Examining the Trauma-focused Cognitive Behavioral Therapy Model

A five-year study looks at the applicability of a behavioral therapy model on children whose mothers experienced domestic violence in the community setting.

A shortened, adapted version of the trauma-focused cognitive behavioral therapy model proved to be moderately effective for treating posttraumatic stress disorder (PTSD) and anxiety relating to domestic violence in the community setting, according to findings presented Tuesday, Oct. 26, at the AACAP 57th Annual Meeting in New York, NY.

In a collaborative effort, researchers from Allegheny General Hospital, Pittsburgh, PA, and the Women’s Center and Shelter of Greater Pittsburgh, conducted a five-year study to determine whether trauma-focused child behavioral therapy (TF-CBT), which has shown to produce positive outcomes for children with social anxiety disorder, would yield similar results in children whose mothers experienced domestic violence—a population that can be challenging to treat, said to Judith Ann Cohen, MD, of the Center for Traumatic Stress in Children and Adolescents, at Allegheny General.

According to Cohen, more than 20% of children in the US are exposed to domestic violence, and as a result, experience diverse mental health issues that present as both externalized behaviors and internalized problems such as PTSD, anxiety, and depression. However, few studies have focused specifically on the effects of internalization following an episode of domestic violence. Further, the services provided at women’s shelters tend to focus more on battered women than on the issues faced by children, she added.

The Children Recover After Family Trauma (CRAFT) study aimed to determine how trauma-focused therapy can be applied to children in this environment and how successful it can be in comparison to the child-centered therapy (CCT) normally applied, in improving PTSD and other symptoms. One key challenge Cohen and colleagues faced was the fact that the TF-CBT model is usually carried out over 10-12 sessions; however, most families at the shelter attended a maximum of eight sessions. As a result, the researchers created a modified version of the model that focused on children ages 7-14 whose mothers sought shelter from domestic violence. Children who exhibit symptoms of PTSD received TF-CBT therapy as administered by child psychiatrists, along with undergoing interviews and other assessments; parents were also interviewed.

The primary components of the therapy focused on: psychoeducation and parenting skills, relaxation, affective expression and modulation, cognitive coping, trauma narrative and processing, in vivo mastery of trauma reminders, conjoint parent child sessions, and enhancing safety and future development.

Child-centered therapy (CCT) focused on reestablishing trust, empowering the child and parent through active listening, and allowing the child and parent to direct the session to meet their needs in the moment, said Cohen.

Of the 140 children who were recruited, 75 completed the therapy—a figure that Cohen said was higher than expected. Although the CCT was found to be a successful treatment, the TF-CBT model was significantly more effective in improving symptoms of avoidance and hyperarousal.

Although the investigators did encounter challenges—including conflicting reports from the child and parent in some cases, difficulties convincing participants to attend all sessions, and boundary violations by some staff members at the shelter—they did find that the TF-CBT model can be “effectively applied, accepted, and implemented” in the community domestic violence setting.