Trauma Therapy For Teens: How To Treat Young People Exposed To Trauma

Although many people associate conditions like post-traumatic stress disorder with adult populations like veterans, young people can also encounter traumatizing experiences that can negatively impact their mental health. Treatment for adolescents may involve unique challenges and call for different strategies than working with adult trauma survivors. What kinds of therapies can help teens recover from the effects of traumatic events?

Several methods may support youth mental health, but two therapies have demonstrated particular effectiveness for adolescent trauma symptoms: trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing therapy (EMDR). We’ll review these practices in more detail below and discuss what parents can do to improve their child’s likelihood of successful treatment, including seeking help from a therapist themselves.

Recognizing trauma symptoms in teens

While the effects of trauma can be difficult to resolve at any age, providing effective treatment for adolescents may have some unique challenges. Young people may have less mental health literacy and emotional insight than adults, potentially making them less likely to recognize when they’ve been affected by trauma. 

Further complications can arise when the trauma involves abuse from an authority figure or trusted adult. Teen survivors may be pressured by their abusers to hide what’s happened, and they may be reluctant to talk about their experiences due to fear of retaliation, disbelief, or causing trouble for others. 

In addition, some young people may engage in “traumatic reenactment,” in which they incorporate behaviors related to their traumatic experiences in their daily lives. For example, teens who have experienced sexual abuse may be more likely to engage in risky or age-inappropriate sexual behavior. Physical abuse might result in fighting or bullying behavior.

PTSD and psychosis symptoms in teens

Other impacts of trauma in adolescents may resemble standard symptoms of post-traumatic stress disorder (PTSD), such as those listed below:

• Excessive watchfulness and fear
• Being easily startled
• Panic attacks 
• Intrusive thoughts or memories of a traumatic event, sometimes including flashbacks
• Avoidance of particular people, places, situations, and sensations due to reminders of trauma
• Difficulty concentrating
• Lack of pleasure and motivation
• Difficulty sleeping
• Persistent negative feelings, such as anger, fear, guilt, and shame
• Negative beliefs about themselves or the world

Childhood trauma exposure may also increase a young person’s risk of developing psychotic symptoms. If your teen has begun expressing persistent strange beliefs, describing or reacting to perceptions that don’t correspond to reality, talking in nonsensical or hard-to-follow ways, or engaging in bizarre behavior, it could be a response to trauma.

How common are trauma and PTSD in teens? 

Research suggests that adolescent exposure to potentially traumatizing events can be common. According to the National Center for PTSD, some surveys indicate that nearly half of children in the U.S. have witnessed violence or experienced sexual or physical assault by age 17. 

Not all teens exposed to trauma develop mental disorders as a result. The National Institutes of Mental Health estimates that roughly 5% of adolescents have had PTSD at some point in their lives, with 1.5% experiencing severe impairment. The prevalence may be higher in girls than boys, with roughly 8% of females surveyed being affected, compared to 2.3% of males. 

What types of therapy can treat trauma in teens?

While many forms of trauma-focused therapies may help with symptoms of post-traumatic stress, researchers have identified two leading treatments for children and adolescents based on superior evidence of effectiveness:

1. Eye movement desensitization and reprocessing (EMDR)
2. Trauma-focused cognitive behavioral therapy (TF-CBT)

Other treatment modalities that are strongly recommended for adult trauma symptoms, such as cognitive processing therapy (CPT) or prolonged exposure, aren’t supported by as robust an evidence base. This doesn’t necessarily mean they’re ineffective, but they aren’t currently considered first-line treatments. 

Some studies suggest alternate therapies like these can still be effective in certain situations. For example, a 2018 paper suggested that a combination of dialectical behavior therapy (DBT) with prolonged exposure therapy could be helpful for trauma-affected youths experiencing severe suicidal ideation.

EMDR for teens affected by trauma

Eye movement desensitization and reprocessing therapy is largely based on the idea that PTSD could be caused by improper or incomplete processing of traumatic events, resulting in persistent fear and stress. 

To work through these feelings, clients are typically encouraged to recall memories of traumatic experiences while attending to sensory stimulation alternating between different sides of the body. Between recollections, clients may discuss their thoughts, beliefs, and feelings about their traumatic experiences with the therapist. This process is generally intended to change the way these memories are stored in the brain, decreasing the strength of the individual’s negative emotional responses.

While the theoretical underpinnings of EMDR may remain controversial in the psychological community, researchers have compiled a substantial amount of evidence that it can produce positive results. A 2021 meta-analysis concluded that this treatment “had a large and significant overall effect” on adolescent trauma symptoms and behavioral challenges. 

TF-CBT for teens affected by trauma

TF-CBT was specifically developed for use with youths impacted by trauma. The technique is primarily based on core principles of cognitive behavioral therapy, such as the idea that distorted patterns of thought can reinforce the bodily and emotional symptoms of trauma. Treatment usually involves rethinking counterproductive beliefs and responses, as well as learning coping skills to regulate difficult emotions. 

Trauma-focused CBT may also incorporate elements of family therapy, involving parents or caregivers in the treatment process (provided that they aren’t the source of the trauma, as in cases of child abuse). Since parents may also be traumatized by learning that their teen has been harmed, TF-CBT often aims to support their emotional healing while educating them on how they can support their child's recovery. 

This approach has demonstrated positive results in adolescents affected by a variety of traumas, including sexual abuse, natural disasters, war, and domestic violence. A 2018 research review concluded that TF-CBT may be slightly more effective than EMDR for children and teens.

Preventative trauma therapy for teens

Most research to date on treating trauma in youth has focused on therapies provided after the affected individuals have been diagnosed with a mental health condition. However, a 2016 study found support for the effectiveness of cognitive therapy for PTSD (CT-PTSD) as an early treatment for preventing mental illness in young people exposed to trauma.

If you know that your adolescent child has experienced a potentially traumatizing event, and they’re displaying early symptoms of post-traumatic stress like those described above, they might be able to benefit from cognitive therapy.

Factors enabling successful trauma therapy in teens

If your teen is engaging in trauma treatment, taking an active role in their recovery process may help them achieve better results. A 2020 review of studies on adolescent PTSD identified parental involvement as a factor that led to larger treatment effects. That’s one reason why TF-CBT might be marginally more effective than EMDR — parents and caregivers are typically invited to take an active role.

If you’re not able to participate directly in therapy sessions with your teen, you can get involved by educating yourself on trauma, PTSD, and adolescent mental health. You may also want to make sure your child knows they can talk openly with you about anything they’re comfortable discussing from therapy sessions. 

Higher treatment doses — meaning more or longer therapy sessions — also tended to be linked with better outcomes. You may be able to give your teen better odds of recovery by ensuring that they’re getting enough help to make a difference and that they don’t drop out of therapy prematurely. 

Another factor that appears to positively influence treatment is a trusting, cooperative relationship between a teen’s therapist and parents or caregivers. When selecting a treatment provider for your adolescent child, you may want to take time to meet with them ahead of time, ask them about their treatment methods, and make sure they seem like someone with whom you have a decent rapport.

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Finding mental health care when your teen is engaged in trauma therapy

One factor that may reduce treatment effectiveness for trauma in adolescents is the presence of mental disorders like depression in their parents. Finding a therapist to help you support your own mental health could enable you to provide more effective support for your teen’s recovery from trauma.

Seeking a referral from your primary care physician can be a simple but useful way to get started. You might also want to search for a qualified mental health professional through your insurance provider, or use free online resources such as the following:

• American Psychological Association: Psychologist Locator
• American Psychiatric Association: Find a Psychiatrist
• Substance Administration and Mental Health Services Administration: FindTreatment.gov
• National Register of Health Service Psychologists: Find a Psychologist
• International Society for Traumatic Stress Studies (ISTSS): Find a Clinician
• American Academy of Cognitive and Behavioral Therapies: Find a Therapist

Online therapy may be another convenient option, especially if you’re unsure how to find time to go to therapy while also assisting with your teen’s treatment and managing your other responsibilities. Internet therapy typically allows for flexible scheduling, with no need to commute to sessions.

Web-based therapy can be an effective way to improve your mental health. A research overview published in 2017 concluded that online cognitive-behavioral therapy can successfully treat a wide range of conditions, including major depression, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and bipolar disorder (among others). Seeking help online may help you assist your teen’s healing journey more effectively.