Have you been able to follow any groups for the long
The longest we’ve been able to follow them is two years, which
isn’t a super-long time, but not bad for a treatment outcome
study. In the follow-ups we’ve done, we’ve found that the
treatment gains that children made at the end of TF-CBT were
maintained two years out. Those gains include reductions in
PTSD symptoms, depression, anxiety and behavior problems.
What’s also really important is that parents who participated
in the treatment make significant gains as well. They have
reductions in their own depression, PTSD symptoms, and
distress related to the child’s trauma experience, and also
significant increases in their support of the child.
Our research shows that the significant gains the parents
have made correlate with children having reductions in their
own symptoms, particularly with the younger children. If
parents have made gains in their own PTSD and depression,
they’re going to be more available for their children in the
aftermath of trauma, and that’s going to make a big difference.
You’ve said that early on, one barrier to
implementing this therapy was therapists’ hesitancy
to talk to children directly about trauma. Is this still a
Sometimes therapists have been reluctant or worried that they
would retraumatize children if they encouraged them to talk
about it. But the truth is that whether we ask them to talk about
it or not, those memories are living inside of these children and
affecting their minds, bodies and brains in highly adverse ways.
So as therapists, we have to be brave enough to talk to
children about it so that they can begin to externalize their
feelings and their thoughts instead of those memories just living
inside of them. The purpose of TF-CBT is to help families and
children become less avoidant and be able to confront their
feelings and their thoughts about the trauma experience.
Of course, trauma work can be painful for therapists because
What are your future directions for research?
we’re having to hear the stories that children tell us about their
trauma backgrounds. Because of that, when therapists are
learning TF-CBT, we strongly encourage them to make sure
they’re taking good care of themselves, having a life away from
work and actually practicing some of these same relaxation
skills that we’re encouraging children to learn as part of therapy.
We hear with some frequency from therapists that the early
cognitive processing part of the treatment — helping children
understand the connections between thoughts, feelings, and
behaviors — isn’t easy for children to learn. And sometimes it’s
hard for therapists to teach, particularly therapists who aren’t all
that experienced with a cognitive behavioral approach.
Because of that, Judy Cohen and I teamed up with
students and faculty from the Entertainment Technology
Center at Carnegie Mellon University to develop a video
game to help therapists teach children cognitive processing.
The game is called TF-CBT Triangle of Life, and it’s free
through the Apple store or the Google Play store. The game
is set in an African jungle, where a lion teaches other animals
to connect thoughts, feelings and behaviors, and most
importantly to modify thoughts to help them feel better. For
example, a fish gets hit with a banana peel and immediately
thinks the monkey threw it because he was mad at him. The
lion helps this fish understand that maybe the monkey didn’t
purposely throw the banana peel at him, maybe it was an
accident. And then the lion discusses how if you thought it
was an accident, how would you think about that versus if
you thought the monkey was actually trying to hit you with
the banana peel?
Those kinds of situations help children learn to connect
thoughts, feelings and behaviors, and also to help them see that
if you change your thoughts, you can feel better as well. The
game has been downloaded several thousand times, and we’ve
gotten a lot of good feedback on it. n
“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.”