Treatment of traumatized children and adolescents, TF-CBT

Main objective

The study has three objectives:

1. to give therapists training in a trauma-focused therapeutic model
2. to implement this model in regular polyclinics
3. to study the extent to which this therapeutic model is more effective in relation to traumatized children and adolescents than usual polyclinical practice.

The therapeutic model that was examined is Trauma-Focused Cognitive Behavioural Therapy (TF-CBT).

TF-CBT was developed by Ester Deblinger, Judy Cohen and Anthony Mannarino in the USA. It was first used with children exposed to sexual abuse. It has been gradually adapted for use with children who have been exposed to types of traumas other than violence, who have been witnesses to violence and certain disasters. In addition, work is being done to adapt the model for use with children who have been exposed to traumatic grief. Several studies show documented effectiveness, and the treatment principles have been included in ‘Best Practice’ guidelines in the USA and England.

Similar studies have not been conducted in Norway or in the rest of Europe. NKVTS is the first organization to test TF-CBT in Europe. Experiences from this study will also provide the basis for planning similar studies pertaining to the treatment of refugee children and adult refugees.

Method

The study is a randomized, controlled study conducted in regular polyclinics in Norway. Therapists from eight mental health clinics were trained in the model. Other therapists in the clinics were the control group.

Children who meet the criteria for participation were randomly allocated to receive TF-CBT or traeatment as usual. Each is assessed at the start of therapy, during the course of therapy, at the end of treatment, one year after treatment start and at 18 months follow-up. 

Further information

International and national partners

Judith Cohen and Anthony Mannarino of the Center for Traumatic Stress in Children & Adolescents in Pittsburg, USA, have assisted in both the training and the research aspects associated with carrying out the project.

Professor Stephen Shirk of the University of Denver has advised on process objectives.

Collaboration with Dr. Lutz Goldberg of the Department for Child and adolescent Psychiatry, University of Ulm, Germany, is established. A joint European cooperation on implementing TF-CBT in Europe has started. 

Publications

Birkeland, M. S., Holt, T., Ormhaug, S. M., & Jensen, T. K. (2020). Perceived social support and posttraumatic stress symptoms in children and youth in therapy: A parallel process latent growth curve model. Behaviour Research and Therapy, 132. doi:10.1016/j.brat.2020.103655

Knutsen, M., & Jensen, T. K. (2019). Changes in the trauma narratives of youth receiving trauma-focused cognitive behavioral therapy in relation to posttraumatic stress symptoms. Psychotherapy Research, 29(1), 99. doi:10.1080/10503307.2017.1303208

Knutsen, M. L., Knutsen, M. L., Czajkowski, N. O., & Ormhaug, S. M. (2018). Changes in posttraumatic stress symptoms, cognitions, and depression during treatment of traumatized youth. Behaviour Research and Therapy, 111, 119-126. doi:10.1016/j.brat.2018.10.010

Ormhaug, S. M., & Jensen, T. K. (2018). Investigating treatment characteristics and first-session relationship variables as predictors of dropout in the treatment of traumatized youth. Psychotherapy Research, 28(2), 235-249. doi:10.1080/10503307.2016.1189617

Jensen, T. K. (2017). Behandling av traumatiserte barn og ungdom: Traume-fokusert kognitiv atferdsterapi. In J. Kjøbli, H. Eng, S. K. Ertesvåg & I. Frønes (Red.) Å mestre det vanskelige. Individrettede intervensjoner for barn og unge (pp. 97-112). Gyldendal Akademisk.

Jensen, T. K., Holt, T., & Ormhaug, S. M. (2017). A follow-up study from a multisite, randomized controlled trial for traumatized children receiving TF-CBT. Journal of Abnormal Child Psychology, 45(8), 1587-1597. doi:10.1007/s10802-017-0270-0

Dos Santos, N. E., Jensen, T. K., & Ormhaug, S. M. (2016). Er det så ille å bli spurt om traumer? : barns opplevelser av traumekartlegging i BUP[ Is it really so upsetting? Traumatized children’s reaction to screening and symptom assessment] Norwegian only. Tidsskrift for Norsk Psykologforening, 53(7), 536-545.

Holt, T. (2016). Betydningen av foreldres reaksjoner og støtte. In C. Øverlien, M. I. Hauge & J. H. Schultz (Red.) Barn, vold og traumer. Møter med unge i utsatte livssituasjoner. (pp. 63-75). Universitetsforlaget.

Jensen, T. K., & Ormhaug, S. M. (2016). Behandling av barn og ungdom som har erfart traumer [Treatment for children and adolescents exposed to trauma] Norwegian only. In C. Øverlien, M. I. Hauge & J. H. Schultz (Red.) Barn, vold og traumer. Møter med unge i utsatte livssituasjoner. (pp. 237-250). Universitetsforlaget.

Jensen, T. K., & Ormhaug, S. M. (2016). Tidlig intervensjon og forebygging av traumerelaterte vansker og posttraumatisk stress hos barn og unge [Early intervention for traumarelated sypmtoms and posttramatisc stress] Norwegian only. In C. Øverlien, M. I. Hauge & J. H. Schultz (Red.) Barn, vold og traumer. Møter med unge i utsatte livssituasjoner. (pp. 23-44). Universitetsforlaget.

Ormhaug, S. M. (2016). The therapeutic alliance in the treatment of traumatized youths. Relationship to outcome and dropout across rater perspectives and therapeutic interventions.. (Dissertation).

Dittmann, I., & Jensen, T. K. (2014). Giving a voice to traumatized youth-Experiences with Trauma-Focused Cognitive Behavioral Therapy. International Journal of Child Abuse & Neglect, 38(7), 1221-1230. doi:10.1016/j.chiabu.2013.11.008

Holt, T., Cohen, J., Mannarino, A., & Jensen, T. K. (2014). Parental Emotional Response to Children’s Traumas. Journal of Aggression, Maltreatment & Trauma, 1057-1071. doi:10.1080/10926771.2014.953717

Holt, T., Jensen, T. K., & Wentzel-Larsen, T. (2014). The change and the mediating role of parental emotional reactions and depression in the treatment of traumatized youth: results from a randomized controlled study. Child and Adolescent Psychiatry and Mental Health (CAPMH), 8(1). doi:10.1186/1753-2000-8-11

Hukkelberg, S. S., Ormhaug, S. M., Holt, T., Wentzel-Larsen, T., & Jensen, T. K. (2014). Diagnostic utility of CPSS vs. CAPS-CA for assessing posttraumatic stress symptoms in children and adolescents. Journal of Anxiety Disorders, 28(1), 51-56. doi:10.1016/j.janxdis.2013.11.001

Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. E. C., Hukkelberg, S. S., Indregard, T., Stormyren, S., & Wentzel-Larsen, T. (2014). A Randomized Effectiveness Study Comparing Trauma-Focused Cognitive Behavioral Therapy With Therapy as Usual for Youth. Journal of Clinical Child & Adolescent Psychology, 43(3), 356-369. doi:10.1080/15374416.2013.822307

Ormhaug, S. M., Jensen, T. K., Wentzel-Larsen, T., & Shirk, S. R. (2014). The Therapeutic Alliance in Treatment of Traumatized Youths: Relation to Outcome in a Randomized Clinical Trial. Journal of Consulting and Clinical Psychology, 82(1), 52-64. doi:10.1037/a0033884

Glad, K. A., Jensen, T. K., Holt, T., & Ormhaug, S. M. (2013). Exploring self-perceived growth in a clinical sample of severely traumatized youth. International Journal of Child Abuse & Neglect, 37(5), 331-342. doi:10.1016/j.chiabu.2013.02.007

Jensen, T. K., Granly, L., Hoaas, L. E., & Stormyren, S. (2012). Traumefokusert kognitiv atferdsterapi for barn og unge som har vært utsatt for traumer [Traumafocused cognitive behavioral therapy for children exposed to trauma.] Norwegian only. In K. Martinsen & R. Hagen (Red.) Håndbok i kognitiv atferdsterapi i behandling av barn og unge (pp. 169-199). Gyldendal Akademisk.

Ormhaug, S. M., Jensen, T. K., Hukkelberg, S. S., & Egeland, K. (2012). Traumer hos barn – blir de gjemt eller glemt? Kartlegging av traumatiske erfaringer hos barn og unge henvist til BUP[ Screening for traumatic experiences among children and adolescents referred to outpatient clinics] Norwegian only. Tidsskrift for Norsk Psykologforening, 49, 234-239.

Hukkelberg, S. S., & Jensen, T. K. (2011). The Dimensionality of Posttraumatic Stress Symptoms and Their Relationship to Depression in Children and Adolescents. Journal of Traumatic Stress, 24(3), 326-333. doi:10.1002/jts.20637

Jensen, T. K. (2007). Hvordan kan vi forstå og hjelpe barn som har vært utsatt for traumer? [How can we understand and help children exposed for trauma?] Norwegian only. In H. Haavind & H. Øvreeide (Red.) Barn og unge i psykoterapi: samspill og utviklingsforståelse (pp. 294-327). Gyldendal Akademisk.