Trauma-Focused Therapy

Case Example

The following fictitious case is used to illustrate the general course of TFT. A woman sexually assaulted at night in a parking garage has developed anxiety in a broad spectrum of situations that she has associated with the traumatic event. She fears going out at night, experiences anxiety when she is in enclosed places, and has frequent nightmares. In addition, she has lost interest in sex with her husband. She reports feeling guilty and blames herself for not being more aware of her surroundings and not taking appropriate precautions. In this example, a trauma-focused therapist would likely ask the woman to repeatedly detail the events surrounding the sexual assault until her emotional response decreases. Additionally, the therapist may introduce the patient to feared and avoided stimuli (e.g., going out at night, parking garages) in hopes of reducing her anxiety around these situations and ultimately improving her ability to function. Moreover, by examining and cognitively processing the trauma in a relaxed state, the patient is more likely to recognize faulty or exaggerated perceptions of the event and future danger. For example, cognitive restructuring might be useful to help her reconceptu-alize the traumatic event and decrease overgeneraliza-tion of fear, potentially leading to an improved relationship with her husband.

Efficacy

TFT has generally been found to be an effective method of treatment across a variety of samples (e.g., children, adolescents, adults), modalities (e.g., individual, group), and techniques (e.g., trauma-focused cognitive-behavioral therapy, imaginal exposure, in-vivo exposure, EMDR). Moreover, these therapies have been shown to be beneficial in reducing psychological symptoms resulting from a wide variety of traumas including child abuse, sexual assault, intimate partner violence, wartime trauma, and natural disasters. In several randomized controlled studies, patients receiving variations of TFT were found to have less PTSD and related symptoms as compared to patients receiving supportive therapy, relaxation training, or wait-list controls. Studies comparing TFT to cognitive-behavioral therapy (CBT) techniques that do not include a focus on the traumatic experience generally do not support one technique over the other. For example, in a seminal study of patients with PTSD, one group of researchers reported that while exposure and coping skills enhancement (i.e., stress inoculation training) were both effective in reducing PTSD severity and depression compared to wait-list controls, their relative effectiveness was not significantly different. Combining the two forms of treatment (exposure and stress inoculation training) was no better at reducing symptoms than either treatment alone. Similarly, in a study comparing trauma-focused CBT and skills-focused CBT (with no exposure to traumatic memories), a team of researchers found little overall difference between the two forms of treatment with respect to PTSD, substance abuse, or violence perpetration.

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