What You'll Learn
- What kind of therapy is used for treating PTSD in kids?
- Why does the child’s age matter in PTSD treatment?
- What is a trauma narrative?
Treating PTSD in kids depends on their age and development. That’s because age affects how they experience trauma.
Trauma-focused cognitive behavior therapy (TF-CBT) is considered the best PTSD therapy for younger kids and teens. The first part of TF-CBT is teaching kids and parents what trauma symptoms look like. Just learning that trauma can cause changes in a child’s mood, thoughts and behavior can make kids and parents feel better. Then they understand where these confusing and upsetting changes are coming from.
The next part of the therapy helps kids learn how to manage their symptoms. It helps them change upsetting thought patterns and manage their emotions. Once they have those skills, the therapy moves toward helping them talk about their trauma. It’s normal for kids to avoid doing this because the memories are scary. Part of this therapy is creating a “trauma narrative,” which may be a written story about what happened. The story ends with the safe place the child is in now. It’s important for parents to be involved in the therapy and for kids to share their trauma narratives with them.
There are two therapies aimed at helping older kids. In Prolonged Exposure Therapy, kids tell the story of the trauma over and over in order to stop avoiding it. They also make lists of things they’ve been avoiding because those things remind them of the trauma. Avoiding thinking and talking about the trauma keeps kids from moving on.
Cognitive Processing Therapy is focused on how a teen’s beliefs may have been changed by the trauma. For example, they may feel they can’t trust anyone or that what happened was their fault. Cognitive Processing Therapy works to correct those harmful beliefs which keep kids from recovering.
When children develop post-traumatic stress disorder, treatment depends on their development level, which affects how they perceive and process trauma. And as they get older, they may develop different symptoms, which may call for more therapy. “You treat PTSD at the current developmental level the child is at,” explains Jamie Howard, PhD, director of the Trauma and Resilience Service at the Child Mind Institute, “and then it might recur as kids get older.”
There are several evidence-based treatments for young people diagnosed with PTSD. The most appropriate treatment depends on their age and symptoms.
Trauma-focused cognitive behavior therapy
Trauma-focused cognitive behavior therapy, or TF-CBT, is considered the gold standard treatment for children and adolescents with PTSD. TF-CBT has several components, the first being teaching a child and her parents about what trauma looks like.
The symptoms that come with PTSD can be disruptive and confusing, both to the child who has been traumatized and to her loved ones. Explaining that a child’s changes in mood, behavior or thinking might be attributed to trauma is important. “To understand that these are all part of a syndrome, and common experiences for people who have been through the type of things that you went through, in and of itself is therapeutic,” explains Joan Kaufman, PhD, the director of research at the Center for Child and Family Traumatic Stress at Kennedy Krieger Institute.
Next TF-CBT moves to helping children learn how to deal with those symptoms. A major part of this is helping children learn how to better understand their thinking, and how their thinking affects how they feel and what they do. “When they’re better able to label what it is they’re feeling, it actually helps them to become better regulated,” says Janine Domingues, PhD, a child psychologist who specializes in trauma at the Child Mind Institute. Children also learn specific techniques for modifying their emotions and challenging unhelpful thoughts, as well as relaxation skills to help them feel more in control of physical symptoms they might be experiencing.
After children have that skill base, treatment moves on to helping them talk about their trauma in as much detail as possible. Children may want to avoid talking about what happened, or gloss over it, either because it makes them feel safer not to think about it or because they are trying to protect other people, like parents. But avoiding thinking about the traumatic event means that you aren’t processing the experience, and it will continue to cause you distress.
“Throughout therapy we’re talking about the event in a very open way” notes Dr. Domingues. “We don’t call it ‘the event’ or ‘the trauma.’ We say specifically, ‘that time mom and dad fought’ or, ‘when dad hit mom.’ We want kids to get used to the idea that we’re going to talk about it very openly.”
Part of processing the event is creating what is known as a “trauma narrative.” These are often written stories that the clinician can help the child create, but could also be cartoons, drawings or PowerPoint presentations. By thinking and talking about what happened in a calm, safe space, the child learns that the more she can face the trauma memory and talk about it, the less scary that memory becomes. That helps her be better able to manage her feelings when the memory comes up. “At the end of it we create a statement that states how they are safe now and how they make meaning of where they are currently in their life,” says Dr. Domingues.
It is important for parents or caretakers to be involved throughout TF-CBT.
It can be just as helpful for parents to understand how PTSD is impacting their child’s thinking and behavior, and parents can play a big role in helping children practice the skills they are learning for coping with their symptoms.
Treatment sometimes includes individual parent sessions to help parents express how they feel about what happened, and their emotions, too. Sometimes parents may also benefit from a course of therapy on their own. As part of treatment clinicians will help prepare parents for listening to a child share his experience.
Parents, too, will sometimes avoid talking about the traumatic event, often because they are following the cues from their child. But being open about the experience is essential for helping children confront their trauma memory and know that they are safe in talking about it. Children sharing the trauma narrative with parents and caregivers is an important step. “As a parent they don’t have to fix anything, but just validate their child’s emotions and be there to listen and say, “Thank you so much for sharing,” says Dr. Domingues.
Prolonged exposure therapy
Young adults can benefit from a kind of treatment called prolonged exposure therapy. This treatment is designed to help people stop avoiding thinking about their traumatic experience or anything that might remind them of it.
In prolonged exposure therapy the clinician helps the client confront their trauma memory by purposefully retelling the traumatic experience and creating a list of the things he has been avoiding associated with the traumatic event, ranking them in order of how distressing they are. Slowly and with the assistance of the clinician, he begins to gradually habituate to the things he has been avoiding.
“Prolonged exposure helps to tease apart the memory from the fear response,” explains Dr. Domingues. “It shows, ‘I can still feel sad or angry or scared of it, but I can manage the emotions, because I have faced that memory fear, and now I can move forward.’ ”
Cognitive processing therapy
Cognitive processing therapy is another treatment for young adults that helps them talk about what happened to them, but with a focus on identifying how the trauma altered their beliefs. After a trauma people will often develop new ways or adapt old ways of thinking to try to make sense of what happened to them. For example, they might think “I can never trust anyone again,” or “I should have known better.” People get caught on these points, which prevent them from recovering.
In CPT clinicians help a client examine how her beliefs have changed. They talk through those thoughts and break down what’s true and what isn’t.” The goal in the end is to help her develop a healthier view of what happened so that she can move past it.