Trauma-Informed Therapy for Teens: What It Is and Why It Matters

Among the youth population, trauma is, unfortunately, quite common: As many as 1 in 4 young people may go through a significantly traumatic experience at some point in their childhood or adolescence. People assigned female at birth and people of color are more likely to go through a potentially traumatic event in childhood.

The effects of trauma can be extremely challenging to manage. Accessing trauma-informed care — which can be offered through medical care, in-school support, as well as mental healthcare — can create environments that are supportive, affirming, and cognizant of a child or adolescent’s trauma-related struggles. 

In this article, we’re explaining what trauma-informed care is, how it is used in therapy, what therapeutic modalities may be best for teens who’ve experienced trauma, and how Charlie Health can support teens’ healing post-trauma.

What is trauma?

Trauma is a type of emotional response that can occur after sexual assault, a natural disaster, an accident, the loss of a loved one, or another adverse life event.

Those who experience a traumatic event may deal with effects like:

• Higher levels of stress hormones
• Maladaptive (unhelpful) beliefs
• Depression
• Mood and anxiety disorders
• Substance use
• Suicidality
• Post traumatic stress disorder (PTSD)

What is post traumatic stress disorder?

Post traumatic stress disorder (PTSD) is a formal diagnosis involving the persistent re-experiencing of trauma, marked by symptoms like:

• Unwanted upsetting memories
• Nightmares
• Flashbacks
• Emotional distress after a reminder of the trauma
• Heightened physical awareness after a reminder of the trauma

People who are diagnosed with PTSD may also:

• Avoid trauma-related thoughts, feelings, and reminders.
• Have negative thoughts or feelings, including loss of recall, negative assumptions about the self or world, exaggerated self-blame or blame of others, negative affect, or isolation.
• Experience increased arousal or reactivity (e.g., irritability, aggression, high-risk behavior, hypervigilance, heightened startle response, difficult concentrating or sleeping).

An estimated 1 in 20 teens between the ages of 13 and 18 have met the diagnostic criteria for PTSD. Teens who experience trauma-related symptoms may benefit from a trauma-informed approach to therapy.

What is trauma-informed therapy? 

Trauma-informed care of any kind seeks to incorporate what’s known as “the four R’s”:

• Realize trauma’s far-reaching impact and possible treatment paths.
• Recognize the signs and symptoms of trauma.
• Respond by fully integrating what we know about trauma into practices.
• Resist re-traumatization of the people being supported.

Trauma-informed therapy encompasses any trauma-informed approach to psychotherapy. This category of therapy hinges on the impact of trauma on overall emotional well-being, day-to-day coping, and helpful versus harmful thoughts and behaviors. The goal is to help clients process, understand, and manage emotions and memories informed by past trauma so they can lead happier, more fulfilling lives.

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Are there different types of trauma-informed therapy?

While any mental health clinician can take a trauma-informed approach to providing care, there are several specific therapeutic modalities that experts recommend for treating people who’ve experienced trauma:

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) is the gold standard for PTSD. CBT is a form of psychotherapy that aims to help people identify maladaptive patterns of thinking and behavioral responses to curb distressing feelings. Variations and derivatives of CBT that are more focused on trauma responses, emotions, and memories (e.g., cognitive processing therapy, cognitive therapy, prolonged exposure) are also strongly recommended for treating PTSD.

Brief eclectic psychotherapy 

In brief eclectic psychotherapy, aspects of CBT and psychodynamic therapy (focused on self-reflection and the therapeutic alliance) are combined to address negative effects of trauma or other mental health challenges.

Eye movement desensitization and reprocessing therapy

In eye movement desensitization and reprocessing (EMDR) therapy, stimulation of one side of the brain at a time, using light or sound, is performed to decrease the emotional intensity associated with a trauma.

Narrative exposure therapy 

Narrative exposure therapy (NET) is a therapeutic modality in which clients establish their own narratives to provide new context for their trauma.

How does trauma-informed therapy for teens work?

Any mental health clinician who works with teens has the opportunity to incorporate the four R’s of trauma-informed care into all therapeutic modalities. That said, experts and researchers have uplifted specific modalities that are more effective for young people who’ve experienced trauma.

In 2013, the World Health Organization recommended only two treatment options for children and adolescents with PTSD after examining the existing literature: The first was a form of CBT called trauma-focused CBT (TF-CBT), and the second was EMDR therapy.

What happens in trauma-focused cognitive behavioral therapy?

Trauma-focused CBT (TF-CBT) was developed in 1996 by psychiatrist Dr. Judith A. Cohen and psychologists Dr. Anthony P. Mannarino and Dr. Esther Deblinger. It’s a kind of CBT designed exclusively for children and adolescents ages 13-18 who’ve experienced trauma. These “PRACTICE” components make up TF-CBT: 

Psychoeducational and parenting skills

Learning and skill building for clients and their parents. ƒ 

Relaxation techniques

Relaxation methods like focused breathing and visual imagery. ƒ 

Affective expression and regulation

Managing emotional reactions, identifying and expressing emotions, and self-soothing.

Cognitive coping and processing

Understanding how thoughts, feelings, and behaviors connect and correcting inaccurate or distorted thinking.

Trauma narration and processing

Gradual exposure to the traumatic event through verbal, written, and/or other creative exercises—and the processing of incorrect or maladaptive thinking. 

In-vivo exposure

Gradual exposure to reminders of the trauma to better manage emotional responses.

Conjoint parent/child sessions

Working with the family to support discussion of the traumatic event and trauma narration.

Enhancing personal safety and future growth

dditional education on establishing safety skills, healthy relationships, healthy sexuality, and management skills for future activation of trauma.

The TF-CBT protocol can be as short as 12 weeks.

What happens in trauma-informed EMDR therapy?

EMDR therapy was created by psychologist Dr. Francine Shapiro in 1989 as a way to treat trauma, but it wasn’t applied to the youth population until 1999.

EMDR typically involves a structured, eight-phase approach to care:

Taking a history and planning treatment: In the first phase, the client and therapist will review mental health history, the traumatic memory, related symptoms, coping needs, and goals for treatment.

Preparation

This phase involves an introduction to treatment and resourcing through guided visualization of a “safe place.”

Assessment

This phase involves activating the memory and taking stock of images, thoughts, feelings, and body sensations that come up.

Desensitization

This phase involves mentally and verbally processing the memory while following a stimulus with the eyes.

Installation

This phase involves shifting negative thoughts and feelings to positive ones.

Body scan

This phase involves observation of the physical and mental response to the memory.

Closure

This phase ends the session by actively containing any lingering processing needs until next time.

Re-evaluation

This phase involves evaluation of the prior session and the client’s current state to identify new targets.

EMDR treatment may continue for about 6 to 12 sessions, once or twice a week.

What can teens get out of trauma-informed therapy?

Trauma-informed therapy can be very helpful for teens who need support managing distressing symptoms related to post traumatic stress in the following ways:

• Learn more about trauma responses and the impact of trauma.
• Rebuild a sense of internal and external safety.
• Adapt to newly identified triggers and reminders of trauma.
• Develop a toolkit of coping strategies for when triggers and reminders come up.
• Reduce distressing symptoms related to the trauma.
• Process the trauma and narrating their own story.

The authors of a 2018 meta-analysis reviewing the research on TF-CBT and EMDR for children and adolescents who experienced trauma determined that TF-CBT and EMDR are both effective in reducing symptoms, but that TF-CBT may be slightly more effective. A theory for TF-CBT’s minor advantage, according to the study’s authors, is the gradual exposure to trauma. In the study, the effectiveness of TF-CBT and EMDR in treating trauma in adolescents held true regardless of the type of trauma.

Can trauma-informed therapy also help teens with complex trauma?

Complex trauma is repeated exposure to traumatic events. For example, a child or adolescent may have experienced long-term abuse or neglect from a caregiver. 

The meta-analysis we mentioned in the last section also found that there wasn’t a significant difference in treatment effectiveness between TF-CBT and EMDR for people who experienced one versus multiple traumatic events. 

However, the National Child Traumatic Stress Network also recommends a multimodal trauma-informed approach called Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) for complex trauma. ITCT-A combines several therapeutic modalities, including cognitive therapy, exposure therapy, mindfulness, and psychoeducation.

Trauma-informed therapy for teens at Charlie Health

Charlie Health’s virtual Intensive Outpatient Program (IOP) offers a range of therapeutic modalities for adolescents dealing with distressing trauma-related symptoms. 

All of our clinicians take a trauma-informed, evidence-based approach to care — whether that’s through individual therapy, supported groups, or family therapy. All three types of care are part of Charlie Health’s IOP.

If you, or your teen, are experiencing post traumatic stress, we can help you better manage those symptoms and begin to feel better. Start your journey with Charlie Health today.