Decades ago, psychologists had little in the way of evidence-based help to offer these children, according to Mannarino, a
professor at the Drexel University College of Medicine and vice
chair of the department of psychiatry at Allegheny General
Hospital in Pittsburgh. That’s what inspired him and colleagues
Judy Cohen, MD, a psychiatrist, and Esther Deblinger, PhD, a
psychologist, to develop Trauma-Focused Cognitive Behavioral
Therapy (TF-CBT) in the 1980s. The course of therapy — usually
12 to 18 sessions — has been shown to reduce PTSD, anxiety,
depression and other symptoms in children and families.
Mannarino spoke to the Monitor about how Trauma-Focused Cognitive Behavioral Therapy works, and how he is
using mobile technology to enable more children to benefit
Who is this therapy for?
We’ve been studying Trauma-Focused Cognitive Behavioral
Therapy, TF-CBT for short, for 25 years, and we have pretty
good data showing its effectiveness with children as young as 3
and as old as 18.
We’ve studied the treatment with children who’ve been
sexually abused, children exposed to domestic violence, children
who’ve had traumatic losses, children exposed to multiple
traumas. And it’s been studied around the world at this point
— in Japan, in Norway, in Germany, in the Netherlands, and
even in some low-resource countries like Zambia and the
Democratic Republic of Congo, where children have been
exposed to civil war, to sex trafficking, to really complicated
trauma backgrounds and histories.
Is it equally effective in all those situations?
Yes, fortunately, it has worked equally well with different
How does the treatment work?
traumas. There have been 16 randomized controlled trials that
have been done, demonstrating the efficacy with a variety of
populations of children. Eight have been conducted by our
team and the other eight by other research teams around the
Maybe the biggest surprise was that it was effective even in the
low-resource countries like Congo and Zambia, where some of
these children have been exposed to as many as 10 different types
of trauma experiences, and have had little or no access to mental
health services. You wouldn’t necessarily expect that it would
work as effectively with children with such extensive trauma
backgrounds. But the research that’s come out from us and others
has shown that some of the effect sizes, the actual size of the
outcomes, are equal to if not greater than what we’ve found here
in the United States with the populations we’ve studied.
It’s a phase-based treatment. The first part focuses on stabilizing
The essentials of TF-CBT
a child’s clinical symptoms, and includes psychoeducation. We
work with families to help them understand the connection
More than two-thirds of American children will experience a potentially traumatic life event by age 16, according to psychologist Anthony Mannarino, PhD. That number might sound high. But “when you
think about violence, abuse, traffic accidents, bullying, deaths in the family — you
can get up to two-thirds pretty quickly,” he says.
Getting TF-CBT right takes PRACTICE —
the acronym, that is. It describes the key
components of the therapy:
Psychoeducation and parenting skills
Affect expression and regulation skills
Cognitive coping skills and processing
In vivo exposure
Conjoint parent-child sessions
Enhancing safety and future development