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UCLA Trauma-Grief Focused Treatment Program for Adolescents

(TGFT)

Christopher M. Layne William R. Saltzman

Robert S. Pynoos

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Implementation Sites to Date

• Armenia (massive earthquake) • Post-War Bosnia (war) • Inglewood, California (school shooting)• Pasadena, California (community violence)• Columbine/Santee High Schools (school

shootings) • World Trade Center (terrorist attack,

community & domestic violence) • Florida (selected components; hurricane)

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Empirical Evidence(Layne et al., 2001)

• Significant pre-post reductions in: – PTSD symptoms – complicated grief symptoms – depression symptoms

• Reliable improvement rates (RCI’s): – 49% in PTSD scores– 51.4% in complicated grief scores– 35.2% in depression scores

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Program Characteristics

• Ages: 11-20 years old

• Focus: Trauma (single or multiple exposure) & traumatic death/loss.

• Setting: School or community clinic

• Assessment-driven

• Length of Treatment: 10-24 sessions (modular design – varied length depending on which parts are used).

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Overview of Trauma/Grief-Focused Group Psychotherapy

Module I(6 sessions)

Module II(8-12 sessions)

Module III(8 sessions)

Module IV(4 sessions)

Group Phase

Opening Working Through Termination

ModuleTitle

Group Cohesion, Psychoeducation, and Basic Coping

Skills

Working Through Traumatic Experiences

Coping with Traumatic Loss and

Grief

Re-Focusing on the Present and Looking to the

Future

Therape-utic

Tasks

1: Welcome and introduction (program overview, barriers, group contract, posttraumatic stress, depression, and grief reactions)2: Learning about trauma and loss reminders (how I react to, and cope with, reminders)3: Learning coping skills4: The event-thought-feeling link 5: Identifying and challenging distressing thoughts (“Three Steps to Taking Charge of Your Feelings”) 6: Support seeking (“Five Steps to Getting Support”)

First: Preparing for trauma narrative work (constructing the group narrative, constructing my personal trauma timeline)

Middle: Constructing the trauma narrative (prolonged therapeutic exposure; develop a vocabulary for communicating about the trauma)

Final: Exploring the worst moments (prolonged therapeutic exposure; using trauma reminders to understand the nature and personal meaning of traumatic experiences; cognitive restructuring cognitions associated with guilt and shame; exploring intervention fantasies)

1: Learning about grief (grief reactions, loss reminders, and grief processes / tasks) 2: Understanding grief reactions: Focus on anger3: Understanding grief reactions: Focus on guilt4: Remembering and reminiscing 5: Guided imagery: Retrieving a non-traumatic image of the deceased 6: Adjusting to a world in which the deceased is absent7: Planning for difficult days (relapse prevention)8: Saying goodbye in a good way

1: Resuming developmental progression2: Problem-solving current life (“Three Steps to Solving a Problem”)3: Dealing with problems that are not my job to fix 4: Saying goodbye in a good way

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Trauma/Grief Focused Psychotherapy:

Five Therapeutic Foci

1) Traumatic Experiences

2) Trauma & Loss Reminders

3) Post-Trauma Stresses & Adversities

4) Bereavement and the Interplay of Trauma & Grief Reactions

5) Developmental Impact

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Intervention Strategies

• Psychoeducation

• Skills Training

• Cognitive Interventions

• Prolonged Therapeutic Exposure

• Grief Processing/Facilitation

• Social Network Interventions

• Relapse Prevention

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My Timeline

What was happening outside of me:

What was happening inside of me: (thoughts, feelings, bodily sensations)

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Situations Thoughts

Behaviors Feelings

Trauma Narrative

Construction Algorithm

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Practice Exercise: Parts of my life I want or need to change

to adjust to the loss

Overall Change I Want/Need

First Steps I need to Take

Living situation and finances

Mealtimes/ time spent with family

School, homework, preparation for college

Choice of friends/ time spent with friends

Daily interactions with people

Favorite activities and hobbies

Chores and Responsibilities

Other (describe)____________