Table Of ContentTrauma-Focused cBT
For children and adolescenTs
Also from Judith A. Cohen,
Anthony P. Mannarino, and Esther Deblinger
For more information, visit drs. cohen and mannarino’s website:
http://pittsburghchildtrauma.net
effective Treatments for PTsd, second edition:
Practice Guidelines from the international society
for Traumatic stress studies
Edited by Edna B. Foa, Terence M. Keane,
Matthew J. Friedman, and Judith A. Cohen
Treating Trauma and Traumatic Grief
in children and adolescents
Judith A. Cohen, Anthony P. Mannarino,
and Esther Deblinger
Trauma-Focused cBT
For children
and adolescenTs
Treatment Applications
edited by
Judith A. Cohen
Anthony P. Mannarino
Esther Deblinger
The Guilford Press
new York london
© 2012 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored
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Last digit is print number: 9 8 7 6 5 4 3 2 1
The authors have checked with sources believed to be reliable in their efforts to provide information
that is complete and generally in accord with the standards of practice that are accepted at the time
of publication. However, in view of the possibility of human error or changes in behavioral, mental
health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party
who has been involved in the preparation or publication of this work warrants that the information
contained herein is in every respect accurate or complete, and they are not responsible for any errors
or omissions or the results obtained from the use of such information. Readers are encouraged to
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Library of Congress Cataloging-in-Publication Data
Trauma-focused CBT for children and adolescents : treatment applications / edited by
Judith A. Cohen, Anthony P. Mannarino, Esther Deblinger.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4625-0482-4 (hardback)
1. Cognitive therapy for children. 2. Cognitive therapy for teenagers.
3. Post-traumatic stress disorder in children—Treatment. 4. Post-traumatic stress
disorder in adolescence—Treatment. I. Cohen, Judith A.
II. Mannarino, Anthony P. III. Deblinger, Esther.
RJ505.C63T73 2012
618.92′891425—dc23
2011052458
about the editors
Judith A. Cohen, MD, a board-certified child and adolescent psychia-
trist, is Medical Director of the Center for Traumatic Stress in Children
and Adolescents at Allegheny General Hospital, Pittsburgh, Pennsylvania.
With Anthony P. Mannarino, she has received funding since 1986 from
the National Institute of Mental Health, the Substance Abuse and Mental
Health Services Administration, and the U.S. Department of Justice to assess
and treat traumatized children. Dr. Cohen is a recipient of the Outstanding
Professional Award from the American Professional Society on the Abuse
of Children (APSAC) and the Norbert and Charlotte Rieger Psychodynamic
Psychotherapy Award from the American Academy of Child and Adolescent
Psychiatry.
Anthony P. Mannarino, PhD, is Director of the Center for Traumatic Stress
in Children and Adolescents and Vice Chair of the Department of Psychiatry
at Allegheny General Hospital. He is also Professor of Psychiatry at Drexel
University College of Medicine. Dr. Mannarino has been a leader in the field
of child traumatic stress since the 1980s. He has been awarded numerous
federal grants from the National Center on Child Abuse and Neglect and
the National Institute of Mental Health to investigate the clinical course of
traumatic stress symptoms in children and to develop effective treatment
approaches for traumatized children and their families. He is a recipient of
many honors, including the Betty Elmer Outstanding Professional Award
from Family Resources of Pennsylvania, the Most Outstanding Article
Award for papers published in the journal Child Maltreatment from APSAC,
the Model Program Award from the Substance Abuse and Mental Health
Services Administration for “Cognitive-Behavioral Therapy for Child Trau-
matic Stress,” and the Legacy Award from the Greater Pittsburgh Psycho-
v
vi about the editors
logical Association. Dr. Mannarino is a past president of APSAC and of the
Section on Child Maltreatment, Society for Child and Family Policy and
Practice (Division 37), American Psychological Association.
Esther Deblinger, PhD, is Co-Founder and Co-Director of the CARES (Child
Abuse Research Education and Service) Institute and Professor of Psychiatry
at the School of Osteopathic Medicine, University of Medicine and Dentistry
of New Jersey (UMDNJ). She has received funding since 1986 from the Foun-
dation of UMDNJ, the National Center on Child Abuse and Neglect, and the
National Institute of Mental Health to investigate the impact and treatment
of child abuse. Dr. Deblinger has collaborated with Judith A. Cohen and
Anthony P. Mannarino over many years on the development, evaluation,
and dissemination of trauma-focused cognitive-behavioral therapy, recog-
nized for its efficacy by the U.S. Department of Health and Human Services
and the Kaufman Best Practices Task Force. She has coauthored numerous
scientific publications and two widely acclaimed professional books on the
treatment of child sexual abuse and trauma and traumatic grief, as well
as several children’s books on body safety. Her work has been recognized
with awards from Woman’s Day magazine and the State of New Jersey’s
Office of the Child Advocate. In addition, Dr. Deblinger is a recipient of the
Outstanding Research Career Achievement Award from APSAC and the
Rosenberry Award for Excellence in Teaching, Innovative Research, and
Scholarly Vision from the Children’s Hospital, Aurora, Colorado.
contributors
Dolores Subia BigFoot, PhD, Center on Child Abuse and Neglect, University of
Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Angela M. Cavett, PhD, RPT-S, Knowlton, O’Neill and Associates, West Fargo,
North Dakota
Judith A. Cohen, MD, Center for Traumatic Stress in Children and Adolescents,
Allegheny General Hospital, Pittsburgh, Pennsylvania
Stephen J. Cozza, MD, Center for the Study of Traumatic Stress, Uniformed
Services University of the Health Sciences, Bethesda, Maryland
Carla Kmett Danielson, PhD, Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, South Carolina
Michael Andrew de Arellano, PhD, National Crime Victims Treatment and
Research Center, Department of Psychiatry and Behavioral Sciences, Medical
University of South Carolina, Charleston, South Carolina
Esther Deblinger, PhD, CARES Institute, School of Osteopathic Medicine,
University of Medicine and Dentistry of New Jersey, Stratford, New Jersey
Shannon Dorsey, PhD, Department of Psychiatry and Behavioral Sciences, School
of Medicine, University of Washington, Seattle, Washington
Athena A. Drewes, PsyD, RPT-S, Astor Services for Children and Families,
Rhinebeck, New York
Julia W. Felton, PhD, Department of Psychiatry and Behavioral Sciences, Medical
University of South Carolina, Charleston, South Carolina
Christina A. Grosso, LCAT, ATR-BC, BCETS, Center for Trauma Program
Innovation, Jewish Board of Family and Children’s Services, New York,
New York
Matthew Kliethermes, PhD, Children’s Advocacy Services of Greater St. Louis,
University of Missouri–St. Louis, St. Louis, Missouri
vii
viii contributors
Anthony P. Mannarino, PhD, Center for Traumatic Stress in Children and
Adolescents, Allegheny General Hospital, Pittsburgh, Pennsylvania
Laura K. Murray, PhD, Department of International Health, Johns Hopkins
University Bloomberg School of Public Health, Baltimore, Maryland
Daniela Navarro, MA, LPC, LCDC, Serving Children and Adolescents in Need,
Inc., Laredo, Texas
Susana Rivera, PhD, LPC, Serving Children and Adolescents in Need, Inc.,
Laredo, Texas
Susan R. Schmidt, PhD, Center on Child Abuse and Neglect, University of
Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Stephanie A. Skavenski, MSW, MPH, Department of International Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Rachel Wamser, MA, Children’s Advocacy Services of Greater St. Louis, University
of Missouri–St. Louis, St. Louis, Missouri
acknowledgments
The growth and dissemination of the trauma-focused cognitive-behavioral
therapy (TF-CBT) model as reflected in this book is a direct result of the
enormous support we have enjoyed from friends and colleagues too numer-
ous to name. These colleagues include individuals who helped us get started
in the field and showed us the ropes and those who supported our efforts
along the way, as well as our more recent collaborators. We are particu-
larly indebted to our respective institutions—the CARES Institute at the
School of Osteopathic Medicine at the University of Medicine and Dentistry
of New Jersey and Allegheny General Hospital/Allegheny–Singer Research
Institute—and their leadership for providing the supportive atmospheres in
which we have been able to successfully engage in the clinical, research,
and training efforts that have made the development, evaluation, and wide-
spread dissemination of TF-CBT possible.
We would like to express our appreciation to our many clinical col-
leagues, within our institutions as well as those across the United States and
the rest of the world. Their creative clinical ideas and insights over the years
have greatly contributed to the appeal and flexibility of TF-CBT. In addi-
tion, we are very thankful for the commitment and diligence of our research
colleagues whose important contributions allowed us to develop the evi-
dence base that sets this treatment model apart and provides clinicians and
consumers with confidence that their children can and will overcome the
devastating effects of trauma. We are also greatly encouraged by the work
of researchers outside of our institutions who are replicating our findings
and adding to our understanding of how best to support the healing of chil-
dren and their families.
We would like to acknowledge the funding agencies that have supported
our work for over 25 years. These agencies include the National Center
ix
