TF-CBT to Reduce PTSD in Survivors of Sex Trafficking...TF-CBT Stages and Components Of the 31...
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)