Cognitive-Behavioral Treatment for Posttraumatic Stress Disorder in Children and Adolescents

Abstract

A number of Cognitive Behavioral Therapy (CBT) approaches are available for treating child and adolescent posttraumatic stress disorder (PTSD). Similar to other CBT treatments, particularly those for anxiety disorders, these treatments all include common elements (e.g., psychoeducation, relaxation and affective modulation skills, exposure). The goals of this review are to: 1) delineate common elements in CBT approaches for treating child and adolescent PTSD; 2) provide a detailed review of two CBT approaches with substantial evidence of effectiveness; and 3) describe “Promising Practices,” in the area of CBT approaches to treating child and adolescent PTSD. The two treatments reviewed in detail are Trauma-focused Cognitive Behavioral Therapy (TF-CBT) and Cognitive Behavioral Intervention for Trauma in Schools (CBITS). For these treatments, we describe the research evidence to date, specific elements of the treatment model, and discuss implementation and cultural considerations. In the “Promising Practices” section, other CBT approaches are reviewed that include many of the common elements; however, these approaches have accumulated less evidence of effectiveness to date. Research on CBT approaches to treating PTSD is ongoing, with a growing focus on explicit consideration of the multiple systems in which youth exposed to trauma are involved, and ways to better address co-occurring difficulties (e.g. serious behavior problems, substance use). Future directions for the field are discussed. These include further study of promising practices, cultural applicability of CBT approaches to treating PTSD, and strategies to enhance implementation and dissemination efforts to improve access to high-quality, evidence-based care for children and adolescents with PTSD.

The Body Can Change the Score: Empirical Support for Somatic Regulation in the Treatment of Traumatized Adolescents

“…Such research demonstrates the efficacy of CBT in reducing PTSD symptoms (Cohen and Mannarino 2010;Donnelly and Amaya-Jackson 2002;Dorsey et al 2011). Brain imaging studies lend additional support, showing neural effects of cognitive strategies.…”

“…Several promising, evidence-based interventions designed to treat children and adolescents with complex trauma have emerged in the past decade (Dorsey et al 2011;Knoverek et al 2013;Zelechoski et al 2013). Some of these models highlight targeting self-regulation capacity as an essential therapeutic component.…”

A Statewide Common Elements Initiative for Children’s Mental Health

“…Trauma-focused CBT is a well-established EBT for trauma-related sequelae, including PTSD. 27 The TF-CBT focus began with a National Child Traumatic Stress Network grant (second author, PI). When grant support ended in 2005, the state provided funding to sustain yearly TF-CBT training and consultation.…”

Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies

“…Efficacy data exists for preschool, school-aged, and adolescent male and female children (for reviews, seeDorsey, Briggs, & Woods, 2011; Silverman et al, 2008). Studies have included a substantial percentage of African American children, with no significant differences by ethnicity (e.g., Cohen, Deblinger, Mannarino, & Steer, 2004).…”