TF-CBT may sound like an intense acronym and a bit overwhelming. We therapists love our acronyms! It stands for Trauma-Focused Cognitive Behavioral Therapy. In everyday terms, it is a trauma-focused intervention that is specifically for people from ages 3 to 18 that are diagnosed with PTSD due to experiencing a traumatic event. The key components of TF-CBT that make it a unique intervention is it utilizes measures to track symptoms, it emphasizes gradual exposure, it includes the caregiver throughout the entire treatment, and it provides the client and caregiver with multiple skills to utilize at home to combat symptoms. Also, to become fully certified and recognized on the roster, a clinician must complete a year-long intensive training that includes multiple two-day in-person seminars, biweekly supervision with a consultant, monthly group consultation calls, and an exam at the end if the clinician chooses to become nationally certified. Throughout the training, the clinician is working with at least two cases and receiving constant supervision to ensure fidelity to this model.
Within the first couple of sessions, the clinician will ask the client and caregiver to complete some pre-treatment measures. These measures will be completed before treatment and then after treatment to show exactly how and where the client and caregiver have improved. Trauma and PTSD symptoms in a child have a significant effect on caregivers as well, so some of the measures will be specific to the caregiver. TF-CBT has a significant amount of research to back up why and how it works. Measuring symptoms before and after treatment continues to add to that research as clinicians can track symptoms with clients and provide clients and caregivers with straight numbers to show improvements. Often it can be difficult for the client to feel the changes at first, so tracking symptoms is helpful to instill hope as well.
This is another one of those therapy words that we all love. Gradual exposure means that the clinician will not dive into the dark depths of the trauma right off the bat. Flooding is a term that is used often in therapy and it means overwhelming the client by moving too deeply too quickly during trauma treatment. TF-CBT emphasizes gradual exposure every single step of the way to avoid flooding and an increase in symptoms. We want to dip our toe in the water and SLOWLY move into the shallow end and eventually into the deep end of the pool. We never want to jump into the deep end when it comes to trauma. One of the first steps of TF-CBT is teaching the client and caregiver coping skills. Coping skills are used for two main reasons: to begin decreasing symptoms and to provide client and caregiver with tools to use to calm themselves as the trauma is being processed throughout treatment.
The caregiver is an integral part of treatment for many reasons. The caregiver provides support for the client and is with the client day in and day out. The trauma the client experienced also significantly affects the caregiver. It is difficult to care for a child that has experienced a trauma. It can trigger the caregiver if he/she has his/her own past trauma, it can be traumatizing and cause the caregiver to experience symptoms of anxiety or vicarious trauma, and it is difficult to fully understand the client’s symptoms and behaviors related to the trauma. Education is an important part of TF-CBT, as well. Psycho-education is provided throughout treatment to the client and the caregiver. It is important that both parties understand the ins and outs of trauma to better equip themselves to heal from it. A caregiver can be a parent, another family member, a foster parent, a social worker, or whoever is the primary caretaker of the child at that time. It is ideal to have someone that will be able to commit to the full process of treatment to provide the greatest benefits to the child. TF-CBT treatment works to heal the child and the family because trauma often ripples farther than we realize.
As I mentioned earlier, the clinician will provide the client and caregiver with coping skills from the beginning of treatment. These skills will include calming skills, grounding skills, communication skills, and mindfulness skills. The skills will be tailored to the client’s and caregiver’s symptoms. One of the goals of providing these skills is to allow the client and caregiver to see that they can begin to combat the symptoms in a healthy way. It is ideal that the client and caregiver work on these skills together outside of sessions to increase efficiency. These skills are also important as the client continues in treatment and begins to get to the deep side of the pool that involves the details of the traumatic experience. These skills will allow the client and caregiver to be able to walk into those deep dark places knowing they can come out of them and ground themselves and calm themselves. Coping skills can provide a sense of empowerment to the client and caregiver during treatment and throughout life.
Valerie Smith is our lead clinician doing TF-CBT. For more information on TF-CBT please contact us.
Flashbacks are our brain’s way of processing traumatic events that we’ve experienced. Our subconscious taps into those important memories but they are not contained- meaning they tend to spill out everything related to the traumatic event. For many individuals, this experience can be just as terrifying as the initial event.
Flashbacks usually happen without warning. Most result from a “triggering” that occurs by an external experience. Triggers are typically sensory-based experiences that manifest via smells, sounds, tastes, textures that remind the person of the traumatic event. The sound of fireworks or a car backfiring can remind a soldier of gunfire. I once had a patient who would have flashbacks around flower shops, as the overwhelming smell of flowers would bring him back to his sister’s funeral.
Living with flashbacks is very difficult, but with practice there are some ways you can work through these disturbing events:
Remind yourself that you are in a safe place and having a flashback. Use that self-talk and tell yourself, as many times as necessary, that these are only memories until you can feel yourself begin to calm.
Sometimes using your five senses can help you to be in the present moment. If one sense is causing the flashback use your other senses to place yourself in the actual current environment. The tactile experience of stamping your feet on the ground can remind yourself that you are free to get away from any situation that has become uncomfortable for you. See more here on mindfulness tips.
Fear and panic causes our breathing to become shallow and erratic. Shallow our erratic breathing exacerbates the stress we feel in that moment because our body is literally panicking from a lack of oxygen. In these fearful moments, when we slow our breathing and take deeper and deeper breaths, we actually signal to our brain and body that everything is okay. One of my favorite breathing tricks is to trace one hand with the opposite. When you go up a finger breathe in, then breathe out as you trace back to the palm of you hand. Repeat till you are calm and your breathing is regular.
No one wants to remember their trauma, let’s face it it’s not an easy experience and I understand you want to move on and forget it NOW. However, our bodies and our minds need time to process what has happened. It’s normal, expected, and honestly needed to experience a full range of emotions. Honor your experience and yourself for making it through and surviving.
Going through trauma alone is not really advisable. I understand there may be feelings of shame, guilt, fear that are preventing you from feeling comfortable opening up. However, it is important for you to have supports
It’s important that you let loved ones know about your to help you through this process. Opening up to trusted loved ones can allow for them to help you work through flashbacks and process what has happened. You may also want to open up to a mental health professional to gain a deeper understanding of what is happening to you, how to cope with flashbacks and triggers and work through those difficult memories and emotions.
If you or a loved one is suffering from flashbacks and would like to explore treatment options, please be in touch, we would be happy to discuss how we may be able to help.
Stay Shining,
Unfortunately, being a survivor of trauma or abuse is exceedingly common. According to the National Sexual Violence Resource Center,one in four girls and one in six boys will be sexually abused before they turn 18 years old. Additionally, they also found that one in five women and one in 71 men will be raped at some point in their lives.
Being a survivor of abuse can be challenging, thankfully with some self-care in place you can begin your healing journey to a healthier you. That journey from feeling scared, afraid, angry and/or alone to a place of peace and acceptance can be an empowering one. Regardless of whether your trauma was recent or happened years ago, a daily self-care regimen will help you cope with the trauma that still affects you today.
An essential component of maintaining optimum physical, mental, and emotional health is ensuring you get adequate sleep each night. According to The Sleep Foundation, “while sleep issues after a traumatic experience can be distressing, they may also be an important opportunity for treating and healing from trauma. Research suggests that being able to sleep after a traumatic event can reduce intrusive trauma-related memories and make them less distressing.” Additionally, getting adequate sleep helps to improve memory, increase positive mood and decrease stress.
Meditating for just five to ten minutes can have some really positive benefits including: boosting immune response, regulating stress levels, increasing focus and elevating mood. Headspace (the App) now has a program on Netflix that not only guides you through meditations but also explains why and how a particular exercise can help you. I’ve also always been a big fan of the App Insight Timer. I find guided meditations are often easier for people to start off with and you can then work your way into solely music, nature sounds or silent meditations. For anxious folx, guided meditation can help to give you a focus point so it is not so overwhelming in the beginning.
Exercise is beneficial for just about everyone, but for trauma survivors it can also be a way to release pent-up emotions you have relating to what has happened to you. The type of exercise is not really as important, as engaging in a daily practice of release. If you like to dance, do some Zumba, if you are more of a yoga lover, go with that. For some, taking kickboxing or jiu-jitsu can help them feel more in control after an assault and better able to defend themselves. No matter what you choose remember that exercise should be an act of self-care, meaning it should be something you enjoy- not a punishment.
For many survivors there is a good-deal of shame and guilt that comes with what has happened to them. For those reasons, it is all the more important to really focus on programing yourself with positive thoughts and beliefs. For example: “I am loved,” “I am worthy,” “I am valued,” “I am strong,” “I am enough.” I often tell client’s to pick an opposite thought to their negative self-talk, so if your inner “Karen” is saying: “I am disposable”, you say to yourself: “I am worthy and deserving of love, respect and affection”. There is a really amazing App that spams your phone, however often you set it, to give you positive affirmations called “I Am”. If its a struggle for you at first to come up with your own affirmations, I really recommend it.
This process of changing that inner voice takes time and truly is a practice so be gentle with yourself. You will have days where it works great and other days where you cannot seem to get “Karen” to stop talking. It’s okay, just take it one step, one moment at a time.
Support is critical need for healing, surround yourself with people who build you up, cheer you on and pick you up when you are down. If you have a solid support system don’t be afraid to engage them, by calling a friend or family member, attending a support group and/or finding a therapist. If your support system is lacking, use a smartphone app or the Meetup website to find a local, like-minded group and make some new friends.
Often times survivors feel alone and like no one can or will understand how they feel, or that they will be judged for what happened to them. However, as said in the beginning abuse is more common than we would like to believe in this country. Sharing your struggles with people who understand and care about you and your well-being is an important aspect of your healing journey. If you are a sexual abuse survivor and need some words of advise from others who have been through it but are not ready to take that step of opening up just yet, I highly recommend Dear Sister by Lisa Factora-Borchers and Aishah Shahidah Simmons - a book of letters from survivors of sexual abuse to other survivors.
Are you a survivor of trauma or abuse? A licensed mental health professional can help you so you don’t have to go through this alone. Give our office a call today so we can set up a time to talk.
Keep Shining,