Treatment of Trauma in Children and Adolescents

1
Treatment of Trauma in Children and Adolescents

• TF CBT Model
• (Cohen, Mannarino, Deblinger)

2
After Trauma
3
Guides

• UCLA PTSD Reaction Index
• Caregiver Report
• UCLA PTSD Reaction Index
• Self report, ages 8-17

4
Provider (provide, latin. to foresee, look after)
Trauma may affect both children and parents.
Childs trauma may awaken parents past
trauma. Childs trauma may awaken providers
past trauma.
5
Good enough ShadeThe family and provider in
treatment with children.
6
Obstacles
7
Patient Obstacles
8
Provider Obstacles
9
TF CBT Model

• Education Parenting
• Relaxation Affective Modulation
• Cognitive Processing
• Trauma Narrative
• Practicing
• Parent Child Sessions

10
Education Parenting
11
Teaching Parenting
If a child is demoralized by a parents
criticism, Avoid every impulse to criticize the
parent, and find every opportunity to praise the
parent when They are kind, they are respectful,
they listen, they praise.
Parents learn parenting From being
parented That includes us
12
Relaxation

• Create a calming space, that includes us
• Breathing Exercises
• Progressive Muscle Relaxation
• Include Parents

13
Affective Expression and Modulation
14
Blue is for worry, Orange is for Anger
Call me AJ
15
Blue is for Worry, Orange is for AngerThis is
how I feel when I remember what happened
Call me AJ, Time to Change Channels
16
Medicine
17
Trauma Narrative

• One of the goals of creating the trauma
  narrative is to unpair thoughts, reminders of the
  traumatic event from overwhelming negative
  emotions such as terror, horror, extreme
  helplessness, shame, or rage. - Judith Cohen

18
Trauma Narrative

• May take several sessions of gradual remembering.
  Can not be rushed.
• Warm up with a narrative of a neutral or fun
  event.
• Use relaxation before and after if needed.
  Reward, praise effort.
• Drawing a series of pictures or writing a story
  both work
• Involve the Parent as partner, facilitator, or
  patient depending on the parents capacity.

19
Using the Narrative to Correct Distortions

• After telling the narrative is complete, but not
  until then, it can be used to look at
  distortions. Distortions can be internal to the
  narrative or external.
• Common internal distortions include guilt, blame
  (I should have, What if I, If only I was,
  Maybe I was the one who)
• Common external distortions include generalizing
  danger (When a kid bumps into me at school I get
  ready to fight, men can not be trusted, the only
  way to protect my children is to keep them at
  home)

20
In Vivo Exposure Therapy

• Gradual, as with narrative therapy
• Relaxation techniques used
• Should always be seen through to completion once
  started!

21
Future Safety

• As a conclusion to therapy, child and parent
  should participate in discussion of safety and
  preparedness.

22
Treatment course Beginning Sessions No direct
discussion of Traumatic Event
23
Treatment course Middle SessionsNarrating the
Traumatic Event
24
Treatment course Later SessionsCorrecting
Distortions and Preparing for the Future
25
Workgroup Ideas

• Traditional Stories to be used for teaching
• Traditional Ceremonies used in healing Trauma
  (EvilWay, Anaaji)
• Use of smoke, cedar for relaxation