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©2006 1
UCLA Trauma-Grief Focused Treatment Program for Adolescents
(TGFT)
Christopher M. Layne William R. Saltzman
Robert S. Pynoos
©2006 2
Implementation Sites to Date
• Armenia (massive earthquake) • Post-War Bosnia (war) • Inglewood, California (school shooting)• Pasadena, California (community violence)• Columbine/Santee High Schools (school
shootings) • World Trade Center (terrorist attack,
community & domestic violence) • Florida (selected components; hurricane)
©2006 3
Empirical Evidence(Layne et al., 2001)
• Significant pre-post reductions in: – PTSD symptoms – complicated grief symptoms – depression symptoms
• Reliable improvement rates (RCI’s): – 49% in PTSD scores– 51.4% in complicated grief scores– 35.2% in depression scores
©2006 4
Program Characteristics
• Ages: 11-20 years old
• Focus: Trauma (single or multiple exposure) & traumatic death/loss.
• Setting: School or community clinic
• Assessment-driven
• Length of Treatment: 10-24 sessions (modular design – varied length depending on which parts are used).
©2006 5
Overview of Trauma/Grief-Focused Group Psychotherapy
Module I(6 sessions)
Module II(8-12 sessions)
Module III(8 sessions)
Module IV(4 sessions)
Group Phase
Opening Working Through Termination
ModuleTitle
Group Cohesion, Psychoeducation, and Basic Coping
Skills
Working Through Traumatic Experiences
Coping with Traumatic Loss and
Grief
Re-Focusing on the Present and Looking to the
Future
Therape-utic
Tasks
1: Welcome and introduction (program overview, barriers, group contract, posttraumatic stress, depression, and grief reactions)2: Learning about trauma and loss reminders (how I react to, and cope with, reminders)3: Learning coping skills4: The event-thought-feeling link 5: Identifying and challenging distressing thoughts (“Three Steps to Taking Charge of Your Feelings”) 6: Support seeking (“Five Steps to Getting Support”)
First: Preparing for trauma narrative work (constructing the group narrative, constructing my personal trauma timeline)
Middle: Constructing the trauma narrative (prolonged therapeutic exposure; develop a vocabulary for communicating about the trauma)
Final: Exploring the worst moments (prolonged therapeutic exposure; using trauma reminders to understand the nature and personal meaning of traumatic experiences; cognitive restructuring cognitions associated with guilt and shame; exploring intervention fantasies)
1: Learning about grief (grief reactions, loss reminders, and grief processes / tasks) 2: Understanding grief reactions: Focus on anger3: Understanding grief reactions: Focus on guilt4: Remembering and reminiscing 5: Guided imagery: Retrieving a non-traumatic image of the deceased 6: Adjusting to a world in which the deceased is absent7: Planning for difficult days (relapse prevention)8: Saying goodbye in a good way
1: Resuming developmental progression2: Problem-solving current life (“Three Steps to Solving a Problem”)3: Dealing with problems that are not my job to fix 4: Saying goodbye in a good way
©2006 6
Trauma/Grief Focused Psychotherapy:
Five Therapeutic Foci
1) Traumatic Experiences
2) Trauma & Loss Reminders
3) Post-Trauma Stresses & Adversities
4) Bereavement and the Interplay of Trauma & Grief Reactions
5) Developmental Impact
©2006 7
Intervention Strategies
• Psychoeducation
• Skills Training
• Cognitive Interventions
• Prolonged Therapeutic Exposure
• Grief Processing/Facilitation
• Social Network Interventions
• Relapse Prevention
©2006 10
My Timeline
What was happening outside of me:
What was happening inside of me: (thoughts, feelings, bodily sensations)
©2006 12
Practice Exercise: Parts of my life I want or need to change
to adjust to the loss
Overall Change I Want/Need
First Steps I need to Take
Living situation and finances
Mealtimes/ time spent with family
School, homework, preparation for college
Choice of friends/ time spent with friends
Daily interactions with people
Favorite activities and hobbies
Chores and Responsibilities
Other (describe)____________