Trauma/PTSD in Children

Question 1

What is the most recommended treatment approach for PTSD?

Answer 1

cognitive behavior therapy followed by exposure therapy

Question 2

What is the recommended treatment approach for sexual abuse?

Answer 2

CBT, in addition to psychodynamic, supportive component, or psychodynamic play therapy

Question 3

What is the acronym for the steps involved in TF-CBT?

Answer 3

PRACTICE!!!

P
R
A
C
T
I
C
E

Question 4

(TF-CBT) Psychoeducation

Answer 4

–Provide the child and caregiver with education about the prevalence of abuse or other traumatic events the child may have experienced, normal reactions to abuse and trauma, and the benefits of treatment.
–The therapist seeks to instill hope and positive expectations about the outcome of therapy.
–Psychoeducation begins treatment and continues throughout the treatment process.

Question 5

(TF-CBT) Parenting Skills

Answer 5

– Important because child victimization often results in behavior problems.
– Provides caregivers with effective strategies for managing disruptive, aggressive, or non-compliant behavior; and/or fears, sleep problems, and inappropriate sexual behaviors.
– Many caregivers of abused and traumatized children struggle with parenting skills, or they may feel guilty about disciplining their children who have experienced trauma.

Question 6

(TF-CBT) Relaxation

Answer 6

– The child and the caregiver learn a set of relaxation skills to help them manage the physiological symptoms of fear and anxiety. (belly breathing, imagery, progressive muscle relaxation)
– Having the body physiologically relax reduces the child’s perceptions of fear and anxiety and encourages a sense of empowerment and mastery over symptoms.
-Self-instruction and relaxation should be used to help tolerate exposure, not to distract from it bc attention is necessary for exposure work.

Question 7

(TF-CBT) Affect Identification and Regulation

Answer 7

– Helps with identifying, understanding, expressing, and regulating their feelings, particularly negative feelings.
– Caregivers often experience a range of difficult emotions following a traumatic event, and they may need help learning how to express and regulate their emotions in a healthy manner.

Question 8

(TF-CBT) Cognitive Coping

Answer 8

– Therapist explains the connections between thoughts, feelings, and behavior.
– Helps the child and caregiver develop the skills to generate alternative thoughts that are more accurate or helpful, in order to feel differently, laying the foundation for later cognitive processing. (cognitive restructuring)
– In parent sessions, caregivers explore specific thoughts related to the traumatic event and how they are connected to specific feelings and behaviors.

Question 9

(TF-CBT) Trauma Narration and Processing

Answer 9

– Children are guided through the creation of a narrative describing the traumatic events with a goal of helping them better manage trauma-related thoughts and feelings.
– Developing the trauma narrative is a form of gradual exposure therapy that allows the child to experience the negative feelings associated with the trauma in small doses in a safe, controlled environment.
– Allows children to manage the feelings associated with the trauma and incorporate them into their life, rather than avoid them.
– The narrative might be accomplished using a variety of methods, including writing a book, drawing a set of pictures, writing poems or writing songs that describe the traumatic event(s) and the child’s reactions.

Question 10

(TF-CBT) In-Vivo Mastery

Answer 10

– Many traumatized kids experience specific, trauma-related fears of things that are not actually dangerous (e.g., rooms in the house). If those fears persist after creating the trauma narrative (i.e., journal writing), in vivo (or “real life,” as opposed to imaginal) exposure activities can be developed to help children overcome these fears (i.e., thru play (psychodynamic)).

Question 11

(TF-CBT) conjoint parent-child sessions

Answer 11

– Virtually all components of TF-CBT involve use of conjoint sessions, but this module focuses on the sharing of the trauma narrative with the caregiver(s).
– Significant caregiver preparation is usually necessary before sharing the narrative to ensure that the sharing sessions are supportive and validating experiences for the children.

Question 12

(TF-CBT) enhancing safety and future development

Answer 12

– Oriented toward ensuring healthy child and family growth after treatment is over.
– Focus is enhancing family communication and children’s personal safety skills, all of which are designed to minimize risk for future victimization and enhance feelings of self-efficacy and self-competence.

Question 13

What kind of psychoeducation can be used with children who have experienced sexual abuse?

Answer 13

– Abuse happens to all kinds of kids; the client is not “the only one,” the abuse does not
“mean something” about the child, and it need not alter the child is some permanent
way.
– Sexual activity is always the responsibility of the adult, regardless of the child’s
behavior. Perpetrators often manipulate children into feeling responsible.
– Sexual stimulation may produce arousal because of the way neurons connect, and
abuse might involve elements of gratification (e.g., attention), but this does not mean
the victim chose to be abused.
– Sex education counters maladaptive learning about sexuality.

Question 14

What are some of the focuses in therapy when working with children who have experienced sexual abuse?

Answer 14

• Work on self-blame should be combined with prevention training to preserve
  and strengthen the client’s sense of control and safety.
• Work on discrimination learning helps children limit the distressing
  implications of the abuse to those persons and situations to which it applies.
• In intrafamilial abuse, child safety is the most urgent priority.
  – Multiple relationships in the family, including the mother-child relationship,
  might need attention.

Question 15

What is the purpose of using a constructivist approach when with clients that have experienced trauma?

Answer 15

the purpose of therapy for PTSD is to help clients reconstruct their problem-saturated stories of victimization, shame, and fear into solution-focused narratives of endurance and survival

Question 16

Why is it important to include a systems-oriented intervention in trauma cases?

Answer 16

Trauma therapy should generally include work with caregivers
because their reactions influence children’s adjustment to negative
Events

Question 17

What does TF-CBT say about why clients develop symptoms?

Answer 17

suggests that the client has internalized or externalized the traumatic event

Question 18

internalizing symptoms

Answer 18

involves symptoms of emotional distress, such as depression, anxiety, low self-esteem, somatization, and withdrawal

Question 19

externalizing symptoms

Answer 19

overt, disruptive behavior problems, such as noncompliance, aggression, and delinquency (narrative therapy may not be helpful for these clients)

Question 20

What is the process of change using TF-CBT?

Answer 20

Training in coping skills is used to reduce the pain of exposure to trauma-related stimuli and to reduce distress in the child’s everyday life. Cognitive therapy addresses the upsetting misunderstandings, especially self blame, that frequently accompany abuse and trauma, and helps clients develop realistic, adaptive understandings of what happened.

Question 21

According to constructivists, why do clients develop symptoms?

Answer 21

Constructivists believe that the etiology of mental health problems is talking about the problem (problem talk) which causes the person to live in a vicious cycle.

Question 22

What is the process of change using a constructivist approach?

Answer 22

Assumes people have the resources within them to fix their problems. Focus in on the solution!

Question 23

What are some of the treatment goals of the constructivist approach?

Answer 23

1. Client will learn to externalize her anxiety as a separate entity not connected to her core self within 3 months.
2. Within 3 months, client will be able to problem-talk about the traumatic experience and address the abuse rather than attempting to forget the abuse.
3. Client will use TF-CBT techniques and coping skills taught in therapy to apply to daily life.
4. Client will learn to rebuild self-esteem and challenge unrealistic expectations of herself within 6 months.

Question 24

what are some of the techniques used in a constructivist approach?

Answer 24

1. Narrative therapy
   -Externalizing the problem → create a name for the problem and portrays it as something separate from the client
   -Encourages clients to develop a different relationship toward the problem
   -Interactive storytelling → client is the main character in the story. in the beginning, client is oppressed by prob, then works thru it, and finally overcomes the prob.
2. Solution-focused therapy
   -Possibility-laced acknowledgement → combine empathy for the client’s past experiences with hope for future changes by means of this strategy
   -Careful, subtle use of language
   -Use time-related aspects of language to break client’s sense of connection between history and future possibilities
   -Miracle question → ask clients to envision their goals for change in a detailed, vivid way
   -exception questions, scaling questions used to ask about when the problem does not happen and severity of the problem, respectively. ID anything that is working!!!!!!