Children or young people between the ages of 3 and 18 who have been sexually or physically abused or exposed to domestic violence may obtain benefit from TF-CBT, whether they have experienced repeated episodes of trauma or a single occurrence of trauma. The non-offending parent or caregiver will typically also participate in the therapy. Children who are learning to cope with the death of a loved one have also been shown to obtain great benefit from TF-CBT.
Components of TF-CBT
In a review published in 2008, Silverman and colleagues (12) compared various psychosocial treatments for children exposed to trauma and included seven studies evaluating cognitive-behavioral therapies, including TF-CBT. This was the only treatment approach determined to meet the criteria of a “well-established treatment.” Another Cochrane Collaboration review that was most recently updated in 2012 examined 14 RCTs covering psychological therapies for the treatment of PTSD among children and adolescents. The authors concluded that compared with control conditions, the “only therapy for which there was evidence” was CBT (including TF-CBT) (35). The six review articles included in this review (10,12,18–20,35) are described in Table 3. Similarities and differences in inclusion and exclusion criteria must be considered when comparing these results with the results of our review, because none of the previous reviews assessed the level of evidence in exactly the same way as we have defined our evidentiary assessment protocol. The reviews examined the status of evidence for similar and overlapping bodies of research, including TF-CBT with maltreated children only (20); TF-CBT for traumas that are not related to abuse, maltreatment, or family violence (19); and all cognitive-behaviorally oriented interventions applied to traumatized children (10,12,18,35).
Evaluation of effectiveness
TF-CBT was significantly more effective in increasing effective parenting practices (with medium effect sizes), compared with active control groups (that is, child-centered therapy and child-only treatment). Seven studies examined co-occurring behavior problems, such as aggression cbt interventions for substance abuse and disruptive behavior (11,24–26,28,31,33); two of these studies included specific measures of sexual behavior problems (24,33). Regarding general behavior problems, two studies did not find significant main effects for pre-post treatment reductions in symptoms (24,28).
- Evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers.
- By understanding the effects of trauma, you are better equipped to cope with it, find practical solutions, and seek support.
- It’s most important to look for someone with experience in the practice and someone with whom you feel comfortable discussing personal problems.
- Adolescents who abuse substances or who are suicidal may temporarily see a worsening of symptoms with TF-CBT’s gradual exposure component.
Group sessions
To date, 11 empirical studies conducted on the impact of TF-CBT on adolescent survivors of trauma have demonstrated its usefulness in reducing symptoms of depression, anxiety, and PTSD. Randomized clinical trials comparing TF-CBT to play therapy, child-centered therapy, and supportive therapy show TF-CBT to yield greater gains over fewer sessions. Studies done up to two years after the conclusion of TF-CBT demonstrated these gains to be sustained over time.
The parallel-treatment components for caregivers can be provided to any available caregiver, such as a foster parent or another adult who can provide appropriate parenting support and is involved in the child’s daily life. During conjoint sessions, a child may choose to share the trauma narrative with an adult whom he or she identifies as supportive and trusted (for example, a grandparent, aunt, trusted teacher, or guidance counselor), regardless of whether this adult is involved in day-to-day care. Sessions are also held between the caregiver and the therapist throughout treatment, including prior to conjoint sessions, to ensure the ability of the caregiver to respond in a caring and supportive manner and to help prepare the caregiver for the sharing of the narrative. The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression.
Level of evidence
Assessing the Evidence Base Series
- In the TF-CBT model, parents and children participate in parallel treatment sessions; for each component of treatment, the therapist spends part of the session with the child and part with the caregiver.
- Research shows children and adolescents experiencing severe emotional repercussions due to trauma frequently respond well to this technique.
- TF-CBT has strong evidence supporting its effectiveness, but it may not be right for everyone.
- We evaluated TF-CBT for the treatment of a broad range of traumatic events, rather than focusing on a specific type of trauma, as was the case for two reviews published in 2013 by the Agency for Healthcare Research and Quality (AHRQ) (19,20).
- The remaining three reviews we identified found that there was a high level of evidence for cognitive-behavioral approaches for traumatized children and adolescents, including TF-CBT (10,20,35).