DEALING WITH TRAUMA: A TF-CBT WORKBOOK FOR TEENS
DEALING WITH TRAUMA: A TF-CBT
WORKBOOK FOR TEENS
By Alison Hendricks, Matthew Kliethermes, Judith A. Cohen, Anthony P. Mannarino, and
Esther Deblinger
For personal/clinical use only. Please do not distribute for other purposes without written permission from the authors.
DEALING WITH TRAUMA: A TF-CBT WORKBOOK FOR TEENS
TABLE OF CONTENTS
INTRODUCTION
3-4
WHY AM I HERE?
5
GETTING TO KNOW YOU
6
ABOUT YOUR FAMILY
7
LEARNING ABOUT TRAUMA
8
TYPES OF TRAUMA
9
HOW DOES TRAUMA AFFECT YOU?
10
DEALING WITH TRAUMA REMINDERS
11
MORE ABOUT AVOIDANCE
12
CHILLING OUT
13
WHAT HELPS YOU CHILL OUT?
14
MY PLAN FOR CHILLING OUT
15
CHECKING IN: CHILLING OUT
16
ABOUT FEELINGS
17
FEELING NUMB
18
EXPERIENCING FEELINGS IN YOUR BODY
19
FACIAL EXPRESSIONS
20
HOW STRONG OR INTENSE ARE YOUR FEELINGS?
21
COPING WITH DIFFICULT FEELINGS
22
CHECKING IN: COPING SKILLS
23
GROUNDING SKILLS
24
MINDFULNESS
25
CHECKING IN: GROUNDING AND MINDFULNESS
26
THOUGHTS, FEELINGS, AND ACTIONS
27
THOUGHTS MATTER
28
THOUGHT TROUBLES
29
EXAMINING THE EVIDENCE
30
TRAUMA NARRATION
31
SELF-CARE PLAN
32
YOUR THOUGHTS AND FEELINGS ABOUT THE TRAUMA(S)
33
SHARING ABOUT YOUR TRAUMATIC EXPERIENCES
34
BEING AND FEELING SAFE
35
YOUR SAFETY PLAN
36
YOUR SUPPORT SYSTEM
37
ADVICE TO OTHER TEENS
38
YOUR FUTURE
39
LET'S REVIEW
40
SAYING GOOD-BYE
41
2
DEALING WITH TRAUMA: A TF-CBT WORKBOOK FOR TEENS
Introduction
This workbook has been developed for use with teenagers who have experienced one or more traumatic events. The activities in the workbook correspond to the treatment components of the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) model, which was developed by Judith Cohen, Anthony Mannarino, and Esther Deblinger (Cohen, Mannarino, & Deblinger, 2017). The intended use of the workbook is by master's level mental health professionals or graduate students under appropriate supervision who have completed TF-CBT Web 2.0 and have also participated in the live Initial TF-CBT training with a Nationally Approved TF-CBT Trainer and have participated in follow-up consultation and/or supervision with an approved TF-CBT Trainer, Consultant, or Supervisor.
The workbook was created as a supplemental resource to assist therapists as they work through each component of the TF-CBT model with their clients. This workbook is one of the many resources that therapists can use in implementing TF-CBT, and the manual cited above provides and extensive list of books, activities, and other therapeutic aids. Additional resources can be found at: . The workbook intends to provide a helpful framework to cover each component of TF-CBT, but other resources and activities should also be utilized as clinically indicated (i.e., books, role plays, art activities, audio relaxation exercises, therapeutic board games, music, etc). Get creative! As always, clinical judgment takes precedence. It is important to adjust TF-CBT components to meet the specific strengths and needs of each teenager. Some of the activities included in the workbook may not be appropriate for all teens, and flexibility needs to be balanced with fidelity to the treatment model. For example, if you are working with an adolescent who is not avoidant regarding his or her trauma(s), you would skip page 12 (More about Avoidance). Moreover, trauma narration and processing, an important component of TF-CBT, generally includes the creation of a separate project or book often referred to as a narrative that would not be incorporated as part of this workbook.
The workbook activities were developed for implementing the PRACTICE components of the TF-CBT model: Psycho-education, Relaxation, Affective regulation and modulation, Cognitive coping and processing, Trauma narration and cognitive processing of the traumatic experience(s), In vivo mastery of trauma reminders, Conjoint sessions, and Enhancing future safety and development. The teen and caregiver will initially need some orientation to TF-CBT, and issues of confidentiality and sharing of the teen's work need to be discussed from the outset. The workbook may be used in its entirety or just some pages maybe be used for specific components. Keep in mind that some traumatized adolescents may require other types of treatment before, during, or after TF-CBT. The workbook activities correspond to the components of the TF-CBT model as follows:
Orientation to Therapy and TF-CBT, Engagement Psycho-education on Trauma and Reactions to Trauma
Pages 5-7 Pages 8-10, 12
3
Relaxation Feelings Identification Feelings Ratings and Affect Modulation Grounding and Mindfulness Cognitive Processing Creating the Trauma Narrative Processing the Traumatic Experience(s) In Vivo Mastery of Trauma Reminders Conjoint Session ? Sharing about Traumatic Experiences Enhancing Future Safety and Development Review and Termination
Pages 13-16 Pages 17-20 Pages 21-23 Page 24-26 Pages 27-30 Pages 31-32 Page 33 Page 11 Page 34 Pages 35-37 Pages 38-41
Following the structure of the TF-CBT model, the therapist meets individually with the teen each week to complete the above (and other supplemental) treatment activities. Then the therapist meets with the caregiver individually to work with the caregiver on the same component, to teach him/her the skills to support the teen at home and for the caretaker to process his/her own feelings about the trauma. Sharing the activities completed by the teen in the workbook can be a helpful way to work with the caregiver on the treatment components if the teen is comfortable with that. Caregivers usually appreciate seeing their adolescent's artwork and writing, and sharing these provides the opportunity for the therapist to increase the caregiver's empathy and understanding of the teen's experience, however, it is not essential. Use your clinical judgment if the teen does not want you to share a particular page with a caregiver or if sharing is contraindicated in any way. Some games or activities may be used during conjoint sessions in which the teen and caregiver can practice and share together. For example, teens may enjoy teaching their caretaker the relaxation activities or talking about feelings together in session. It is important to have caretakers involved in the safety component. Again, flexibility is important!
Practice activities can be assigned each week for the teen, caretaker, or dyad at the discretion of the therapist. The workbook includes homework/practice activities that are labeled as practice and are intended to help the teen apply and integrate the coping skills in their daily lives and to manage trauma reminders and trauma-related distress. You may create activities for the dyad to play at home, assign thought logs, etc. Use your imagination, and tap into the individual teen's strengths and interests when planning your interventions.
For further information on TF-CBT and its components, please refer to the treatment manual:
Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents: 2nd Edition. New York: The Guilford Press.
An additional resource is the on-line TF-CBT Web 2.0 training at: .
4
WHY AM I HERE?
TF-CBT is an effective approach that helps teens deal with and make sense of their traumas. You will learn about trauma and coping skills to help you feel better and be more successful in achieving your goals. You will also learn ways to keep yourself safe. Feel free to write down your responses to the questions below or just tell your therapist.
v How does that sound?
v What questions or concerns do you have?
v What do you hope to accomplish?
v What could your therapist do that would be the most (and LEAST) helpful?
5
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