Cognitive Behavioral Therapy For Children Research Articles

The state of psychological treatments for social anxiety disorder in children and adolescents: An Umbrella Review

Social Anxiety Disorder (SAD) is a very common disorder in childhood and adolescence. Many studies have examined various types of Cognitive Behavioral Therapy (CBT), meaning there is a need for a study exploring the efficacy of CBT. The objectives of this study are to determine what treatments and factors can improve treatment outcomes for SAD. We performed an umbrella review of the effectiveness of psychological interventions in treating SAD in children and adolescents. Nine databases were searched using a combination of keywords. Risk of bias was assessed using AMSTAR-2. Six systematic reviews and meta-analysis were selected and reported. All of those studies assessed the efficacy of CBT in children and adolescents with SAD, demonstrating its short- and long-term effectiveness. The components that seem to be most effective are exposure in any modality and social skills training. Other considerations to take into account are addressed in the discussion.

Right Prefrontal Cortical Thickness Is Associated With Response to Cognitive-Behavioral Therapy in Children With Obsessive-Compulsive Disorder

Cognitive-behavioral therapy (CBT) is considered a first-line treatment for obsessive-compulsive disorder (OCD) in pediatric and adult populations. Nevertheless, some patients show partial or null response. The identification of predictors of CBT response may improve clinical management of patients with OCD. Here, we aimed to identify structural magnetic resonance imaging (MRI) predictors of CBT response in 2 large series of children and adults with OCD from the worldwide ENIGMA-OCD consortium. Data from 16 datasets from 13 international sites were included in the study. We assessed which variations in baseline cortical thickness, cortical surface area, and subcortical volume predicted response to CBT (percentage of baseline to post-treatment symptom reduction) in 2 samples totaling 168 children and adolescents (age range 5-17.5 years) and 318 adult patients (age range 18-63 years) with OCD. Mixed linear models with random intercept were used to account for potential cross-site differences in imaging values. Significant results were observed exclusively in the pediatric sample. Right prefrontal cortex thickness was positively associated with the percentage of CBT response. In a post hoc analysis, we observed that the specific changes accounting for this relationship were a higher thickness of the frontal pole and the rostral middle frontal gyrus. We observed no significant effects of age, sex, or medication on our findings. Higher cortical thickness in specific right prefrontal cortex regions may be important for CBT response in children with OCD. Our findings suggest that the right prefrontal cortex plays a relevant role in the mechanisms of action of CBT in children.

Extended treatment of multimodal cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder improves symptom reduction: a within-subject design.

Based on the current state of research regarding the treatment in pediatric obsessive-compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients' characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research. This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6-20years) with OCD (n = 38) within routine care. Effects on obsessive-compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons. During the standard treatment and extended treatment, obsessive-compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided. These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030050 ).

Clinical, demographic and theory-derived maintaining factors as moderators of treatment outcome in internet-delivered cognitive behavioural therapy for children and adolescents with social anxiety disorder

Internet-delivered cognitive behavioural therapy (ICBT) is an efficacious treatment for social anxiety disorder (SAD) in youth. However, we have limited knowledge about patient characteristics that may be associated with better (or worse) treatment outcome. Particularly concerning factors suggested to be involved in the maintenance of SAD (e.g., anticipatory anxiety and post-event processing). The aim of the current study was to evaluate possible predictors and moderators of the effect of ICBT in a randomised controlled trial where children and adolescents (N = 103; 10–17 years) with SAD received either ICBT or internet-delivered supportive therapy, ISUPPORT. Examined variables were pre-treatment levels of social anxiety, depression symptoms, putative maintaining factors as well as demographic variables like age and gender. Latent growth curve models were used to examine predictors and moderators of changes in youth and clinician rated social anxiety symptoms, from pre-treatment to 3-month follow-up. Baseline depression symptoms moderated the outcome, with higher depression scores being associated with greater reduction of SAD symptoms in ICBT compared to ISUPPORT. More difficulties at baseline with anticipatory anxiety, post-event processing, focus of attention and safety behaviours predicted greater reduction of SAD symptoms, regardless of treatment condition. No other clinical or demographic variable predicted or moderated the outcome. In summary, baseline depression severity may be an important moderator of ICBT, but the preliminary finding needs replication in sufficiently powered trials.

Child-therapist and parent-therapist alliances and outcome in the treatment of children with oppositional defiant/conduct disorder

Objective This study examined the quality of therapeutic alliance from different rater perspectives (child, parent, therapist) in cognitive behavioural therapy for children with oppositional defiant disorder (ODD) and conduct disorder (CD), and its association with symptom severity. Further, a panel model with an autoregressive cross-lagged panel design was used to explore whether therapist-rated and parent-rated therapeutic alliance influences change in symptom severity, or vice versa. Methods Sixty boys aged 6–12 years with a principal diagnosis of ODD/CD, and their parents, received individually delivered social competence training for childhood aggressive behaviour problems. Child, therapist, and parent ratings of therapeutic alliance and symptom severity were measured twice. Results Our results indicate good to very good therapeutic alliance that was relatively stable over time. The cross-sectional analyses of the alliance-symptom association revealed moderate correlations. However, effects of early alliance on later treatment outcome or of early symptom severity on later alliance were marginal. The only significant association was found between early parent-rated therapist-parent alliance and later parent-rated symptom severity. Conclusion Our study shows a moderate correlation between simultaneously assessed therapeutic alliance and symptoms. The findings of the panel model indicate that an early good therapeutic alliance is a component of later therapeutic success (parent perspective).

Internet-based cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder: A randomized controlled trial

Obsessive-compulsive disorder (OCD) in childhood and adolescence often leads to significant impairment in various areas of life and has a high risk of becoming chronic. Cognitive behavioral therapy (CBT) is the recommended first-line treatment, but it is too rarely implemented in accordance with guidelines and is often not available close to the patient's home. Importantly, internet-based CBT could help to reduce this gap in care. Having previously successfully demonstrated the feasibility of an internet-based CBT approach, we aimed to assess its effectiveness in a waiting list controlled randomized trial. Children and adolescents aged 6-18 years with a principal diagnosis of OCD received 14 sessions of therapist-delivered CBT via videoconference distributed over 16 weeks. After inclusion, participants were randomly assigned to either the treatment or waiting list group. Participants in the treatment group began treatment immediately after baseline diagnostics, and participants in the waiting list group began treatment after a 16-week waiting period. The primary outcome was a pre-post comparison of OCD symptoms as measured with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Additionally, remission was an important outcome measure. Follow-up assessments were conducted for all measures 16 and 32 weeks after completion of treatment. A total of 60 children and adolescents were included into the analyses. Over the course of the treatment, OCD symptoms according to the CY-BOCS significantly decreased in the treatment group compared to the waiting-list control group. Cohen's d between groups was 1.63. After the patients in the waiting list group also received the treatment, the OCD symptoms decreased significantly in this group as well. This improvement of symptoms increased over the course of the follow-up assessments. Remission rate peaked at the 32-week follow-up, with 68% in the treatment group and 79% in the waiting list group. Importantly, patient satisfaction with treatment was high to very high. In our study, OCD symptoms decreased significantly and remission rate was high after internet-based CBT. Those effects were comparable to those found in studies of face-to-face treatment. Although further evidence is needed, these are early indications that our approach may be a viable way to provide access to adequate treatment for children and adolescents affected by OCD. [www.ClinicalTrials.gov], identifier [NCT05037344].

Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior

BackgroundPsychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AimsThe current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. Methods and proceduresSeventy-two children (aged 9–18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children’s externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. Outcomes and resultsThe results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 – 3) and TA-BB (M = 4.11; SD = 0.32; range 1 – 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). Conclusions and implicationsThe current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF.

The Efficacy of Parent Management Training With or Without Involving the Child in the Treatment Among Children with Clinical Levels of Disruptive Behavior: A Meta-analysis

A systematic review and meta-analysis was conducted where we evaluated the effects of Parent Management Training (PMT), Parent–Child Interaction Therapy (PCIT) and PMT combined with child cognitive behavioral therapy (CBT) using data from 25 RCTs on children with clinical levels of disruptive behavior (age range 2–13 years). Results showed that PMT (g = 0.64 [95% CI 0.42, 0.86]) and PCIT (g = 1.22 [95% CI 0.75, 1.69]) were more effective than waiting-list (WL) in reducing parent-rated disruptive behavior, and PMT also in improving parental skills (g = 0.83 [95% CI 0.67, 0.98]) and child social skills (g = 0.49 [95% CI 0.30, 0.68]). PCIT versus WL had larger effects in reducing disruptive behavior than PMT versus WL. In the few studies found, the addition of child CBT to PMT did not yield larger effects than PMT or WL. These results support offering PMT to children with clinical levels of disruptive behavior and highlight the additional benefits of PCIT for younger ages.

The relationship between homework adherence and outcome in family-based cognitive-behavioral therapy for early-onset obsessive compulsive disorder

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homework adherence between sessions can increase treatment dose and predict improved outcome. However, no studies have specifically examined the effect of homework adherence on treatment outcome for early-onset OCD. This study examined homework adherence during family-based CBT for young children (N = 63) with early-onset OCD. Caregiver and child homework adherence were rated weekly by clinicians and symptom change was assessed at multiple timepoints across treatment. Caregivers and children were both rated as highly adherent with homework, although caregivers were rated as more adherent than children. Structural equation modeling indicated that early homework adherence predicted later homework adherence, which predicted improved treatment outcome.

Associations between therapist factors and treatment efficacy in randomized controlled trials of trauma-focused cognitive behavioral therapy for children and youth: A systematic review and meta-analysis.

Previous research suggests that the effect of therapist factors on patient outcomes is significant. Yet, to date, no reviews have explored the potential effects of therapist characteristics on treatment outcomes for children and youth with posttraumatic stress disorder (PTSD). This systematic review and meta-analysis aimed to summarize the professional characteristics of trial therapists delivering trauma-focused cognitive behavioral interventions (TF-CBT) for child PTSD in clinical trials and understand the association between treatment efficacy and therapist factors. Systematic searches for randomized controlled trials (RCTs) published through November 3, 2020, were conducted; 40 RCTs were included in the full review. PTSD treatment outcome data were extracted from each publication along with any available data regarding trial therapists. Subgroup analyses were conducted to compare the outcomes of interventions conducted by different types of therapists. All therapist groups yielded significant effects for TF-CBT relative to active and passive control conditions, with the largest effect size, Hedges' g = -1.11, for RCTs that used clinical psychologists and psychiatrists. A significant moderating effect was found when comparing the treatment outcomes of clinical psychologists and psychiatrists versus other professionals, p = .044; however, this effect was no longer apparent when only studies with an active control arm were included. Further moderator analyses demonstrated no significant differences regarding therapists' educational and professional backgrounds and PTSD treatment outcomes. The current RCT evidence for TF-CBT for children and youth with PTSD does not suggest that therapist educational or professional background influences treatment efficacy. Limitations and implications for future research are discussed.

Cognitive behavioral therapy for children and adolescents with post-traumatic stress disorder: meta-analysis

BackgroundChildren and adolescents who experience traumatic events may develop post-traumatic stress disorder (PTSD), which is often associated with other psychiatric disorders, including depression and anxiety. Cognitive behavioral therapy (CBT) is widely used in psychotherapy to treat PTSD in children and adolescents. This meta-analysis evaluated previous studies on the effectiveness of CBT in the treatment of PTSD in children and adolescents. MethodsRandomized controlled trials (RCTs) published before July 25, 2021, were retrieved from seven databases. All RCTs of CBT compared to control, including conventional treatment or other treatments, in children or adolescents with PTSD. Random effect models were employed for all outcomes. Risk of bias was performed by Cochrane Collaboration's tool. The publication bias was evaluated using the Egger's regression analysis. ResultsNineteen RCTs were included in the meta-analysis. Compared with control, CBT was effective in reducing the symptoms of PTSD in children and adolescents, with a variety of scales used to measure the overall PTSD symptoms: CAPS (SMD = −0.41, 95%CI [−0.71, −0.12]), CPSS (SMD = −0.88, 95%CI [−1.42, −0.34]) and UCLA-PTSD RI (SMD = −1.70, 95%CI [−2.98, −0.42]). Furthermore, CBT also improved the comorbidities of depression (SMD = −0.43, 95%CI [−0.70, −0.17]) and anxiety (SMD = −0.29, 95%CI [−0.56, −0.03]) associated with PTSD. However, CBT was not effective in reducing avoidance symptoms (SMD = 0.38, 95%CI [−0.55, 1.31]). ConclusionCBT can reduce the severity of PTSD in children and adolescents and improve the symptoms of depression and anxiety, as evident in the treatment of PTSD victims of sexual abuse and war and in patients aged more than 7 years.

Cognitive Behavioural Therapy for children and adolescents with intellectual disability and anxiety: a therapist manual

Up to 50% of children with intellectual disability (ID) have a comorbid mental illness, yet to date, there has been a lack of evidence-based treatments for this population. This paper discusses the development and application of the Fearless Me! © treatment program, a multimodal Cognitive Behavioural Therapy (CBT) intervention for children with mild to moderate ID and anxiety. The program development involved a review of the literature to identify the neuropsychological deficits present for children with ID and suggested ways in which therapy could be adapted for their needs. This was followed by gathering feedback from parents and mental health practitioners. From this, the Fearless Me! © program was developed, involving face-to-face sessions and an online component to support the practice of CBT skills. The program has been trialed among children and adolescents with ID, and shows promise in reducing anxiety in children with mild to moderate ID.

Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study.

This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5–11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents’ ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges.

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Sleep and Actigraphy Research Trends: A Bibliometric and Keyword Network Analysis From 2004 to 2020

Background and Objective As sleep is a predictor of quality of life, studying sleep health and measurement is important. Actigraphy as a physiologic measure based on monitoring an individual’s movement has also been increasing in use as it has several advantages over traditional self-reports. This study aimed to report the research trends of sleep and actigraphy using a bibliometric and keyword analysis.Methods Using topic search queries, this study collected data from 3955 publications published between 2004 and 2020 and listed in the Web of Science Core Collection. A text-mining unstructured data analysis was performed using author keywords and a bibliographic analysis.Results Studies on sleep and actigraphy have been actively conducted in the fields of neurosciences and neurology but not in other fields. A gradual increase in publication and the steep increase in citations related to this topic occurring during the period considered. By clustering the author keywords, the analysis revealed five clusters: 1) monitoring physical activity and blood pressure, 2) measuring sleep quality, 3) insomnia and cognitive behavioral therapy for adolescents and children, 4) disorders and circadian rhythms, and 5) shift work. The leading research cluster has changed over the time.Conclusions With the increase in the number of studies and citations on sleep and actigraphy over the past 16 years, the trend of sleep and actigraphy studies have shifted from a focus on sleeprelated psychiatric disorders to a focus on cognitive behavioral therapy for children and adolescents and, more recently, the measurement of sleep quality.

Cognitive-behavioural therapy for children with irritable bowel syndrome.

A child with irritable bowel syndrome (IBS) presented to the clinic with a chief concern of ongoing gastrointestinal symptoms. The parents reported no improvement despite dietary modifications and are not interested in any medications. Is cognitive-behavioural therapy (CBT) an effective treatment for IBS in children? Traditional CBT and its subtypes, including Internet-based CBT and gut-directed hypnotherapy, are more effective in reducing pain and gastrointestinal symptoms in children and adolescents with IBS compared with standard treatment or no treatment. This therapy should be recommended to patients and parents.

Internet-based cognitive behavioral therapy in children and adolescents with obsessive compulsive disorder: a feasibility study

Cognitive behavioral therapy (CBT) is the first choice of treatment of obsessive–compulsive disorder (OCD) in children and adolescents. However, there is often a lack of access to appropriate treatment close to the home of the patients. An internet-based CBT via videoconferencing could facilitate access to state-of-the-art treatment even in remote areas. The aim of this study was to investigate feasibility and acceptability of this telemedical approach. A total of nine children received 14 sessions of CBT. The first session took place face-to-face, the remaining 13 sessions via videoconference. OCD symptoms were recorded with a smartphone app and therapy materials were made accessible in a data cloud. We assessed diagnostic data before and after treatment and obtained measures to feasibility, treatment satisfaction and acceptability. Outcomes showed high acceptance and satisfaction on the part of patients with online treatment (89%) and that face-to-face therapy was not preferred over an internet-based approach (67%). The majority of patients and their parents classified the quality of treatment as high. They emphasized the usefulness of exposures with response prevention (E/RP) in triggering situations at home. The app itself was rated as easy to operate and useful. In addition to feasibility, a significant decrease in obsessive–compulsive symptoms was also achieved. Internet-based CBT for pediatric OCD is feasible and well received by the patients and their parents. Furthermore, obsessive–compulsive symptomatology decreased in all patients. The results of this study are encouraging and suggest the significance of further research regarding this technology-supported approach, with a specific focus on efficacy.Trial registration number: Clinical trials AZ53-5400.1-004/44.

Research Review: A meta-analysis of relapse rates in cognitive behavioral therapy for anxiety and related disorders in youth.

Cognitive behavioral therapy (CBT) is an effective treatment for youth with anxiety and related disorders, with a 59% remission rate at post-treatment. Results of reviews and meta-analyses indicate that treatment gains are maintained across long-term follow-up, at least in terms of symptom improvement. Less is known about relapse, defined as patients who initially achieve remission status but then experience a return of symptoms after a follow-up period. The current study used meta-analysis to determine the overall rate of relapse in CBT for children and adolescents (age 18 years or younger) with anxiety and related disorders. Potential moderating factors of relapse rates, including demographic, methodological, and clinical/intervention characteristics, were also examined. Out of a pool of 78 abstracts, 13 full-text articles were retained for meta-analysis. An additional two articles were identified from other sources (total N = 535 patients). Results showed an overall relapse rate of 10.5% (including comorbid autism spectrum disorder) and 8% (excluding comorbid autism spectrum disorder) across studies. Moderator analyses demonstrated that relapse rates were higher among younger and more racially diverse samples, as well as among patients with comorbid externalizing disorders and those taking psychiatric medications. There were no differences in relapse rates as a function of primary diagnosis. Taken together, the findings indicate that relapse rates in CBT for anxious youth are relatively low, suggesting that treatment development and refinement efforts should focus on improving treatment response and remission rates for this population.

Cognitive, behavioural and familial maintenance mechanisms in childhood obsessive compulsive disorders: A systematic review

Cognitive Behavioural Therapy (CBT) for preadolescent children with obsessive compulsive disorder (OCD) is typically derived from adult cognitive behavioural models of OCD; however, it is unknown whether these adult models apply to preadolescent children. This systematic review examined whether 11 cognitive, behavioural and familial maintenance mechanisms identified from adult cognitive behavioural models of OCD and descriptions of how family factors may maintain OCD applied to preadolescent children with obsessive compulsive symptoms/disorder (OCS/OCD; Prospero:CRD42019153371). PsycINFO, MEDLINE and Web of Science Core Collection were searched in March 2019, with forward citation handsearching conducted in March/April 2020. Twenty-nine studies were synthesised. Studies were identified for only six of the 11 proposed maintenance factors. Of the cognitive and behavioural factors, only inflated responsibility and meta-cognitive beliefs showed evidence of independent and/or specific associations with childhood OCS. Of the family factors, only less frequent displays of parental confidence, positive problem solving and rewarding of children’s independence showed some evidence of specificity to childhood OCD. Notably, findings across studies were inconsistent and existing studies have considerable methodological limitations. Experimental and prospective longitudinal studies are needed to determine whether the proposed factors maintain childhood OCS/OCD, to improve the effectiveness and efficiency of CBT for preadolescent children with OCD.

TF-CBT Group Intervention for Children in High Conflict Custody Disputes

This article proposes a conceptual group approach using trauma-based cognitive behavioral therapy for children involved in high conflict custody disputes. Traditionally, interventions for this population have focused on repairing the relationship between parent and child and less on addressing the traumatic symptoms with which the child is suffering. The proposed intervention focuses solely on the needs of the child and provides an outline for seven sessions during which the PRACTICE model of trauma-focused cognitive behavioral therapy is used. Additionally, ethical implications and directions for future research are discussed.