TF-CBT to Reduce PTSD in Survivors of Sex Trafficking...TF-CBT Stages and Components Of the 31...
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CELEBRATING YEARS Katie Collier TF-CBT to Reduce PTSD in Survivors of Sex Trafficking Introduction • Sex trafficking involves the use of force, fraud or coercion to control someone for the purpose of engaging in commercial sex acts (UNODC, 2018) • Prevalence is currently underesFmated due to the hidden nature of the industry, variaFon in definiFons, and underreporFng (Ulibarri et. al, 2017) • Limited literature has invesFgated effecFveness of intervenFons for PTSD(Cohen et. 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 • In a RCT that compared TF-CT to a waitlist control group, the TF-CBT group experienced a much larger reducFon in trauma symptoms (n=52, p<0.001, d=0.518) at posWest and at a 3 month follow up(O’Callaghan et. al, 2013) • Another mulFsite RCT showed that TF-CBT was superior to Child Centered Therapy (CCT) and a waitlist control group in treaFng PTSD (n=180, p<0.001, d=0.26) at posWest, and at 6 and 12 month follow up (Cohen et al, 2004 & Deblinger et al, 2006) • It is modified to fit the unique needs of this populaFon, because it emphasizes safety planning and affect regulaFon before moving onto more psychologically demanding tasks in therapy (Cohen, Mannarino & Kinnish, 2017) • Addresses other factors such as drug use, running away, or other risky behaviors that influence their ‘performance’ in therapy, and is easily culturally modified Rationale Conclusion & Recommendations for practice and research • TF-CBT appears to be most safe and effecFve intervenFon to reduce trauma symptoms for this populaFon (Cohen et al, 2017) • TF-CBT is best delivered with adjunct services such as vocaFonal, educaFonal and caregiver training, and should include opportuniFes for empowerment and leadership (Ulibarri et al, 2017); “not trauma alone” approach (Courtois, 2008) • PracFFoners should be trained in MoFvaFonal Interviewing and the Stages of Change to best engage with clients (Cohen et al, 2017) • Due to aWachment and relaFonal deficits experienced, the therapist must be consistent and not allow crises to disrupt the therapy process (Cohen et al, 2017) • More research is needed to support the selected intervenFon modality in diverse groups of clients • Future intervenFons may be inclusive of caregivers and mentorship • Future studies should invesFgate which component of treatment is more effecFve, as well as treatment delivery with comorbid substance abuse and with other populaFons Enhancing Safety PsychoeducaFon RelaxaFon Affect ModulaFon CogniFve Coping Trauma NarraFve and Processing In vivo Conjoint Sessions Enhancing Safety ß Time: 16-25 sessions Stabiliza5on Phase (1/2) Trauma Narra5ve Phase (1/4) Integra5on & Consolida5on phase (1/4) ParenFng Skills Gradual Exposure J. Cohen, A. Mannarino & E. Deblinger, (2012) • TF-CBT is an evidence-based treatment for individuals impacted by complex trauma (Courtois, 2008) • It prioriFzes safety and affect regulaFon, and seeks to idenFfy and change inaccurate or unhelpful cogniFons (Cohen, Mannarino & Kinnish, 2015) that lead to negaFve feelings or behaviors • TF-CBT has been shown to reduce symptoms of PTSD and externalizing behavior problems(Cohen, Mannarino & Kinnish, 2015) • The therapist administers this intervenFon when the client decides they are ready to “leave the life” (Cohen et al, 2017) • Can be delivered individually or in a group (O’Callaghan, et al, 2013) TF-CBT Stages and Components Of the 31 articles meeting inclusion criteria, 6 were used to complete this research. Search Terms PTSD OR post-traumaFc stress disorder OR trauma OR trauma symptoms Adolescent girls OR young girls OR adolescent females OR females OR adolescents Sex-trafficking OR sex work OR human trafficking OR sexual exploitaFon OR commercial sex IntervenFon OR therapy OR treatment OR akercare Databases Used PsychINFO, MEDLINE, SocINDEX, PubMed, ERIC Inclusion Criteria Empirical studies, Peer- reviewed articles, Quantitative Studies, and published 2004-2018 Limita5ons -Small sample size (n=52) -Self-report was the only method used to measure symptoms -One study was only conducted with girls from Africa -AWriFon concerns with the mulFsite RCT Narra5ve Exposure Therapy (NET) • Therapist guides client through detailed exploraFon of previously experienced traumaFc events (Robjant, Roberts & Katona, 2017) • Therapist helps integrate contextual informaFon into the client’s narraFve • No dropouts, which suggests that this intervenFon is tolerable • Several study limitaFons such as small sample size (n=10) and retrospecFve design Comprehensive Care: Live in Residence • Client lives in a residenFal home/shelter where they receive individual counseling, group counseling, adjunct therapies, and academic/job training (Munsey, Miller and Rugg, 2018) • Individual therapy is oken supplemented with Eye Movement DesensiFzaFon and Reprocessing (EMDR) • High dropout rates, and program is expensive • Concerns with safety in akercare faciliFes and compounding trauma (Rafferty, 2018)
Transcript of TF-CBT to Reduce PTSD in Survivors of Sex Trafficking...TF-CBT Stages and Components Of the 31...
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)
