Early Life Stress and Pediatric Anxiety Program

Treatment Programs

Our treatment services rely on Evidenced Based Practice, approaches developed through scientific research that indicate which treatments are most effective for particular childhood difficulties. Services are provided by licensed clinical psychologists, board certified child psychiatrists, and advanced postdoctoral fellows in child psychiatry and psychology specializing in the treatment of anxiety and mood disorders.

Our psychosocial treatments are based on cognitive-behavioral principles and education about anxiety as well as teaching children and parents specific skills to cope with challenging situations.  When devising a treatment plan, it is our goal to tailor the therapeutic approach to meet the specific needs of your child. We aim to address emotional symptoms and behaviors, as well as any impairment in social, academic, or family functioning. To provide comprehensive care, our clinicians may consult with professionals outside of our center, such as teachers or speech and language therapists.  We will only do so when you offer your written consent.

Specialized Clinical Interventions

Behavioral Parent Skills Training for Young Children with Disruptive Behaviors and Temper Outbursts

What is Parent Skills Training?

This treatment program is based on Parent Child Interaction Therapy (PCIT), a scientifically supported approach for 2- to 7-year-old children exhibiting significant disruptive behaviors, such as throwing toys and refusing to follow parent direction.  PCIT gives equal attention to the parent-child relationship and to parents' behavior management skills. The goals of the program are to increase positive feelings and interactions between parents and children, to improve child behavior, and to empower parents to use consistent, predictable, effective parenting strategies.  Parents are first taught positive parenting skills in a supportive office environment.  Therapists then help parents to transition these skills to daily family life, by providing guided practice in community settings where children are more likely to display problem behaviors, such as busy shopping centers.  During regularly scheduled appointments, therapists may accompany children and parents on brief trips outside the office setting to practice skill implementation.

What happens during Parent Skills Training sessions?

Modified-PCIT consists of 12 to 20 weekly, hour-long sessions. Early sessions involve an introduction to behavioral parenting principles, an opportunity to observe the therapist modeling specific skills, and guided practice through role-playing. Subsequent sessions involve live coaching of parent-child interactions. Through a one-way mirror and an audio transmitter worn in the parent's ear, the therapist gives ongoing coaching, advice, and encouragement while the parent interacts with his or child. New skills are thus practiced, reviewed, and mastered in the office.  Home practice sessions of 5 to l5 minutes daily are a critical part of the treatment.  Therapists review parents’ experiences of home-practice at each treatment session and help trouble-shoot any difficulties.

What do parents learn in the sessions?

Parents learn to increase their positive attention when their child's behavior is appropriate and to use differential attention to reduce minor negative behaviors. Parents also learn a specific time-out procedure to use when their child does not comply with a command or demonstrates other rule-breaking behaviors (e.g., back talking, hitting a sibling).

For more information regarding Parent Skills Training at Stanford, please contact Rebecca Rialon Berry, PhD., 650-723-5511.

Groups for Adolescent Girls

Dialectical Behavior Therapy for Adolescents (DBT-A)

Stanford offers 17-week Multi-Family Groups for Adolescent Girls who are struggling with difficulties of emotion dysregulation and interpersonal conflict, and engaging in problematic coping strategies such as avoidance, self-harm, or substance use.  Parents and teens meet together with other families and learn applied coping skills to regulate mood, improve communication, and replace problem behaviors with healthier, sustainable coping strategies.  Group leaders are Intensively Trained in DBT (hyperlink to behavioraltech.org) and participate in a weekly Consultation Team. 

For more information regarding DBT-A Groups at Stanford, please contact Sanno Zack, PhD, 650-723-5511.

Acceptance and Commitment Therapy (ACT)

ACT groups at Stanford are a mindfulness-based approach to managing the stress and pressure of navigating the teen years as a girl growing up in the Bay Area. Group members share common struggles related to academic demands, high expectations, upcoming college and work transitions, and may be coping with related anxiety and depression.  ACT is a hands-on, experiential approach that teaches skills for disentangling from the daily life struggle, identifying personal core values, and engaging in committed action to living these values in day-to-day life with the goal of reducing stress and improving well-being.  Groups are for high school age girls and are 8-10 weeks in duration.

Contact Sanno Zack, PhD, 650-723-5511, for additional information.

Trama-Focused Interventions for Youth

Stanford Cue-Centered Treatment (CCT)

The Stanford Cue-Centered Treatment (CCT) is a manualized protocol designed for youth ages 8-18, who have experienced repeated exposure to traumatic events.  CCT consists of 15 weekly, individual sessions, designed to last approximately 50 minutes in duration.  CCT is an integrative approach, combining elements from cognitive, behavioral, psychodynamic, expressive, and family therapies to address four core domains (cognition, behavior, emotions, and physiology). The primary goal of CCT is to build strength and resilience by empowering the child through knowledge regarding the relationship between their history of trauma exposure, and current affective, cognitive, behavioral, or physiological responses. Children and parents learn about the significance of traumatic stress, how adaptive responses become maladaptive, how to cope with rather than avoid ongoing stress, and the importance of verbalizing their life experiences. The treatment process involves overall competence building, reduction of physical symptoms of anxiety, modification of cognitive distortions, and facilitation of emotional expression. In CCT, youth and caregivers learn to recognize and effectively manage maladaptive responses that occur in response to traumatic reminders (cues).

CCT incorporates several unique components.  First, through the use of a life timeline, CCT aims to address the impact of the allostatic load, examining the direct influence of circumscribed traumatic events as well as other daily or life stressors. Second, several CCT sessions focus on teaching youth and caregivers about the conditioning process that occurs through repeated exposure to trauma, resulting in increased sensitivity of fear and anxiety networks. As the child identifies cues associated with this conditioning and develops more adaptive responses to the cues, the child develops self-efficacy.  Third, through the use of insight-oriented strategies and visual icons linking history, emotions and behaviors, the child is challenged to avoid compartmentalization of these constructs while current behaviors are placed in an empathic context. Finally, in addition to utilizing behavioral, cognitive and emotional approaches to develop new responses, CCT includes a physiological approach (how the child feels physically) recognizing that many children who experience trauma are sensitive to their interoceptive cues (e.g.; increased heart rate, sweating).

For information about study participation, please contact Hilit Kletter, PhD, 650-724-3377.

Brain Imaging Study of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

We are studying how the brain changes when adolescents recover from trauma.  We will measure brain structure and function using Magnetic Resonance Imaging, or MRI,  before and after Trauma-Focused Cognitive Behavioral Therapy. This study could help us to develop better treatments for children and adolescents who have experienced trauma. 

The therapy that we provide is a well-known and highly successful treatment for children and teens who have experienced a traumatic event. Therapy will be provided free of charge as part of this study. The brain scans are safe and non-invasive and give NO radiation.

Who we are studying:

We hope to recruit 30 adolescent girls  who have experienced a trauma (such as being physical abused, sexual abused, or witnessing violence), and are bothered by symptoms of posttraumatic stress disorder. For example, symptoms might be: having upsetting memories of the trauma, recurring dreams about the trauma, avoiding people or places that remind you, or feeling anxious and jumpy.

Participants must be between 12 and 17 years old, and must speak English in order to complete the requirements of the study.

Participation Includes the following:

Volunteers will be asked to come to Stanford for an interview and questionnaires, and for weekly meetings with a therapist. The therapist meets with the adolescent for
1 hour and with the parent for 30 minutes each week. TF-CBT is a structured treatment that offers education and coping skills to help children and caregivers actively process traumatic experiences in the context of individual and conjoint child-caregiver sessions.

Brain Imaging:

Some of the participants will be asked to have an MRI scan of the brain.  The MRI scan process takes about an hour, includes several short scans, with scan times ranging from 30 seconds to about 8 minutes long.

Compensation to Participants:

Participants will be paid for the clinical interviews ($75) and the pretreatment scan ($75), and additionally for completing therapy and the follow-up questionnaires and scan.

For more information or to enroll, parents/caregivers should contact Dr. Garrett by phone: (650)736-1874 or email: PTSDtherapyForTeens@lists.stanford.edu.

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