Common elements of evidence-based trauma therapy for children and adolescents

Figures & data

Figure 1. Review of the literature.

Figure 2. Overview of the research procedure. TF-CBT = trauma-focused cognitive–behavioural therapy; EMDR = eye movement desensitization and reprocessing; KIDNET = narrative exposure therapy for children; PE-A = prolonged exposure therapy for adolescents; TRT = teaching recovery techniques.

Table 1. Parameters.

	Description or range
Referral assessment	Diagnosed PTSD or PTS symptoms
Age	0–18 years
Frequency	Once weekly
Sessions	1–25 sessions
Session length	45–90 minutes
Therapist qualification	Licensed child and adolescent psychotherapists, certified in the specific therapy

Note: PTSD = post-traumatic stress disorder; PTS = post-traumatic stress.

Table 2. Common techniques.

Technique
Technique	Description	Child*	Caregiver(s)*
Psychoeducation	Providing information about the occurrence and frequency of traumatic events; normalizing stress reactions, feelings, and thoughts; explaining the therapeutic rationale and providing information about symptoms, diagnosis, and how treatment will address these; explaining the therapy procedures and the structure of the sessions	X (5)	X (5)
Relaxation	Acquiring skills for coping with the tension in everyday life that arises from the trauma-related stress reactions	X (4)
Recording the critical experiences	Tracing back the critical experiences; ascertaining what happened, when it happened, and what symptoms, feelings, and thoughts are linked to it	X (4)
Traumatic recollection	Starting to recall the traumatic memories; detecting arousal by activating the traumatic memory	X (5)
Exposure	Repeated exposure to the traumatic memories (imaginal exposure, x = 3) and/or repeated exposure to feared and avoided situations associated with the traumatic memories (in vivo exposure, x = 2)	X (3)
Homework	Practising at home with learned skills from the session(s)	X (3)	X (2)
Cognitive shifting	Discussing cognitions; attempting to influence or modify dysfunctional cognitions	X (4)
Sharing the trauma story with others	Showing the young person’s finished product about the trauma story to people in the support system and communicating with them about the trauma	X (3)	X (3)
Future perspectives	Identifying the acquired skills and knowledge that can strengthen the resilience and future security of the young person and reduce the likelihood of recurrence	X (3)	X (1)
Termination	Evaluating the course of treatment in terms of the PTSD symptom scale and the learning effects; discussing how to deal with a recurrence of symptoms; marking the end of the therapy and the new start in the therapist’s absence	X (5)	X (4)

Note: *(#) = number of protocols or manuals in which the technique appeared.

Table 3. Common mechanisms.

Element
Mechanism	Description	Child*	Caregiver(s)*
Consolidation	Repetition of various domains, exercises, and skills during the therapy, to reinforce trauma processing	X (5)	X (2)
Trauma processing	Reframing; reorganization and sequence of fear-reducing changes that take place through exposure to the traumatic memory (inhibitory learning, x = 3; desensitization, x = 1)	X (4)
Therapeutic relationship	Mutual attitudes, feelings, and trust between therapist and young person, parent, or system, and the ways in which these find expression during the treatment	X (5)	X (4)
Motivation	Sufficient drive in the young person to sustain the confrontation with the traumatic memory and its triggers	X (5)
Affect modulation	Learning to recognize, label, and manage overwhelming and other negative emotions	X (5)
Reciprocal integration	Altered feelings with respect to the critical experiences induce changes in cognitions, and vice versa	X (5)
Sharing	Fostering support from the network; enhancing ties with significant others; fostering attachment relationships	X (3)	X (3)

Note: *(#) = number of protocols or manuals in which the mechanism appeared.

Data availability statement

Data sharing is not applicable to this article as no new data were created in this study.

Acknowledgements

We would like to thank all the trauma therapists for their knowledge, thoughts, and time throughout the Delphi method; all the original authors of the researched evidence-based trauma therapies for their contribution; and Michael Dallas for his support in the English language.