In the United States, one of the worst, most prolific epidemics often goes unseen: child abuse.
More than 6.6 million children annually are referred to child protection agencies, according to the Children’s Bureau 2014 Child Maltreatment report. The report states that the most common types of child maltreatment are neglect (75%) and physical abuse (17%). In severe cases, death can be the final outcome, as more than 1,500 children died that year from abuse and neglect, the report states.
While horrifying in its own right, victims of child abuse may suffer adverse effects later in life, such as developing mental health disorders, addiction, reproductive risks and lower life expectancies – by as much as two decades, according to the American Journal of Preventative Medicine. While the facts are undeniably grim, child victims are not condemned to the resulting issues. Instead, trauma-focused cognitive behavioral therapy (CBT) can equip these children to grapple with and overcome a history of child abuse.
What is Trauma-Focused Cognitive Behavioral Therapy (CBT)?
Trauma-focused CBT is a treatment based on learning and cognitive therapies that strives to address the warped beliefs and perceptions children may have obtained as a result of the abuse. The overall objective is to mitigate negative emotional or behavioral responses traumatic events may trigger in children by encouraging children to talk about their experiences, whether that trauma is related to sexual, physical or verbal abuse, traumatic loss or other events.
Children are not the only ones who stand to benefit from trauma-focused CBT – adolescents, adult survivors, and whole families can also leverage the treatment to address trauma collectively. Even in cases where only the child was affected by the trauma, the therapy is often conducted with caregivers or non-offending parents in a family therapy environment. This method can be applied for children who experience a single traumatic event (like a sudden death) or those who experience sustained, multiple traumas (like ongoing physical abuse).
How Does Trauma-Focused CBT work?
Trauma-focused CBT strives to achieve five key goals:
- Correct warped views related to the trauma. For example, a child may believe the abuse was his or her “fault.”
- Equip children and their caregivers to manage and address upsetting thoughts, feelings, or behaviors that stem from the trauma
- Develop skills for response and support in caregivers
- Bolster personal safety and mitigate risks to experience abuse again
- Mitigate children’s responses, emotionally and behaviorally, that relate to reminders of the traumatic event
To achieve these goals, trauma-focused CBT addresses the individuals involved and the family unit together. First, the therapy seeks to support the child, through exploring ways to cope with trauma and providing a space for children to share the story of the traumatic event when they feel ready. This can take the form of a verbal or written story, or even an art form as a means of communication. In a family context, the family is partnered with psychologists, psychiatrists, clinical social workers or professional clinical counselors for support. Together, the parent or caregiver and child explore how negative thoughts, feelings and behaviors relate to the trauma, and participate in joint sessions together. Each also typically participates in separate, individual sessions. Through trauma-focused CBT, parents or caregivers learn about PTSD and childhood trauma and develop strategies for coping with their child’s specific trauma, which could include different parenting approaches, stress-management and communication methods. Trauma-focused CBT is typically a short-term treatment, ranging from eight to 25 sessions and occurring in many different settings: an outpatient mental health clinic, a group home, a hospital, school or home.
How Does Trauma-Based CBT Help Children?
According to UCLA’s Semel Institute for Neuroscience and Human Behavior, more than 80% of children treated with trauma-focused CBT therapy show “significant “ symptom reduction within 12-16 weeks of treatment. The Child Welfare Information Gateway highlights 11 different empirical studies that have evaluated how trauma-based CBT impacts children using the therapy. The findings all indicate the therapy effectively mitigates PTSD, depression and behavior challenges spurred by traumas. This improvement can include reduced intrusive thoughts or avoidance, better coping with reminders and associations, reduced depression, anxiety, behavior issues, sexualized behavior, trauma-related shame and anxiety, increased interpersonal trust and social skills, and increased personal safety skills.
Therapists who provide trauma-based CBT must be licensed mental health professionals, and often specialize in cognitive behavioral therapy and family therapy. Professionals are often required to have supervised experience in trauma-focused therapy as well. In applying trauma-focused cognitive behavior therapy in children, professionals are arming them to not only overcome past traumas, but also to better prepare themselves to navigate life after the trauma has subsided, and to prevent the likelihood they will suffer another, similar trauma.