Trauma-Informed CBT: A Framework for Integrating Affective, Narrative & More Approaches

CPD

Handouts

Faculty

Robert Lusk, PhD Related seminars and products

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Robert Lusk, PhD, has devoted his career to working with trauma survivors and their families, and providing training and consultation to parents, military families, and professionals on trauma-related issues, parenting special needs children, attachment disorders, psychotropic medications, reintegration after deployment, and psychiatric disorders. For the past 26 years, Dr. Lusk has served as clinical director at The Baby Fold. There, he designs and implements new programs, and provides clinical supervision, consultation and oversight to all the agency’s treatment programs.

Dr. Lusk completed a full-time internship at the Brentwood Veterans Administration Medical Center in Los Angeles, where he focused on PTSD treatment for combat veterans. He has continued to provide supervision, training, and treatment for veterans and other adult trauma survivors for the past 30 years.

Dr. Lusk also instructs courses at Illinois Wesleyan University and has been actively involved in investigative research on trauma for over 30 years, including studies of treatment approach efficacy and cognitive and school-related effects of trauma. He has published several journal articles and book chapters on understanding and treating trauma.

Dr. Lusk earned his Master’s and Doctoral degrees in clinical psychology from the University of California at Los Angeles and has trained in a variety of interventions including Trauma-Focused Cognitive Behavioral Therapy, the Attachment, Regulation, and Competency (ARC) model, Collaborative Problem-Solving, couples and family therapy, Trust-Based Relational Intervention, and Eye Movement Desensitization and Reprocessing (EMDR).

Speaker Disclosures:
Financial: Dr. Robert Lusk maintains a private practice and has an employment relationship with Illinois Wesleyan University. He is a consultant for The Baby Fold. Dr. Lusk receives a speaking honorarium and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Robert Lusk is a member of the American Psychological Association.

Objectives

1. Theorize foundations of TI-CBT.
2. Apply concepts and interventions from TI-CBT to case study examples.
3. Formulate treatment plans and progress based on therapy stages and PRACTICE model.
4. Implement Trauma-Informed CBT strategies in session. 
5. Integrate interventions from somatic, in vivo, mindfulness with cognitive and behavioural strategies.
6. Build preventative and support factors to encourage post-trauma growth.

Outline

Foundations of TI-CBT 

• History of CBT
• Core assumptions of CBT
• Mechanisms of change in CBT
• Problematic core beliefs & doubt labels
• The broad definition of “behavioural” in TI-CBT
• Compensatory behaviours

The Transdiagnostic Approach, Core Regulation Issues, and the Universal Protocol

• Transdiagnostic Approach and the Universal Protocol 
• Core emotional regulation issues 
• Universal Protocol (UP) & core skills 

Two main types of Post-Trauma Treatment 

• Therapeutic interventions
• Post-crisis interventions
  • Illustrative Example: Psychological First Aid (PFA)

TI-CBT: Conceptual and Research Basis

• 3 Pillars of Trauma-Informed Care
• TF-CBT: The “gold standard” for trauma treatment
• American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults
  • Recommended models
    • Cognitive Processing Therapy
    • Prolonged Exposure Therapy
  • Suggested model: EMDR
• Stages of Trauma Treatment applied to CBT
• Assessment client readiness, apply screens & measures

What Do TI-CBT Models Have in Common? The PRACTICE Acronym  

• P - Psychoeducation & Parenting skills (Stage One)
  • Cognitive Factors
• R - Relaxation & coping techniques (Stage One)
• A - Affective expression & regulation (Stage One)
• C - Cognitive coping & processing (Stage One)
  • In CBT models, this is the majority of the focus (along with the narrative)
  • When the upsetting thought is accurate (often true for real-life problem areas involving basic needs), teach clients to create Action Plans to implement practical solutions
• T - Trauma narrative & processing (Stage Two if needed)
• I - In vivo (real life) exposure (Stage Two)
• C - Conjoint parent/child sessions (All stages for youth)
• E - Enhancing personal safety & future growth (Stage Three)

Diving into PRACTICE with Illustrative Case Examples 

• Case #1: 14-year-old female sexual abuse survivor
• Case #2: 35-year-old male who lost a child 

Building a Treatment Plan (including Interventions & Methods for Evaluating Progress)

• Stage One
  • Psychoeducation Goal & Objectives
  • Parenting Goal & Objectives (Youth)
  • Emotion Identification & Expression Goal & Objectives
  • Coping Skills & Emotional Regulation Goal & Objectives
  • Healthy Thinking Goal & Objectives
• Stage Two
  • Arousal Modulation Goal & Objectives
  • Trauma Narrative/Exposure Goal & Objectives
• Stage Three
  • Enhancing Personal Safety Goal & Objectives
  • Planning for Future Triggers Goal & Objectives

Interventions for Parents of Youth Trauma Survivors 

• Caregiver Emotional Control
• Building Emotional Safety and Parenting Skills
• Positive Discipline
• Example: Family/Parent work in Case #1

Implementing Relaxation, Coping and Grounding techniques 

• Behavioural and related strategies
• Breathing retraining/controlled breathing
• Movement-based strategies
• Bruce Perry’s Neurosequential Model of Therapeutics
• Using Props/The Comfort Kit (with examples)
• Cognitive strategies
• Distraction
• Mindfulness practice
• Problem-solving

Building Affective Expression & Regulation Skills

• Identifying feelings
• Expressing feelings
• SUDs scales & Zones of Regulation

Correcting Cognitive Distortions

• The 5-step process
• Most common targets of cognitive processing
• The Franklin Method

Examples of building regulation skills

• Case #1
• Case #2

Examples of cognitive work

• Case #1
• Case #2

Implementing Stage Two: The Trauma Narrative 

• But first . . . Stage One additional components
  • Safety plans
  • Trauma-specific areas of focus
  • Case example: Sexual abuse-specific focus
  • Case example: Prolonged exposure for avoidance of triggers
• Stage Two: Trauma Processing
  • Creating the trauma narrative
    • Methods
    • Process
  • When is your client done with Stage Two?
  • Example: processing trauma/trauma narrative in Case #1
  • Example: processing trauma/trauma narrative in Case #2

Implementing Stage Three: Enhancing personal safety & post-traumatic growth 

• Stage Three components
• Example: Stage Three in Case #1
• Example: Stage Three in Case #2

Target Audience

• Counselors
• Social Workers
• Psychologists
• Case Managers
• Addiction Counselors
• Therapists
• Marriage & Family Therapists
• Nurses
• Physicians
• Physicians Assistants
• Other Mental Health Professionals
• Other Healthcare Professionals