to identify any inaccurate or unhelpful thinking which may hinder the healing process. With CBT many people learn that they can change their unhelpful thoughts, generating a more realistic, accurate understanding of the trauma and its impact, and in so doing change their feelings and resulting behaviors.
  6. Trauma narrative | After the establishment of a positive, safe therapeutic alliance with the child and family, the accumulation of various coping skills, and opportunities to process thoughts and feelings, this component is introduced.
    • Art
    • Puppets (for kids)
    • Sand tray
    • Writing are choices available to the child, teen or adult in creating their story. The activity gives “voice” to the trauma and follows a gradual tolerable pace with your comfort level. At the conclusion, the trauma narrative can be shared with a parent or loved one.
  7. In Vivo mastery of trauma reminders | Assesses for any fears which may manifest as a result of the trauma in the child, teen or adult causing them to avoid certain trauma reminders or triggers. In a unhealthy way it could be the avoidance of a certain road, location, or building associated with a trauma that impedes normal adaptive functioning, or development of the child or teen.
  8. Conjoint sessions
    • Child/teen parents | For the building of the therapeutic relationship, sharing and practicing of information and techniques. The goal is to enhance the child/teen – parent relationship and support.
    • Adult/Spouse sessions | For the building of the therapeutic relationship, sharing and practicing of information and techniques. The goal is to enhance the spouse relationship and support.
  9. Enhancing future safety and development | By considering the victim and family’s feelings of safety, preparedness for what-if situations, future life events, and how to go on living life after a trauma.

As a licensed mental health counselor and play therapist, Cynthia Wanberg, M Ed, LMHC, RPT-S has been trained in working with children, adolescents, individuals and families following the TF-CBT model with children who have disclosed abuse. She is mindful in seeking to understand the family’s cultural, religious and family values in presenting the techniques and understanding the impact of the traumatic experience with each family. Having a multi-disciplinary approach in considering other identified care providers and agencies involved with a child/family, has been a critical aspect in providing the most effective support. While a traumatic event impacts the victim, the event has a secondary trauma effect on the victim’s loved ones as well. True healing does involve “a village” in navigating a path towards wholeness.

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