CELEBRATING YEARS Katie Collier

TF-CBT to Reduce PTSD in Survivors of Sex Trafficking

Introduction

•  Sextraffickinginvolvestheuseofforce,fraudorcoerciontocontrolsomeoneforthepurposeofengagingincommercialsexacts(UNODC,2018)

•  PrevalenceiscurrentlyunderesFmatedduetothehiddennatureoftheindustry,variaFonindefiniFons,andunderreporFng(Ulibarriet.al,2017)

•  LimitedliteraturehasinvesFgatedeffecFvenessofintervenFonsforPTSD(Cohenet.al,2015)

•  ññ

Trauma-Focused Cognitive Behavioral Therapy

Research Question What is the most effective intervention to reduce PTSD symptoms among adolescent females who are survivors of sex-trafficking?

Methods

Alternative Treatments

•  InaRCTthatcomparedTF-CTtoawaitlistcontrolgroup,theTF-CBTgroupexperiencedamuchlargerreducFonintraumasymptoms(n=52,p<0.001,d=0.518)atposWestandata3monthfollowup(O’Callaghanet.al,2013)

•  AnothermulFsiteRCTshowedthatTF-CBTwassuperiortoChildCenteredTherapy(CCT)andawaitlistcontrolgroupintreaFngPTSD(n=180,p<0.001,d=0.26)atposWest,andat6and12monthfollowup(Cohenetal,2004&Deblingeretal,2006)

•  ItismodifiedtofittheuniqueneedsofthispopulaFon,becauseitemphasizessafetyplanningandaffectregulaFonbeforemovingontomorepsychologicallydemandingtasksintherapy(Cohen,Mannarino&Kinnish,2017)

•  Addressesotherfactorssuchasdruguse,runningaway,orotherriskybehaviorsthatinfluencetheir‘performance’intherapy,andiseasilyculturallymodified

Rationale

Conclusion & Recommendations for practice and research

•  TF-CBTappearstobemostsafeandeffecFveintervenFontoreducetraumasymptomsforthispopulaFon(Cohenetal,2017)

•  TF-CBTisbestdeliveredwithadjunctservicessuchasvocaFonal,educaFonalandcaregivertraining,andshouldincludeopportuniFesforempowermentandleadership(Ulibarrietal,2017);“nottraumaalone”approach(Courtois,2008)

•  PracFFonersshouldbetrainedinMoFvaFonalInterviewingandtheStagesofChangetobestengagewithclients(Cohenetal,2017)

•  DuetoaWachmentandrelaFonaldeficitsexperienced,thetherapistmustbeconsistentandnotallowcrisestodisruptthetherapyprocess(Cohenetal,2017)

•  MoreresearchisneededtosupporttheselectedintervenFonmodalityindiversegroupsofclients

•  FutureintervenFonsmaybeinclusiveofcaregiversandmentorship

•  FuturestudiesshouldinvesFgatewhichcomponentoftreatmentismoreeffecFve,aswellastreatmentdeliverywithcomorbidsubstanceabuseandwithotherpopulaFons

EnhancingSafetyPsychoeducaFonRelaxaFonAffectModulaFonCogniFveCoping

TraumaNarraFveandProcessing

InvivoConjointSessionsEnhancingSafety

ßTim

e:16-25

sessions Stabiliza5on

Phase(1/2)

TraumaNarra5vePhase(1/4)

Integra5on&Consolida5onphase(1/4)

ParenFngSkills

GradualExposure

J.Cohen,A.Mannarino&E.Deblinger,(2012)

•  TF-CBTisanevidence-basedtreatmentforindividualsimpactedbycomplextrauma(Courtois,2008)

•  ItprioriFzessafetyandaffectregulaFon,andseekstoidenFfyandchangeinaccurateorunhelpfulcogniFons(Cohen,Mannarino&Kinnish,2015)thatleadtonegaFvefeelingsorbehaviors

•  TF-CBThasbeenshowntoreducesymptomsofPTSDandexternalizingbehaviorproblems(Cohen,Mannarino&Kinnish,2015)

•  ThetherapistadministersthisintervenFonwhentheclientdecidestheyarereadyto“leavethelife”(Cohenetal,2017)

•  Canbedeliveredindividuallyorinagroup(O’Callaghan,etal,2013)

TF-CBTStagesandComponents

Of the 31 articles meeting inclusion criteria, 6 were used to complete this research.

SearchTerms

PTSDORpost-traumaFcstressdisorderORtraumaORtrauma

symptoms

AdolescentgirlsORyounggirlsORadolescentfemalesORfemales

ORadolescents

Sex-traffickingORsexworkORhumantraffickingORsexual

exploitaFonORcommercialsex

IntervenFonORtherapyORtreatmentORakercare

DatabasesUsed

PsychINFO, MEDLINE, SocINDEX,

PubMed, ERIC

InclusionCriteria

Empirical studies, Peer-

reviewed articles,

Quantitative Studies, and

published 2004-2018

Limita5ons-Smallsamplesize(n=52)-Self-reportwastheonlymethodusedtomeasuresymptoms-OnestudywasonlyconductedwithgirlsfromAfrica-AWriFonconcernswiththemulFsiteRCT

Narra5veExposureTherapy(NET)

•  TherapistguidesclientthroughdetailedexploraFonofpreviouslyexperiencedtraumaFcevents(Robjant,Roberts&Katona,2017)

•  TherapisthelpsintegratecontextualinformaFonintotheclient’snarraFve• Nodropouts,whichsuggeststhatthisintervenFonistolerable•  SeveralstudylimitaFonssuchassmallsamplesize(n=10)andretrospecFvedesign

ComprehensiveCare:LiveinResidence

•  ClientlivesinaresidenFalhome/shelterwheretheyreceiveindividualcounseling,groupcounseling,adjuncttherapies,andacademic/jobtraining(Munsey,MillerandRugg,2018)

•  IndividualtherapyisokensupplementedwithEyeMovementDesensiFzaFonandReprocessing(EMDR)

• Highdropoutrates,andprogramisexpensive•  ConcernswithsafetyinakercarefaciliFesandcompoundingtrauma(Rafferty,2018)