Evidence-based psychotherapies for children and adolescents by Weisz and Kazdin (third edition) – Book summary
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Trauma-focused cognitive behavioural therapy (TF-CBT) addressed problems specifically associated with traumatic events that children experience or witness (e.g. PTSD). TF-CBT targets PTSD symptoms and outcomes associated with trauma. A PTSD diagnosis is not required.
PTSD includes negative cognitions about oneself, others or the world and negative affective states. There may be dysregulation in affective, behavioural, cognitive and physiological areas of functioning. TF-CBT targets reregulation in each of these areas with the goal of optimizing children’s adaptive functioning after trauma.
The main goal of TF-CBT is to help children overcome traumatic avoidance (1), shame (2), sadness (3), fear (4) and other trauma-specific emotional and behavioural difficulties (5). TF-CBT is not a first line treatment but can help children after they have stabilized.
TF-CBT includes cognitive-behavioural, attachment, family, humanistic, and psychodynamic therapy principles. The overall level s of adjustment in all areas (e.g. physiological; emotional) impact each other and influence overall well-being. TF-CBT thus attempts to reduce the impact of trauma across these areas and this is believed to lead to overall improvements.
There are several pathways to PTSD after trauma:
These theories state that exposure is essential. The social-cognitive theory focuses on the impact of trauma on pre-existing or developing beliefs about one’s self, others and the world. It states that trauma-related feelings and thoughts should be reviewed to process the experience fully and correct dysfunctional beliefs and emotional reactions.
The family environment and the therapeutic relationship is also essential. TF-CBT may reduce parental distress and enhances parents’ support for their children.
Goals of TF-CBT include:
TF-CBT focuses on children between the ages of 3 and 18. The treatment is adapted depending on the developmental stage of a child and parents receive TF-CBT in parallel individual or joint child-parent sessions.
TF-CBT consists of several components named PRACTICE:
Each component builds on the previously mastered skills. Each component includes interventions provided to both child and parent. TF-CBT typically lasts 8-20 sessions. It is completed when all components have been provided. Other interventions to consolidate the skills may be necessary.
TF-CBT enhances parental support (1), effective parenting practices (2) and reduces parental levels of depressive and trauma-related symptoms (3). Parental emotional distress and parental support were significant predictors of children’s symptoms for preschool children. Children’s abuse-related attributions and perceptions and parental support predict treatment outcome in older children with a history of sexual abuse. Multiple-trauma history and higher levels of pre-treatment depression are moderators of treatment outcome but only for children receiving child-centred treatment.
TF-CBT may be preferred for children with multiple traumas and those with more depressive symptoms. It may be especially useful to overcome trauma-related behavioural and depressive problems. TF-CBT appears to be useful for children in foster care as well. Therapeutic engagement at the start of the treatment and the importance of successful treatment completion are essential. TF-CBT may also be useful for treatment after disasters.
TF-CBT leads to 80-90% remission rates of PTSD diagnoses. It is efficacious.
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This bundle contains a book summary of the book Evidence-based psychotherapies for children and adolescents by Weisz and Kazdin (third edition). It contains the following chapters:
- 1, 2, 4, 12, 13, 15
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