Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length

Abstract Background: Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists do not always use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior; TPB) and an implementation science framework (the Consolidated Framework for Implementation Research; CFIR) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a comprehensive understanding of factors affecting therapists’ use of TNs.Methods: Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR.Results: While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last six months. Survey data indicate a number of TPB-related determinants to using on trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. Conclusions: These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations.

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Utilization and Implementation of Trauma-Focused Cognitive–Behavioral Therapy for the Treatment of Maltreated Children

Child Maltreatment ◽

10.1177/1077559511418220 ◽

2011 ◽

Vol 17 (1) ◽

pp. 80-85 ◽

Cited By ~ 40

Author(s):

Brian Allen ◽

Jennifer C. Johnson

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavior Management ◽

Behavioral Therapy ◽

The United States ◽

Cognitive Behavioral ◽

Mental Health Clinicians ◽

Management Skills ◽

Trauma Narrative ◽

Full Sample ◽

Maltreated Children

Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) is one of the most researched and widely disseminated interventions for maltreated children. This study describes the findings of a survey of 132 mental health clinicians in children’s advocacy centers (CACs) across the United States to determine the percentage of clinicians who are trained in and utilize TF-CBT and the frequency with which TF-CBT components are implemented. A total of 103 (78%) of the clinicians reported being trained in and utilizing TF-CBT on a regular basis; however, only 66% of these clinicians (58% of the full sample) reported being likely to use each component. The most preferred components were teaching relaxation skills and providing psychoeducation, whereas teaching caregiver child behavior management skills, developing a trauma narrative, and cognitive restructuring were less preferred. Results are discussed in the context of continued dissemination efforts and implications for improving clinical practice.

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Understanding therapists’ perceived determinants of trauma narrative use

Implementation Science Communications ◽

10.1186/s43058-021-00231-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Hannah E. Frank ◽

Briana S. Last ◽

Reem AlRabiah ◽

Jessica Fishman ◽

Brittany N. Rudd ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Qualitative Interviews ◽

Integrated Approach ◽

Cognitive Behavioral ◽

Trauma Narratives ◽

Trauma Narrative ◽

Causal Explanations ◽

Individual Level ◽

Causal Pathways

Abstract Background Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists’ use of TNs. Methods Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. Results While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. Conclusions These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.

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