The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is a school-based, group and individual intervention. It is designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills. CBITS has been used with students from 5th grade through 12th grade who have witnessed or experienced traumatic life events such as community and school violence, accidents and injuries, physical abuse and domestic violence, and natural and human-made disasters. CBITS uses cognitive-behavioral techniques (e.g., psychoeducation, relaxation, social problem solving, cognitive restructuring, and exposure).
Dialectical Behavior Therapy (DBT) is an empirically supported treatment designed to help people manage overwhelming feelings and self-defeating behaviors. These feelings and behaviors may create major challenges in life (such as angry outbursts, violence, depression, immobility and avoidance by suicide attempts, substance abuse, and eating disorders). DBT encompasses core modules of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills training. The emphasis is on building and enhancing skills to regulate emotions, deal with the distressing situations, and improve relationships. DBT was invented by Dr. Marsha Linehan, a psychologist, who used her own insights from living successfully with Borderline Personality Disorder to develop this novel therapy. In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.
DBT Fact Sheet – NAMI
TREM is a fully manualized 24- to 29-session group intervention for women who survived trauma and have substance use and/or mental health conditions. This model draws on cognitive–behavioral, skills training, and psychoeducational techniques to address recovery and healing from sexual, physical, and emotional abuse. TREM consists of three major parts. The first section, on empowerment, helps group members learn strategies for self-comfort and accurate self-monitoring as well as ways to establish safe physical and emotional boundaries. The second component of TREM focuses more directly on trauma experience and its consequences. In the third section, focus shifts explicitly to skills building. These sessions include emphases on communication style, decision-making, regulating overwhelming feelings, and establishing safer, more reciprocal relationships.
Adult women with histories of trauma.
TREM and M-TREM are fully manualized group interventions for women (TREM) and men (M-TREM) who are trauma survivors. These groups are interventions that address a broad range of trauma sequelae among people with severe mental disorders and/or substance abuse problems. Both use cognitive restructuring, psychoeducation, and coping skills training, weaving each of these techniques throughout the intervention, which incorporates a specific recovery topic in each weekly 75-minute session. TREM is 29 sessions long while M-TREM comprises 24 sessions. TREM groups are for women only with female co-leaders; M-TREM groups are for men and routinely have male co-leaders. Both groups are designed for 8-10 members. TREM is organized into three major parts: empowerment, trauma education, and skill-building. Discussions cover topics of sexual, physical, emotional, and institutional abuse, and women explore and reframe the connection between abuse experiences and other current difficulties. M-TREM is similarly organized but differs in the content of the three major parts. In M-TREM, the first section focuses on emotions and relationships, helping men to develop a shared emotional vocabulary and increased capacities to address relationship dynamics. The second section is similar to that of TREM, addressing emotional, physical, and sexual abuse directly. The third part of M-TREM, like TREM, centers most directly on skill-building and problem-solving, but addresses different content issues in a different order than the TREM group.
TREM has been successfully implemented in a wide range of service settings (mental health, substance abuse, criminal justice) and among diverse racial and ethnic populations.
Specifically for women (all ages, all ethnicities) survivors of trauma for whom traditional recovery work has been unavailable or ineffective.
This three-module model, which can be taught on a flexible time and content-specific basis, teaches a basic trauma informed cognitive framework with accompanying skills. The premise is that the developmental disruptions of childhood trauma often prevent the development of a coherent frame of reference for three major areas impacted by trauma: the ability to cope with change in constructive ways; to identify, respond to and modulate affect, and the ability to identify, explore, set and change basic boundaries. Each module can be presented in a four-hour or one day format. An overview of all three, without skill development, is available as a one day program.
The Seeking Safety model, developed by Lisa M Najavits, Ph.D., at Harvard Medical/McLean Hospital, is a manualized, 25-topic, flexible integrated treatment that offers coping skills to help clients attain greater safety in their lives. It is present focused and designed to be inspiring and hopeful. Originally designed to address PTSD and substance abuse, it since has been implemented with diverse traumatized clients who may not necessarily meet criteria for these disorders. Used widely with adults, it has been implemented with adolescents (both boys and girls), and a published randomized controlled trial is available on adolescent girls.
Dual diagnosis of substance abuse and trauma/ PTSD, group and individual, male and female, outpatient and inpatient residential.
The Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) model developed by a team of clinicians at the Kennedy Krieger Institute Family Center is a structured, phase-based, abuse-focused, treatment approach to address the emotional and behavioral needs of young children with a history of sexual abuse exhibiting problematic sexual behavior (PSB). A major premise of the model is that the PSB stems from emotional responses to the prior child sexual abuse causing the child to form cognitive distortions about themselves, others, and the world around them. A unique feature of the model is the formation of parallel narratives of the child’s experiences as a victim and as one who victimizes others. Children are supported to examine their roles and perceptions associated with each of these experiences. Clinicians guide children and their families through this process and provide the context for comparison leading to the integration of these experiences into a single narrative. The SMART model consists of three clinically essential phases: Safety and Stabilization, Triggers/Integration, and Re-Socialization. The SMART model utilizes individual, family, and group therapy simultaneously.
Risking Connection® teaches a relational framework and skills for working with survivors of traumatic experiences. The focus is on relationship as healing, and on self-care for service providers. It provides a comprehensive training curriculum for working with survivors of childhood abuse specially designed for staff in all mental health settings, including public systems. Risking Connection® emphasizes the concepts of empowerment and collaboration, three major goals serve as the main focus: (1) a theoretical framework to guide work with survivors of traumatic abuse, (2) specific intervention techniques to use with survivor clients, and (3) attention to the internal needs of trauma workers as well as clients. In addition, common concerns and skepticism about trauma treatment are addressed. Interspersed in this curriculum are client/clinician worksheets as well as assessment, self-reflection, group discussion, and clinical practice exercises.
PCIT is effective with single parents, cognitively limited parents, court-ordered parents, two-parent families, and foster parents. Cultural adaptations have been effective with Latino/Hispanic families, African American Families, and Native American families. PCIT has been disseminated internationally (e.g. Hong Kong, Norway, The Netherlands) and has been translated into different languages (e.g. Spanish and Mandarin). PCIT has been adapted for: Head Start classrooms;Group treatment; Home rather than office based sessions; Domestic violence shelters; Residential treatment centers.
Seclusion and restraint were once perceived as therapeutic practices in the treatment of people with mental and/or substance use disorders. Today, these methods are viewed as traumatizing practices and are only to be used as a last resort when less-restrictive measures have failed and safety is at severe risk.
For more information on alternatives to seclusion and restraint:
- U.S. Department of Health & Human Services
- National Assoc. of State MH Program Directors
- Problem with Increasing Use of Seclusion and Restraint in Schools