Orientation to
TFCBT
Presentation Overview
1.
Establish context through some quick facts
about trauma in the US
2.
Understand the Trauma Response
3.
Describe 3 sources of trauma & types of
responding
4.
Discuss TF-CBT and manualized treatments
5.
Review organization of remaining trainings
Establishing Context
• Everyone has trauma
• 90% of US adults report
being exposed to
something notably
traumatic1
• Unresolved trauma
reactions may be at the
core of many
developmental, relational,
or clinical impairments
• To increase intrapersonal
well-being and
interpersonal functioning,
meaningful and efficacious
treatment is an imperative
Sources of Trauma
 Many
possibilities, but also some distinct
categories
 Threats
to our body
 Environmental
 Relational
and disaster-related events
trauma
Types of Response
Natural Recovery
Response
Traumatic
Experience
Recovery through
treatment
Persistence of
Trauma Symptoms
Compounding of
symptoms through
non-treatment
Clinical Symptoms of PTSD
 From
the medical model perspective
1.
Exposure to traumatic material (direct or indirect)
2.
Intrusion symptoms (flashbacks, nightmares, physio)
3.
Negative changes in cognitions and mood
4.
Alternations in arousal or activity level
5.
Duration- ASD versus PTSD
6.
Functional significance
Clinical Symptoms of PTSD
 From
a Wellness, Strength-based Perspective

Alterations in positive emotions and happiness

Decreased engagement with life activities

Affected social relationships

Disrupted perceptions of meaning and existential
well-being

Impediment to activities that promote sense of
accomplishment
3 Sources of Trauma Response



Biological dysregulation
Behavioral explanations of trauma-focused
interventions

Behavioral theory

Cognitive-emotional processing theory
Cognitive explanations of trauma-focused
interventions

Social cognitive theory of PTSD
Biological Dysregulation
 Neurocircuitry
models
make reference to
some important brain
areas
 Amygdala,
medial
prefrontal cortex and
anterior cingulate,
and hippocampus
 Activity
in these areas
is markedly different
in those with PTSD
than without
Behavioral Conceptualizations
Mowrer2 provided a framework for development and maintenance of fear
responses
Classical Conditining:
Acquisition of Fear Response
 Classical Conditioning
explains on
onset/acquisition of
fear response
 Operant
Conditioning
maintains response
through avoidance of
fear provoking stimuli
CS
Car
UCS
Hit by Drunk
Driver
CR
Fear of Riding
in Cars
Operant Conditioning
Response:
Avoid Driving or
Riding in Cars
Aversive Stimilus
Removed:
Fear Reduced
Emotional Processing Theory
 Foa’s3 practice-based
theory integrated
meaning into the learned response
 In
response to traumatic experience, we
develop meaning structures with stimulus and
physiological responses
 Maintenance
three factors:
and recovery moderated by

Degree of emotional engagement

Quality of trauma-related cognitions

Degree of narrative articulation
Social Cognitive Theory of PTSD



Resick and colleagues4
depicted this model in
the treatment of
individuals with PTSD.
Avoidance of thinking
about the event and
problematic appraisals
of event contribute to
non-recovery.
Largely moderated
through cognitive
assimilation
Assimilation
Overaccommodation
Keys to
Recovery
•Just-world thinking
•Hindsight bias
•Happily ever after thinking
•Use traumatic event as proof
of negative belief
•Related to safety, trust,
power/control, esteem, and
intimacy
•Experience natural emotions
•Correct misappraisals
associated with
manufactured emotions
TF-CBT and Manualized
Treatments
Manualized Treatment
 What
is a manualized treatment?
 How
do manualized treatments apply to
evidence-based practice?
 Do
I have to do it by the book?
 How
can this help me as a developing
practitioner?
 Our
manual is called Treating trauma and
traumatic grief in children and adolescents7
TF-CBT
 Conjoint
child-parent therapy approach
 Use core set of CBT skills to promote
coping
 Include narrative processing component
 Sequential and components based
 Flexible and responsive
 Culturally sensitive
TF-CBT Protocol
 Psychoeducation
 Relaxation
 Affective
 Cognitive
 Trauma
 In
and Stress Management Training
expression
coping strategies
narrative
vivo mastery of trauma reminders
 Conjoint
kiddo-parent sessions
 Enhancing
future safety
For the Upcoming Weeks
 Sign
up for online modules at https://tfcbt.musc.edu
 Complete
related modules prior to face to face
meetings with clients and after planning/supervision
 Use
manual and resources to extend on information
presented in online modules and provide
opportunity to develop resources and skills for your
use at clinic.

Review manualized treatment article and Lenz and
Hollenbaugh (2015) article
References
1.
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4.
5.
6.
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9.
10.
11.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J.
(2013). National estimates of exposure to traumatic events and PTSD prevalence using
DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537-547. doi:10.1002/jts.21848
Mowrer, O. H. (1960). Learning and behavior. (Vol. 960). New York, NY: John Wiley &
Sons.
Foa, E. B., Huppert, , J. D., & Cahill, S. P. (2006). Emotional processing theory: An update.
In B. O. Rothbaum (Ed.). Pathological anxiety: emotional processing in etiology and
treatment (pp.3-24). New York, NY: Guilford Press.
Larsen, S. (2012). The neurofeedback solution. Rochester, VT: Healing Art Press.
Chapin, T. J., & Russell-Chapin, L. A. (2014). Neurotherapy and neurofeedback: Brainbased treatment for psychological and behavioral problems. New York, NY: Routlede.
Monson, C., & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies:
interventions that work. Washington, DC: American Psychological Association.
Cohen, L., Mannarino, A., & Deblinger, E. (2006). Treating trauma and grief in children
and adolescents. New York, NY: The Guilford Press.
Foa, E. B., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD:
Emotional processing of traumatic experiences. New York, NY: Oxford University Press.
Resick, P. A., Monson, C. M., & Chard, K. M. (2008). Cognitive processing therapy:
Veteran/military version. Washington, DC: U.S. Department of Veteran’s Affairs.
Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress
disorder. Clinical Psychology Review, 23, 339-376.
Thomas, K., Dorrepaal, E., Draijer, N., Jansma, E., Veltman, D., & van Balkom, A. (2013).
Can pharmacological and psychological treatment change brain structure and
function in PTSD? A systematic review. Journal of Psychiatric Research, 50, 1-15.