Conclusions And Recommendations

Back To Life! A Personal Grief Guidebook

Personal Guidebook to Grief Recovery

Get Instant Access

There is increasing evidence supporting the efficacy of the trauma-focused CBT treatment model described in this chapter. Based on the treatment comparisons made thus far, the findings suggest at least two important general guidelines for working with children who have suffered trauma. First, findings across several of the treatment outcome investigations highlight the value of involving a nonoffending parent-figure in treatment. This person may be a supportive mother, father, grandparent, foster parent, or other individual serving in a guardian role. Helping a caregiver to function as a supportive resource for a child has value that may exceed what a therapist can offer in weekly sessions and may produce therapeutic benefits that last long after therapy has terminated. Thus, when possible, it behooves therapists to engage both nonoffending maternal and paternal figures in the therapy process. Second, it appears that the structure and directive nature of the CBT model enables parents and children to focus effectively on skills and/or information relevant to overcoming the traumatic experience(s). The results from several studies in which nondirective and/or client-centered approaches were utilized indicate that children are not likely to focus on the abuse without the structured and directive guidance of a skilled therapist.

Given the mounting evidence that the aftereffects of abuse may not only disrupt children's emotional, behavioral, and social development but also may negatively impact brain development, it is critical that effective treatment models, such as the one described here, be identified and utilized as early as possible. However, there is much work to be done in terms of enhancing the availability and utilization of evidence-based treatment models in community settings. Most children who have suffered abuse either never receive treatment or receive services at agencies where up-to-date training is limited. Recently, however, several organizations, including the Kauffman Foundation, the National Child Traumatic Stress Network, and the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, have recognized the efficacy and/or supported efforts to further training and dissemination of this evidence-based treatment model. Additionally, as noted, this model has been modified and expanded for use with children who have suffered traumatic loss, children exposed to domestic violence, and children who have experienced physical abuse (Cohen et al., in press; Runyon et al., 2004; Cohen et al., 2004).

Although these developments are exciting, much remains to be learned about the effective treatment of children who have suffered abuse and/or other traumas. For example, current treatment practices may be enhanced by research efforts aimed at identifying important underlying psychological processes as well as "critical therapy ingredients." In addition, research may help us better understand differential treatment responses as a function of cultural background, gender, developmental stage, coping style, and other child and family characteristics. Finally, there is a critical need for continued development of innovative treatment approaches for less responsive youngsters as well as high-risk adolescents, such as those engaging in self-destructive behaviors. Continued research efforts in these areas will not only help to improve general practice, but most importantly, may help us to individually tailor treatment approaches to achieve optimal outcomes for all children and families who have suffered traumatic experiences.


Achenbach, T. M., & Edelbrock, C. S. (1991). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont.

American Academy of Child and Adolescent Psychiatry [AACAP]. (1998). Practice parameters for the assessment and treatment of children and adolescents with PTSD. Journal of the American Academy of Child and Adolescent Psychiatry, 37(Suppl.), 4S-26S.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory—Second Edition. San Antonio, TX: Psychological Corporation.

Carlson, B. E. (1998). Children's observations of interparental violence. In A. R. Roberts (Ed.), Battered women and their families. New York: Springer.

Cohen, J. A., Berliner, L., & Mannarino, A. P. (2000a). Treatment of traumatized children: A review and synthesis. Journal of Trauma, Violence, and Abuse, 1, 29-46.

Cohen, J. A., Berliner, L., & March, J. S. (2000b). Treatment of children and adolescents. In E. B. Foa, T. M. Keane, & M.J. Friedman (Eds.), Effective treatments for PTSD (pp. 106-138). New York: Guilford Press.

Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2005). Trauma-focused, cognitive behavioral therapy for sexually abused children. In E. Hibbs & P. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 743-765). Washington, DC: American Psychological Association.

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for sexually abused children with PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393-402.

Cohen, J. A., & Mannarino, A. P. (1993). A treatment model for sexually abused preschoolers. Journal of Interpersonal Violence, 8, 115-131.

Cohen, J. A., & Mannarino, A. P. (1996a). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry 35, 42-50.

Cohen, J. A., & Mannarino, A. P. (1996b). Factors that mediate treatment outcome of sexually abused preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1402-1410.

Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: Outcome during one year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228-1235.

Cohen, J. A., & Mannarino, A. P. (1998). Interventions for sexually abused children: Initial treatment findings. Child Maltreatment, 3, 17-26.

Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000c). Trauma-focused cognitive behavioral therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence, 15, 1202-1223.

Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004). Treating childhood traumatic grief: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1225-1233.

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (in press). Treating trauma and traumatic grief in children and adolescents: A clinician's guide. New York: Guilford Press.

Cole, J. (1988). Asking about sex and growing up. New York: Morrow.

Conte, J. R., & Schuerman, J. R. (1987). Factors associated with an increased impact of child sexual abuse. Child Abuse and Neglect, 11, 201-211.

Curtis, J. L. (1998). Today I feel silly and other moods that make my day. New York: HarperCollins.

DeBellis, M. D., Baum, A., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A.M., et al. (1999). Developmental traumatology. Part I: Biological stress systems. Biological Psychiatry 45, 1259-1270.

Deblinger, E., & Heflin, A. H. (1996). Treating sexually abused children and their nonoffending parents: A cognitive behavioral approach. Thousand Oaks, CA: Sage.

Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310-321.

Deblinger, E., McLeer, S. V., & Henry, D. (1990). Cognitive behavioral treatment for sexually abused children suffering post-traumatic stress: Preliminary findings. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 747-752.

Deblinger, E., Stauffer, L. B., & Steer, R. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6, 332-343.

Deblinger, E., Steer, R., & Lippmann, J. (1999). Maternal factors associated with sexually abused children's psychosocial adjustment. Child Maltreatment, 4, 13-20.

Everett, B., & Gallop, R. (2001). The link between childhood trauma and mental illness: Effective interventions from mental health professionals. Thousand Oaks, CA: Sage.

Everson, M. D., Hunter, W. M., Runyon, D. K., Edelson, G. A., & Coulter, M. L. (1989). Maternal support following disclosure of incest. American Journal of Orthopsychiatry, 59, 197-207.

Feiring, C., Taska, L., & Lewis, M. (1999). Age and gender differences in children's and adolescents' adaptation to sexual abuse. Child Abuse and Neglect, 23, 115128.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A.M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258.

Finkelhor, D. (1994). Current information on the scope and nature of child sexual abuse. Future of Children, 4, 31-53.

Finkelhor, D. (1995). The victimization of children: A developmental perspective. American Journal of Orthopsychiatry, 65, 177-193.

Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1992). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.

Friedrich, W. N., Grambsch, P., Damon, L., Hewitt, S. K., Koverola, C., Lang, R., Wolf, V., & Broughton, D. (1992). The child sexual behavior inventory: Normative and clinical comparisons. Psychological Assessment, 4, 303-311.

Hill, J. (2003). Childhood trauma and depression. Current Opinion in Psychiatry, 16, 36.

Jesse, N. (1991). Please tell! A child's story about sexual abuse. Center City, MN: Hazelden Foundation.

Kaufman, J., Birmaher, B., & Brent, D. A. (1996). Schedule for Affective Disorders and Schizophrenia for school-age children: Present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980-988.

Kelley, B. T., Thornberry, T. P., & Smith, C. A. (1997, August). In the wake of childhood maltreatment. Juvenile Justice Bulletin, pp. 1-15.

King, N., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., et al. (2000). Treating sexually abused children with post-traumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 59, 1347-1355.

Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322-342.

Kolko, D.J. (2002). Child physical abuse. In J. E .B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. A. Reed (Eds.), The APSAC handbook on child maltreatment (2nd ed., pp. 21-54). Thousand Oaks, CA: Sage.

Kovacs, M. (1985). The Children's Depression Inventory (CDI). Psychopharmacology Bulletin, 21, 995-998.

Lippmann, J. (2002). Psychological issues. In M. A. Finkel & A. P. Giardino (Eds.), Medical evaluation of child sexual abuse: A practical guide (2nd ed., pp. 193-213). Thousand Oaks, CA: Sage.

Mackintosh, N. (1983). Conditioning and associative learning. New York: Oxford University Press.

Mannarino, A. P., Cohen, J. A., & Berman, S. R. (1994). The Children's Attributions and Perceptions Scale: A new measure of sexual abuse-related factors. Journal of Clinical Child Psychology, 23, 204-211.

March, J. S. (1997). Multidimensional Anxiety Scale for Children: Technical Manual. North Towanda, NY: Multi-Health Systems.

March, J. S., Amaya-Jackson, L., Murray, M., & Schulte, A. (1998). Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder following a single incident stressor. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 585-593.

Mayle, P. (1977). "Where did I come from?" The facts of life without any nonsense and with illustrations. New York: Kensington.

McLeer, S. V., Deblinger, E., Henry, D., & Orvaschel, H. (1992). Sexually abused children at high risk for PTSD. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 875-879.

Mowrer, O. H. (1939). A stimulus response analysis of anxiety and its role as a reinforcing agent. Psychological Review, 46, 553-565.

Mowrer, O. H. (1960). Learning theory and behavior. New York: Wiley.

Runyon, M., Basilio, I., Van Hasselt, V. B., & Hersen, M. (1998). Child witnesses of interparental violence: A manual for child and family treatment. In V. B. Van Hasselt & M. Hersen (Eds.), Sourcebook of psychological treatment manuals for children and adolescents (pp. 203-278). Hillsdale, NJ: Erlbaum.

Runyon, M. K., Deblinger, E., Ryan, E. E., & Thakkar-Kolar, R. (2004). An overview of child physical abuse: Developing an integrated parent-child cognitive-behavioral treatment approach. Trauma, Violence, and Abuse: A Review Journal, 5, 6585.

Saunders, B. E., Berliner, L., & Hanson, R. F. (Eds.). (2003). Child physical and sexual abuse: Guidelines for treatment (final report: January 15, 2003). Charleston, SC: National Crime Victims Research and Treatment Center.

Stauffer, L., & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 1, 65-76.

Stauffer, L., & Deblinger, E. (2003). Let's talk about taking care of you! Hatfield, PA: Hope for Families.

Sternberg, K. J., Lamb, M. E., Esplin, P. W., & Baradaran, L. P. (1999). Using a scripted protocol in investigative interviews: A pilot study. Applied Developmental Science, 3, 70-76.

Sternberg, K.J., Lamb, M. E., Hershkowitz, I., Yudilevitch, L., Orbach, Y., Esplin, P. W., & Hovav, M. (1997). Effects of introductory style on children's abilities to describe experiences of sexual abuse. Child Abuse and Neglect, 21, 1133-1146.

Straus, M. A., & Gelles, R.J. (1996). Physical violence in American families. New Brunswick, NJ: Transaction.

Swenson, C. C., & Brown, E. J. (1999). Cognitive-behavioral group treatment for physically abused children. Cognitive and Behavioral Practice, 6, 212-220.

U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2000). Child maltreatment, 1998: Reports from the states to the National Child Abuse and Neglect Data System. Washington, DC: Government Printing office.

Weiss, D. S., & Marmar, C.R. (1997). The Impact of Event Scale—Revised. In J. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press.

Widom, C., & Morris, S. (1997). Accuracy of adult recollection of childhood victimization: Part 2. Childhood sexual abuse. Psychological Assessment, 9, 34-46.

Williams, L. (1994). Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. Journal of Consulting and Clinical Psychology, 62, 1167-1176.

Wolfelt, A. D. (1996). Healing the bereaved child: Grief gardening, growth through grief and other touchstones for caregivers. Fort Collins, Co: Companion Press.

Worden, J. W. (1996). Children and grief: When a parent dies. New York: Guilford Press.


Bringing Cognitive-Behavioral Psychology to Bear on Early Intervention with Trauma Survivors

Accident, Assault, War, Disaster, Mass Violence, and Terrorism

Josef I. Ruzek

Increasing recognition of the potential impact of trauma exposure, coupled with humanitarian concern about responding to victims, has led to widespread implementation of trauma-related services in recent years. In particular, interest in working with trauma survivors in the first weeks and months following their traumatic experiences has grown, with goals that include reducing acute distress, limiting suffering, maintaining functioning, and reducing rates of chronic problems. Several systems of early posttrauma intervention have evolved, relatively independently, to serve survivors of diverse traumas, including physical and sexual assault, natural and technological disaster, terrorism and mass violence, war, and the exposure to life threat, human suffering, and loss often associated with emergency response work and peacekeeping operations. Scrutiny of existing early intervention efforts has increased as the field of traumatic stress studies has developed, and has gained greater urgency due to recent terrorist attacks (e.g., September 11, 2001), the Iraq war, and widespread ethnic conflicts. In parallel with an increasing availability of posttrauma services, researchers are beginning to test the efficacy and effectiveness of existing interventions and to design and test new ones. In this context, studying cognitive-behavioral interventions designed to reduce problems associated with traumatic stress has become of increased importance.

In this chapter I look at the trauma resulting from these sources in order to (1) describe the potential for cognitive-behavioral psychology to inform the efforts to help survivors in established domains of post-trauma care; (2) explore the implications of cognitive-behavioral theory and research in relation to the goals and practices embodied in conventional early intervention efforts; (3) outline several key issues that must be confronted during the development of new approaches; and (4) draw attention to the need to plan, at the outset in hwat is a developing field, for the dissemination of new concepts and methods to the real-world settings where professionals work with trauma survivors.

Was this article helpful?

0 0
Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

Get My Free Ebook

Post a comment