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(1) revisiting of the traumatic material, (2) cognitive reprocessing and reframing, (3) stress management, and (4) parent treatment. Specific techniques within these methods can range from talking about the traumatic event to drawing pictures about the trauma, writing about the trauma events, or recounting the events into a tape recorder. The purpose of this chapter is to discuss the use and efficacy of a particular form of CBT, Cognitive Processing Therapy (CPT), with adolescents who have experienced trauma, as well as the advantages and disadvantages of this approach. DESCRIPTION OF THE INTERVENTION Cognitive Processing Therapy was created as a manualized cognitive behavioral protocol to treat PTSD and related symptoms in adult rape survivors (Resick & Schnicke, 1992). The therapy has since been adopted for all types of trauma, including child abuse, military trauma, and natural disasters (see Resick, Monson, & Chard, 2007). CPT is typically offered in 12 sessions, although shorter or longer protocols can be followed, depending on the type of trauma and the amount of distress the individual is experiencing. The treatment is multifaceted and sequentially ordered, with subsequent sessions building on skills learned in previous sessions. In sessions 1–4, clients are given information on the theory behind CPT and are asked to write an impact statement discussing why they believe the traumatic event occurred and how the event has shaped their beliefs about self, others, and the world, particularly in the areas related to safety, trust, power/control, esteem, and intimacy. Next, individuals learn about the connection between events, thoughts, and feelings through the use of the A-B-C Sheet and begin to identify places where they have become “stuck” in their thinking. Disruptive or dysfunctional beliefs are often reGENERAL CONSIDERATIONS Data from a multitude of sources indicate that a significant number of children will be exposed to a traumatic event, including abuse, car accidents, or natural disasters, to name just a few. For example, Finkelhor and colleagues (2009) found that more than 60% of American children experienced some type of violence exposure in the year prior to the survey; in an earlier survey, 22% of children had experienced four or more different types of violence (Finkelhor, Ormrod, & Turner, 2007). Although most children will recover, a sizable percentage will experience heightened levels of psychological distress, subsequently leading to a formal diagnosis of posttraumatic stress disorder (PTSD; American Academy of Child and Adolescent Psychiatry, 1998; American Psychiatric Association, 1994). As a disorder, PTSD shares a high comorbidity with depression and/or anxiety. Among school-age youths, there are also frequent observations of anger or oppositional behaviors. Thus, PTSD treatments specific to this population typically include interventions that can address these related symptoms as well. Cognitive behavioral therapy (CBT) interventions are the most commonly researched and supported treatment models for childhood trauma. As a classification, CBT incorporates several specific models (e.g., Rationale Emotive Behavior Therapy, Prolonged Exposure), and although these models were first designed for and applied to adults, many of their techniques have been refined and modified for use with traumatized adolescents (see Kazdin & Weisz, 2003; Kendall, 2001, Silverman et al., 2008). There is substantial support for CBT interventions that target children as young as 2 years old (Stallard, 2006), although the methods used are contingent on the child’s condition and cognitive level. In terms of youths diagnosed with PTSD, CBT methods typically include one or more of the following: Cognitive Processing Therapy with Adolescents KATHLEEN M. CHARD, PH.D. RICH GILMAN, PH.D. 15 Cognitive Processing Therapy with Adolescents 149 could have prevented the event from happening”), which can then create further overgeneralized thoughts about the self, others, and the world (e.g., “I am a bad person” or “No one in authority can be trusted”). The CBW allows clients to look at their original beliefs, challenge them, and come up with alternative beliefs while also noting their change in emotions. Clients are then able to see how much relief they are likely to feel if they look at the situation more realistically instead of through the lens of PTSD. This will typically result in new thoughts such as, “I could not have prevented the trauma,” “I did the best I could given the situation,” “I am a good person,” and “Many people in authority can be trusted.” Sessions 8–12 allow individuals to focus their thought examination in each of five key areas—safety, trust, power/ control, esteem, and intimacy—using the CBW. For session 12, clients rewrite their impact statement and compare it with the...

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