Trauma Cognitive Behavior Therapy

Trauma Focused Cognitive Behavior Therapy

Trauma Focused Cognitive Behavior Therapy, as the name implies is a form of cognitive behavioral therapy that addresses the specific emotional and mental health needs of children, adolescents, adult survivors, and families who are struggling to overcome the destructive effects of early trauma.

Trauma-focused cognitive behavioral therapy (TF-CBT) is especially sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.

When It’s Used

Anyone who has experienced a single or repeated experience of sexual, physical, or mental abuse or who has developed post-traumatic symptoms, depression, or anxiety as a result of the loss of a loved one or exposure to violence in the home or community can benefit from TF-CBT.

If a child or adolescent also exhibits serious behavioral, substance-abuse, or suicidal-ideation problems, other forms of treatment, such as dialectical behavior therapy, may be more appropriate as an initial intervention and can be followed up with a trauma-sensitive approach.

There is little evidence that trauma-focused cognitive behavioral therapy is the best intervention for adult war veterans with complex post-traumatic stress disorder.

What to Expect

TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community center, hospital, school, or in-home setting. Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors.

At the same time, a family therapy approach looks at interactions among family members and other family dynamics that are contributing to the problem and aims to teach new parenting, stress-management, and communication skills.

How It Works

The trauma-focused approach to psychotherapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced any form of severe trauma or abuse.

Early trauma can lead to guilt, anger, feelings of powerlessness, self-abuse, acting out behavior, and mental health issues, such as depression and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in a number of ways.

Most likely as bothersome recurring thoughts about the traumatic experience, emotional numbness, sleep issues, concentration problems, and extreme physical and emotional responses to anything that triggers a memory of the trauma.

By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in youth.

What to Look for in a Trauma-Focused Cognitive Behavioral Therapist

Look for a licensed mental health professional with specialized training and experience in cognitive behavioral therapy and family therapy as well as further training and supervised experience in trauma-focused therapy. In addition to these credentials, it is important to find a therapist with whom you and your child feel comfortable working.


  • U.S. Department of Health and Human Services. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. August 2012.
  • Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Evidence-Based Child Health. May 2013;8(3):1004–1116.
  • Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews. 2013;12.
  • Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program website.


Hope or Prepare

Prepare For The Worst or Hope For The Best?

Is it better to approach life with great hope or a sense of doom?

A glass-half-full attitude is generally beneficial to your mental, physical, and emotional health, but stark realism is sometimes a smart tactic.

While every situation is unique, research offers some tips on when to brace for impact and when to stay upbeat. —Jill Coody Smits


After taking the Academic Tests, you wonder for weeks whether your score will be embarrassing or brag-worthy.

Expect the worst. Lowering expectations while awaiting test results can reduce disappointment at the big reveal, according to a University of Florida study–meaning you’re less likely to get upset (regardless of your score) than if you’d been counting on a 99th-percentile mark. Preparing for bad news helps in many moment-of-truth situations, such as hearing health outcomes, researcher Kate Sweeny adds.


You learn that your daughter’s fellow eighth-graders were caught drinking wine coolers and wonder if she’ll follow suit.

Expect the best. If you envision your teen swilling beer, you may create a self-fulfilling prophecy. Mothers who pass along low expectations raise kids who embody the party animal persona, Iowa State research shows. But children whose moms believe they’ll be temperate teens shun alcohol. Parents can relay their expectations explicitly or via behavior-shapers like setting a strict curfew.


A week after your honeymoon, your first big fight leaves you questioning whether you’ll make it to your Golden Anniversary.

Expect the best. Long-term love thrives on rose-colored glasses. Optimistic partners engage in “approach” strategies to problem-solving, employing cooperation and refraining from attacks, research in the Journal of Personality and Social Psychology shows. Less optimistic couples often engage in “avoidant” strategies (think: cold shoulder) that further strain the relationship.


You’ve nabbed the degree; now you’re applying for your first job.

Expect the best–realistically. Confident college grads are more successful job-seekers than pessimistic ones, unless they venture into fantasy, research notes. Whereas positive expectations (“I’m a strong candidate”) reflect past successes and acknowledge the value of hard work, fantasies (“I’ll be flooded with job offers!”) disregard attainability. Thinking you’re a workforce wunderkind can lead to laziness, NYU researcher Gabriele Oettingen explains.


You’re dying to beat your boss at the office tennis tournament next month.

Expect the worst, then the best. While training, imagine your boss is Boris Becker and focus on your weak service return. Self-doubt motivates you to practice harder and results in a stronger performance, according to a Michigan State study. But on match day, envision repeatedly crushing his serve. Confidence just prior to and during competition strongly correlates with winning.


Your doctor suggests a flu shot, but you hate needles.

Expect the worst. Hypochondria, a little unease goes a long way in preventive health behaviors. Worrying about breast cancer is a strong predictor of getting screened, and people get flu shots simply because they anticipate regretting not getting the vaccine, studies show. Overall, of course, optimism begets health, but if a kick in the butt leads to a shot in the arm, so be it.

Cope with

How Does Sleep Influence Health?

Sleep is truly the other half of our waking lives, as well as an essential half of modern psychiatry.

During sleep, our brains recharge the neurotransmitters that are so important to our mood and thinking—dopamine, norepinephrine, and serotonin, to name a few. Training in both psychiatry and sleep medicine has allowed me to have an unique perspective on these two highly related fields of medicine, which, unfortunately, tend to be practiced in isolation of each other.

Through this unique perspective, I have seen some truly remarkable breakthroughs in difficult, treatment-resistant cases. A careful analysis and understanding of sleep and sleep architecture has made this possible. “If there is no gas in the tank, you can’t push the gas pedal,” is something I often say to my clients, because indeed, if you are not well-rested and recharged, not much will work.


The effects of sleep on psychiatry cannot be understated. In a study by the Gallup organization, “Sleep in America,” people with impaired sleep suffered some significant daytime consequences. Individuals with frequent sleep difficulty, had a 3- to 5-fold higher incidence of problems coping, accomplishing tasks, and suffering from low mood. Their family and relationships suffered as well, with a similar worsening in personal relationships, as well as social and family life.

Besides having a marked negative impact on emotional and mental well-being, sleep can also be a warning sign for more serious psych-related conditions. In my experience “sleep, sex, and drugs (including alcohol),” are all the “tips of the iceberg,” and when something is wrong in one of these domains, it usually points to something deeper below the surface.

In a large scale analysis of about 1,000 patients, insomnia was a strong predictor of increased risk for depression, anxiety, and substance use. In the case of depression, insomnia was associated with nearly a four-fold increased risk of depression at follow up, in 3.5 years.

The bad news is that we live in an ever busy, 24/7 society in which our days have effectively squeezed out our nights. We are sleeping less than ever, and while some have questioned how much sleep we really need, the line at Starbucks and popularity of energy drinks illustrates we probably need more than we’re getting. The rise in the use of stimulant drugs further supports this point.

The good news is that for most healthy sleep-deprived people, allowing the time for our minds and bodies to de-stress and have a chance to sleep, does a lot of good. Our bodies do this quite well, naturally, and it’s a matter of allowing our biology a chance to do so. Regular sleep schedules, no screens in bed, and getting some exercise can do a tremendous amount of good. In the words of Alan Watts, “Muddy water is best cleared by leaving it alone.” The human mind, is not much different. Leave it alone, and it will settle itself. But you have to leave it alone – and this may take practice and patience.

For those working with either a sleep doctor or a psychiatrist, or planning to do so, it is so important to realize how connected these two fields are. Make sure your psychiatrist is aware of any sleep issue—whether its sleep apnea, insomnia or restless legs syndrome.

Certainly make sure your sleep doctor is aware of any psych issues or medications. Ideally have your doctors be able to communicate about your care, given the tremendous overlap between these two. As there are so few practitioners of psychiatry and sleep, it might be up to you to learn more on this topic.

Sleep is generally more complex than how many hours you slept last night, and at minimum quality is as important as quantity. My hope is that these articles will be a good starting point.




The Sport Science of Brazilian Jiu Jitsu

Competitive Stress

If you’re an athlete, you’ve most likely felt the pressure that comes from competitive stress, because the indisputable essence of sport is competition.

The whole social and pedagogical activity in the service of sport has as a major objective the moment of “confirmation of efficiency” in the competition. Everyone knows that in most situations the competition has the gift of ambitioning the competitors.

The phenomenon is of a social psychological nature and it is a opportunity to bring people together and constructing relationships, based on similar beliefs and experiences.

But from the athlete side, the stress factors involved are huge and needed to be consider in order to understand the whole experience.

Both requirements, external and objective, as well internal, like self-exigencies (aspirations, desire to excel, achieve a great performance, gain) form a complex stressful experience, that puts the entire psycho-behavioral system in a state of tension, mobilization of energy resources and defense.

Sport Performance, especially high professional performance in sport, it is by definition a stressful activity, because of the work put in training – by duration and intensity, by the amount of sacrifices they impose on the athlete; contests – through the high emotional level and motivational, individual and social engagement, plus social relationships – that sport generates.

All of this produces muscular tension, strain, mental tension, claiming physical and mental efforts of adjustment and balance. Unlike training, the competition has a very high emotional load that leads the psycho-behavioral system to a limit.

I will recall here a minimal list of stressors, that determine performance and the state of mind of an athlete:

  • External requests: cold, to warm, timezone differences;

  •  Internal solicitation: enormous efforts of muscle movement ;

  • Psychological intellectual- emotional- requests: decisions in uncertainty and crisis of time, reactions to failure or success, maximum voluntary effort;

  • Psychosocial solicitation: criticism from leadership and press, or family and close friends, spectators’ appreciation;

  • Regulatory restrictions.

All these factors are reflected in the athlete psychic system , either at the level of full awareness or subconscious, by determining the adaptive and defense responses that a good organized scientific training will focus on for effective competitive conduct. The challenging situations of the competition can be intense or less intense and in relation to the athlete’s mental capacity, with his competitive experience and the level of aspiration. However, they are generating psychic tensions, mostly expressed in the emotional, but with an echo over the whole psychic system.

Fatigue also has an important role in determining the capacity of effort especial for adolescents. Research has shown that athletes’ fatigue is manifested by: feeling tired; there is a sign of reducing the ability to understand the more abstract problems, limiting the possibilities of generalization, comparison, performing summation, association, memorization; disturbances of attention.

The emergence of these difficulties creates an imbalance between the difficulty of the task to be fulfilled and the voluntary effort required for it, which leads to the overestimation of the interested functions and necessitates the restructuring of the mechanisms of adaptation to the effort. This restructuring has as a consequence a series of subjective and objective psychological phenomena: feelings of personal insufficiency, depression, irritability, restlessness, apathy, changing school behavior, restless sleep.

In conditions of fatigue, the functional capacity of the visual, auditory, kinestezic-motor and cutaneous analyzers is reduced, which makes the reactions to the stimuli that interest these analyzers have a longer latency period.

The most important causes of fatigue are:

  • the intensity and duration of the effort;

  •  reduced recreation in sleep pattern;

  • prolonged extra scholar activities;

  • reduced sleep ;

  • poor health status;

  • inadequate working conditions and family life;

  • over-learning.

The stress tolerance depends to a large extent to some particularities of our nervous system (strength, balance and mobility of the cortical processes), and the temperamental peculiarities. Researchers believe that stress resistance depends on a certain complex of psychophysiological factors. Horn (1992) asserts that a combination of anxiety, impulsivity and increased emotional reactivity can lead to a high probability of distress reactions. Other studies have highlighted that the intensity of emotional stress in prestart situations is correlated with the need for success or the tendency to avoid failure.

Interesting is that sometimes last-minute mobilization, when there is nothing to lose, all physical, technical and psychological resources strike back, in a last effort, and the athlete, or team win an unexpected success.

This ONE THING  mobilization is more valuable than anything in that moment.

Feel free to comment your thoughts!


The published material is the author’s opinion and meets the accepted scientific standards at the time of publication, but science is constantly changing and therefore can not guarantee that the information is complete, current, or error-free; the material is not and does not substitute for medical and psychological consultation; so use this material for information only and not for self-diagnosis or self-treatment – if you have any doubts about your health – contact your doctor and psychologist.
*For other questions – ask the author.
*The material presented may be further modified.



Overcome Anxiety

Can I Overcome Anxiety?

Explore information about anxiety disorders, including signs and symptoms, treatment, research and statistics, and most of all, learn to overcome anxiety.

Anxiety is a complex system of cognitive, affective, physiological, and behavioral responses. And is activated when anticipated events or circumstances are considered particularly aversive because they are perceived as unpredictable, uncontrollable, events that may threaten the vital interests of a individual.

Anxiety disorders are included in the group of psychiatric disorders because they can alter a person’s behavior so much that the individual can’t longer lead a normal life.

In the absence of special treatment, the patient can’t control their permanent state of fear and concern, even in the absence of a real reason.

Symptoms of anxiety

  • Fear, worry, agitation, irritability, difficulty concentrating, fatigue;
  • Feeling of choking, thirst, feeling hot, dry mouth, nodule in the throat, pressure / chest pressure, hyperventilation, palpitations;
  • “Numbness” in the body / limbs, muscle contractions, tremor;
  • Headaches, dizziness, sweating, waves of heat;
  • Nausea, vomiting, abdominal colic, accelerated intestinal transit;
  • Insomnia;


Witch Are Anxiety Disorders?

They are characterized by constant and overwhelming anxiety that influences everyday life that prevents us from performing our activities effectively.


Types of anxiety disorders according to DSM-5

  • Specific phobia
  • Social anxiety disorder (social phobia)
  • Panic disorder / panic attack
  • Agoraphobia
  • Generalized anxiety disorder
  • Severe anxiety disorder
  • Induced substance / drug-induced anxiety disorder
  • Anxiety disorder due to other medical conditions
  • Other anxiety disorders specified
  • Anxiety disorder not specified

Diseases associated with anxiety

  • Depression
  • Irritable colon
  • Fibromyalgia
  • Sleep disorder
  • Disturbing disorder

Research made on Anxiety Disorders revealed that “are the most commonly encountered health mental problems globally”. Studies conducted on adolescents (for example, Kathleen Merikangas’s JAACAP study in 2010), as in adults (for example, Ronald Kessler’s JAMA study in 2005) show that the prevalence of life-long anxiety disorder is approx. 30%.

The evolution of anxiety disorders is chronic, and in the absence of proper treatment, people suffer major long-term costs such as: increased somatic disease and high comorbidity with other mental health problems (eg depression, abuse of alcohol or other substances) increased disability, academic failure, unemployment or low performance at work.


Psychopharmacological treatment has a high rate of response and avoids anxiolytic medication (especially benzodiazepine), antidepressant (the first being ISSR – selective serotonin reuptake inhibitors.) The lowest doses that control the clinical picture of the patient are generally used.

Cognitivebehavioral psychotherapy targets cognitive techniques (centered on patient’s thoughts, cognitive restructuring) and behavioral techniques (exposure to anxiety, social competence training, control and anxiety behavior).

Psychoeducation contributes to the good information of the patient and his family about anxiety disorders, treatment modalities and evolution over time.

We know that the first step to solving a problem, is to identify it. But you do not have to do it yourself, if you don’t want to. All you need to do is to call a specialist. They exist to guide you, in your process of regaining control over your life. Be brave, you are not alone !


Did you or a loved one struggled with depression, anxiety or any this symptoms ?

Also take a look at this amazing book.

Overcome Anxiety

Meditation and Health

Meditation and Health

Taking a few minutes to focus your mind each day can reduce stress, pain, depression, and more.

You can’t see or touch stress, but you can feel its effects on your mind and body. In the short term, stress quickens your heart rate and breathing and increases your blood pressure. When you’re constantly under stress, your adrenal glands overproduce the hormone cortisol.

Overexposure to this hormone can affect the function of your brain, immune system, and other organs. Chronic stress can contribute to headaches, anxiety, depression, heart disease, and even premature death.

Though you may not be able to eradicate the roots of stress, you can minimize its effects on your body. One of the easiest and most achievable stress-relieving techniques is meditation, a program in which you focus your attention inward to induce a state of deep relaxation.

Although the practice of meditation is thousands of years old, research on its health benefits is relatively new, but promising. A research review published in JAMA Internal Medicine in January 2014 found meditation helpful for relieving anxiety, pain, and depression. For depression, meditation was about as effective as an antidepressant.

Meditation is thought to work via its effects on the sympathetic nervous system, which increases heart rate, breathing, and blood pressure during times of stress. Yet meditating has a spiritual purpose, too.


Types of meditation

Meditation comes in many forms, including the following:

  • Concentration meditation teaches you how to focus your mind. It’s the foundation for other forms of meditation.
  • Heart-centered meditation involves quieting the mind and bringing the awareness to the heart, an energy center in the middle of the chest.
  • Mindfulness meditation encourages you to focus objectively on negative thoughts as they move through your mind, so you can achieve a state of calm.
  • Tai chi and qigong are moving forms of meditation that combine physical exercise with breathing and focus.
  • Transcendental meditation is a well-known technique in which you repeat a mantra — a word, phrase, or sound — to quiet your thoughts and achieve greater awareness.
  • Walking meditation turns your focus to both body and mind as you breathe in time with your footsteps.

Starting your practice

The beauty and simplicity of meditation is that you don’t need any equipment. All that’s required is a quiet space and a few minutes each day. Start with 10 minutes, or even commit to five minutes twice a day. Preferably meditate at the same time every morning. That way you’ll establish the habit, and pretty soon you’ll always meditate in the morning, just like brushing your teeth.

The specifics of your practice will depend on which type of meditation you choose, but here are some general
guidelines to get you started:

  • Set aside a place to meditate, you can surround your meditation spot with candles, flesh flowers, incense, or any objects you can use to focus your practice – or not.
  • Sit comfortably in a chair or on the floor with your back straight.
  • Close your eyes, or focus your gaze on a object if you want.
  • Breathe slowly, deeply, and gently.
  • Keep your mind focused inward or on the object. If it wanders, gently steer it back to center.
  • Breathe peace and quiet into your heart and mind. While you’re breathing out, imagine your breath as a river or a tide that’s carrying your thoughts away .
  • You can also chant out loud. Many people use the Sanskrit word “shanti,” which means “peace.” Or choose a word from your own religious tradition.


Within just a week or two of regular meditation, you should see a noticeable change in your mood and stress level.

Are you ready to try it ?


The published material is the author’s opinion and meets the accepted scientific standards at the time of publication, but science is constantly changing and therefore can not guarantee that the information is complete, current, or error-free; the material is not and does not substitute for medical and psychological consultation; so use this material for information only and not for self-diagnosis or self-treatment – if you have any doubts about your health – contact your doctor and psychologist.
*For other questions – ask the author.
*The material presented may be further modified.