Addressed by Treatment
Post Traumatic Stress
Disorder (or symptoms)
Other: External Locus
Coping (TFC) is a group cognitive behavioral therapy treatment
program for children and adolescents with post traumatic stress disorder
(PTSD) and collateral symptoms of depression, anxiety, anger, and
external locus of control originating from single-incident trauma.
Based on social learning theory, TFC uses a group .skills-oriented. cognitive behavioral therapy (CBT) approach and involves 14 weekly sessions in which the
first few sessions lay the groundwork for the child to think differently about PTSD. The treatment model is one of graded exposure, and begins with psychoeducation and
cognitive therapy before moving to more exposure-based activities. TFC has two overall goals: 1) to help the child organize an accurate trauma narrative that places the
trauma in the past and is without cognitive distortions, and 2) to promote behavior consistent with the view that the world is no longer dangerous when threat is truly
Each child completes
a narrative Chapter Book that tells his or her story, including an
accurate telling of the trauma history, its effects on the child's
life, and successes in overcoming that history so that the child
can live as comfortably as possible in the present. Session components
include: psychoeducation, cognitive therapy, exposure-based behavior
therapy, generalization training, and relapse prevention. TFC also
offers developmentally appropriate treatment adaptations for elementary
school-age children and junior high school adolescents including
therapeutic modalities such as storybooks, narrative exposure, cognitive
games, and peer modeling.
An evaluation of
TFC was conducted in elementary and junior high school settings after
a community disaster. The evaluation results published in a 1998
study used a single case across-time-and-setting experimental design
in 4 schools (2 elementary and 2 junior high) over an 18-week period.
Participating children and clinicians completed assessment instruments
at baseline, post-treatment (18 weeks later) and at 6-month follow-up.
Participants included children in grades 4 through 9 (age range 10-15
Of the 14 participants
who completed treatment, 57% no longer met DSM-IV criteria for PTSD
immediately after treatment and 86% were free of PTSD at the 6-month
follow-up. Treatment also produced reductions in depression, anxiety,
and anger and resulted in children.s
locus of control moving from external to internal between post-treatment
and the 6-month follow-up.
14 Weeks, 14 Sessions
(50-60 minutes each)
Groups can be conducted
by clinician supervisors and therapists with: a master’s degree
or higher, general CBT experience, and understanding of childhood
PTSD and related symptoms. Assessment of the organization (school
and/or clinic) for intervention readiness is also recommended.
It is intended that this program be implemented by mental health professionals with appropriate education, training, credentialing, and experience treating the target population.
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