Trauma-focused therapy (TFT) represents an array of therapeutic approaches that concentrate on a patient’s traumatic experience with the goal of ameliorating the potentially destructive psychological aftereffects.
Generally speaking, TFT is based on the idea that a life-endangering experience for the patient or a loved one can result in a range of psychological symptoms that tax a person’s coping resources and impair his or her ability to adequately function. Indeed, experiencing a traumatic event has been associated with several psychological problems including, but not limited to posttraumatic stress disorder (PTSD), depression, anxiety, hypervigilance, insomnia, and nightmares. From a learning perspective, an initial trauma may condition some people to respond in emotionally maladaptive ways when encountered with memories or situations they associate with that event. This effect often results in the avoidance of situations, environments, or people that may trigger the conditioned response.
Several different clinical approaches fit under the spectrum of TFT. Exposure therapy involves the description and reexperiencing of a traumatic event (i.e., imaginal exposure) and/or exposing the patient to situations that trigger the distressing memories (i.e., invivo exposure). Exposure is accomplished by gradually (e.g., using systematic desensitization) or abruptly (e.g., using flooding) introducing anxiety-inducing stimuli until the patient’s distressed reactions are diminished. It is generally believed that exposing a patient to feared stimuli while in a relaxed, safe environment will allow the person to fully process the event while not being traumatized. Of note, the above approaches are often paired with cognitive-behavioral techniques, such as cognitive restructuring, stress management, relapse prevention, relaxation training, and coping enhancement. Another form of TFT is eye movement desensitization and reprocessing (EMDR). Primarily based on information processing theory, EMDR involves describing past and current experiences while simultaneously focusing on an external stimulus.
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 reconceptualize the traumatic event and decrease overgeneralization of fear, potentially leading to an improved relationship with her husband.
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, invivo 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 cognitivebehavioral 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.
An underlying goal of TFT is the improvement in quality of life following a traumatic event, rather than simply reducing the symptoms associated with the trauma. Consistent with this notion, it has been argued that a major advantage of TFT over other clinical approaches is the beneficial lasting effects on general psychological health. However, additional long-term outcome data are needed prior to making this claim. It should be noted that critics of TFT posit that exposing patients to their traumatic experiences may result in symptom escalation, including increased substance abuse and increased risk of dropping out of therapy. As a result, it is crucial that therapists monitor the safety of their patients and ensure they have adequate coping resources.
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