04 Sep CBT Continues to Gain Traction
The use of Cognitive Behavioral Therapy (CBT) as a means of treating childhood symptoms of depression and anxiety continues to gain traction as an effective evidence-based practice. A 2015 review published in the Journal of Clinical Child and Adolescent Psychology reports that CBT is an “effective and appropriate first-line treatment for youth with anxiety disorders.” Additionally, a study published in the Neuropsychiatric Disease and Treatment journal found that for individuals meeting the criteria for Post-Traumatic Stress Disorder (PTSD), 92% no longer met the diagnostic criteria after being treated with CBT. The implications of this data point us in the direction of continuing to find innovative means to treat child and adolescent mood disorders with models founded in CBT.
Pioneers in the field of treating child and adolescent trauma developed a new and effective approach that has evolved over the past 30 years to be an evidenced-based, manualized practice in CBT. Trauma-Focused CBT (TF-CBT) is an innovative approach to treating children aged 3 to 18 who have experienced a traumatic event and display corresponding symptoms of anxiety, depression or PTSD. This model offers a short-term intervention, with about eight to 25 sessions that involve both the child and guardian in an equal number of sessions. This effective approach evolved from the clinical research and work of psychiatrist Dr. Judith Cohen, psychologist Dr. Esther Deblinger and psychologist Dr. Anthony Mannarino. Seeking to improve treatment outcomes for children who had experienced sexual trauma, they developed a method of combining cognitive behavioral therapy approached with family therapy using a trauma sensitive lens.
TF-CBT is unique in that it is designed specifically for use with children, modeled to be both brief and skills based. These two components lend to the efficacy of this model in several ways. First, being a relatively short-term intervention, children do not identify with an internal concept of being “broken” or having something inherently wrong with them. Treatment without outcomes can perpetuate thoughts that a problem is not “fixable.” When children and the parents see quick results, they can be empowered toward further success in managing those symptoms.
As a skills-based model, children and their guardians learn practical and tangible methods to help process and manage emotions. This offers both the identified patient and their natural supports permanent skills to be apply both to the present problem and symptoms, but to use throughout their lives when faced with new challenges. This can help to prevent escalation of the behavioral health symptoms they experience. Additionally, this offering positive means of coping will help prevent development of maladaptive coping mechanisms such as the use of alcohol or other drugs. Parents can help to reinforce skills they learn as a partner in treatment.
It can change family relationships and dynamics as well. The parenting skills and psychoeducation help inform improved communication, enhanced awareness of emotions and normalizes the behaviors and feelings they are witnessing in their child. This helps dispel feelings of shame, fear and anger experienced by both the child and their family members.
The TF-CBT training network boasts on the efficacy of this model, identifying that TF-CBT has been studied widely with 21 randomized, controlled trials having been conducted worldwide with results that are sustained over time. Additionally, the National Child Traumatic Stress Network cites that this model of care is the strongest empirical evidence in treating traumatized children. There are however limitations in the application of this form of CBT, tending to be effective only with children who have trauma-based symptoms and less efficacy on symptoms of anxiety unrelated to trauma. Pioneers in the field, such as Drs. Cohen, Deblinger, and Mannarino applying their clinical training in CBT to their work in the field with children and families will continue to develop additional applications of CBT to use this powerful approach in innovative ways.