Trauma treatment with children and adolescents

Introduction

Infants, children and adolescents can be exposed to events and experiences that overwhelm them, which possibly lead to damages on their psychological and emotional health. Besides, Müller (2017) notes that such experiences have the capability of affecting the general development of children and adolescents. Different events and experiences have been shortlisted among those that lead to traumatic manifestations in children. Such events may be single or repeated incidents.

Accidents and natural disasters are the most traumatic single events that affect children, while repeated incidences such as serious illness, domestic violence, neglect, death of a loved person, continued exposure to stress and life contexts of violence such as war can lead to trauma among children. According to the study conducted by Tufnell (2008), sexual abuse, physical abuse and domestic violence are the most damaging traumas presented to children. The challenges that these traumas present are enshrined in secrecy, meaning that the occurrence and recurrence of such events confines children and adolescents to oblivion, making them fearful and uncertain of the consequences of revealing their experiences.

Several interventions have been developed to enable children and adolescents overcome the diverse forms of trauma to which they are exposed. Depending on the nature of the experience, children and adolescents have exhibited different behaviors and reactions, with pre-existing vulnerabilities further heightening the effects of the trauma on the victim. This article conducts an empirical review on the cognitive behavior therapy treatment mechanism for children and adolescents suffering trauma. The discussion provides an extensive summary of the available interventions and the context under which this treatment is used with respect to the target population. This paper further analyzes the practice guidelines for trauma treatment using the cognitive behavior therapy, hence providing the implications and benefits of using this trauma treatment method for children and adolescents.

Overview of cognitive behavioral therapy

As defined by Lawson and Quinn (2013), cognitive behavioral therapy is a treatment approach designed to reduce emotional and behavioral responses following traumatic events and experiences such as sexual abuse, domestic violence and other traumatic losses. The cognitive behavioral therapy, therefore, is an evidence-based mechanism of treating trauma-related difficulties. Evidence indicates that this method of treatment has enabled children, adolescents and their caregivers overcome the difficulties related to trauma.

This behavioral intervention is based on the cognitive and learning theories. The main foundation of treatment according to this therapy is anchored on the provision of supportive environment that encourages children to talk about their traumatic experiences. In line with children and adolescents, this therapy enables parents to effectively cope with the effects of emotional distress, further providing frameworks for the development of skills to enable their children overcome trauma.

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This is a topic of interest that reflects on the bulk of literature and evidence available on the methods of trauma treatment with children and adolescents. The main aim of analyzing this treatment method is to establish a stronger understanding of the benefits and characteristics of this intervention. As Cohen and Mannarino (2010) argue, several child welfare experts and organizations have grappled with understanding the best intervention for children and adolescents suffering from trauma. This topic is of vital relevance to psychological experts and professional who work with families at high risk of subjecting children to trauma, as through this article, they are able to make inferences on when to refer traumatized children and adolescents to cognitive behavioral therapists. Besides, the information in this topic is important in highlighting the gains that may accrue from implementing the cognitive behavior therapy as an intervention for trauma among children and adolescents.

While at it, it is necessary to note that this discussion primarily focuses on trauma treatment for children and adolescents using the cognitive behavioral therapy intervention. Rose (2010) explains that the reactions and behaviors of children and adolescents to trauma are unique compared to those of adults. To begin with, children and adolescents are unable to express their feelings and reactions when exposed to trauma. Unlike adults, children and adolescents do not understand what it feels like to be stressed, hence cannot identify any traumatic events and experiences.

Besides, children and adolescents are subject to multiple vulnerabilities that hinder their ability to speak up against the abuses that cause trauma. Such vulnerabilities include the lack of shelter, need for education and need for guardians for social protection and direction. Due to these vulnerabilities, children and adolescents experience difficulties in reporting their experiences, which leads to build-up of stress, which manifests into trauma. The cognitive development of children encompasses the emotional health as well. Adults are identified with strong emotional stability, unlike children and adolescents whose emotions are weak and easily manipulated. This explains why tragic loss can overwhelm children and adolescents and lead to trauma. More to the point, the attachments that children have with other people supersedes the emotional aspect, to envisage the physical, psychological and social attachments.

Best models for cognitive behavioral therapy for children and adolescents

According to Lindauer (2015), the cognitive behavioral therapy was developed to address the negative effects of such events as domestic violence, neglect and sexual abuse. This intervention integrates a consortium of therapeutic approaches to develop a comprehensive management and treatment method for trauma. In a study conducted by Schneider, Grilli and Schneider (2012), it was established that this intervention mechanism was effective for treatment of both single and repetitive traumatic events. In the study, the authors further revealed that cognitive behavioral therapists have registered successes in helping traumatized children and adolescents to address, overcome and resolve the effects related to these experiences.

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Research findings indicate that cognitive behavioral therapy is the leading option and choice used by most therapists to treat children and adolescents suffering trauma (Lawson & Quinn, 2013). These studies further illustrate that Cognitive Behavioral Therapy was developed to specifically help adults, though with advancements in experiments, this therapy was adapted for adolescents and later for children. Several treatment approaches are used for the cognitive behavioral therapy.

The Stanford Cue-Centered Therapy (SCCT)

This cognitive behavioral therapy was developed by researchers at the Stanford School of Medicine to address the trauma presented to children and adolescents. The design of this treatment approach is anchored on addressing problems of a child’s cognitive, behavioral, physical, and affective functioning. The therapy utilizes relaxation training, cognitive behavioral techniques and parental coaching as the pillars of treatment. While testing the validity of this treatment mechanism, Carrion, Kletter, Weems, Berry and Rettger (2013) established that it reduces the negative cognitions and thoughts among children, while in adolescents in standardized the sensitivity to traumatic memory. Through the cognitive behavioral skills, the SCCT minimizes the effects of trauma through enhancing the coping skills among children and adolescents. The SCCT envisages an educational program that highlights the effects of trauma to children and adolescents. Through this way, the victims are able to cope and respond with the negative thoughts and cognitions of traumatic experiences.

In as much as the SCCT incorporates the victims in delivering its treatment plan, (Cohen, Deblinger and Mannarino (2016) observed that this cognitive behavioral therapy is time consuming, as it requires an extensive therapy between the therapist and the victim. Given the short concentration span of children and adolescents, this intervention can be less effective.

Multi-modality Trauma Treatment

This cognitive behavior therapy was developed in 1998. Müller (2017) explains that the MMTT is a developed on the concept of the emotional and physical disruptions caused by trauma subjected to children and adolescents. Therefore, cognitive behavioral therapy strategies were employed to develop this treatment. This 14-session therapy is normally conducted in school settings. These sessions include cognitive restructuring, psycho-education, exposure and relaxation techniques as well as writing narratives on the traumatic events. One core benefit of this treatment mechanism is that it does not only manage the traumatic symptoms in children and adolescents, but also reduces anxiety, anger and depression. This diversity enables the victims of trauma to overcome the spill-over effects of trauma, which manifest in psychological terms. Despite this, the MMTT focuses only on single traumatic events. This limits its applicability in handling trauma accruing from repeated incidences such as child abuse and frequent domestic violence.

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Trauma-Focused Cognitive Behavioral Therapy

In 2006, Judy Cohen led researchers in develop this intervention to specifically target children aged between three and eighteen years. The intervention envisages programs ranging between eight and twenty sessions. While analyzing the workings of this therapy, Cohen (2013) discovered that it is structured to enable children and adolescents learn skills for coping with traumatic memories. These sessions involve a blend of psycho-education, cognitive coping skills, affective modulation and expression, narratives and teachings on relaxation skills. The main advantage of this treatment mechanism is that it is effective with the single, multiple and repetitive forms of trauma subjected to children and adolescents. Besides, this intervention is efficient compared to the other scientifically tested trauma treatment methods. However, a main disadvantage of this therapy is that it does not involve parents. This provision subjects victims of trauma to fear and uncertainty, as they exhibit difficulties in narrating their experiences to therapists in the absence of a trusted figure.

Challenges to the implementation of cognitive behavioral therapy

There are several factors that hinder the implementation of CBT as a treatment for trauma in children and adolescents. The systems of oppressions influence the use of this intervention, as through these systems, societal abuse occurs. It has been identified that CBT among children and adolescents is often effective when the therapist does not exhibit characteristics of the offender, or trigger negative thoughts and cognitions for the traumatic events (Rose, 2010). Therefore, factors such as race, ethnicity, gender and socioeconomic background play a significant role in determining the effectiveness of this therapy.

The systemic stressors influence the implementation of CBT as a treatment mechanism for trauma in children and adolescents. These are the disturbances that manifest in the emotional balance of the trauma victim, as elucidated by Schneider, Grilli and Schneider (2012). Such stresses include depression and anxiety. While administering CBT, emphasizes the need for the therapist to consider developing interventions for these stressors, as studies indicate that these stressors can skew the effectiveness of psychological functioning upon which this intervention is based.