Pitt Psychiatry Researchers Conduct Community Effectiveness Trial of a Novel Form of Cognitive Behavioral Therapy (AF-CBT)

This paper was published in Child Maltreatment, the official publication of the American Professional Society on the Abuse of Children, and was recently named Child Maltreatment Article of the Year for 2018.

Children who experience physical abuse or harsh physical discipline are particularly vulnerable to adverse mental health outcomes such as trauma symptoms, aggression, interpersonal problems, substance use and physical health problems, which can continue into adulthood. Some cognitive-behavioral intervention strategies mitigate the traumatic impact of childhood abuse and/or reduce the likelihood that its negative consequences will persist into adulthood. Efficacy studies have reported the benefits of treatments for families who have a history of—or are at risk for—physical abuse, but they have been conducted under highly controlled and desirable circumstances, lacking the challenges that community-based providers encounter, such as large caseloads, limited time/resources, financial and regulatory requirements and wide patient comorbidity and heterogeneity. 

A team of researchers led by David Kolko, PhD, Professor of Psychiatry, Pediatric, Psychology and Clinical and Translational Science, and including Barbara Baumann, PhD, Research Instructor in Psychiatry, conducted a large-scale effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT), relative to routine treatment as usual, among community providers who served families with a history of physical abuse or physical force/conflict. The researchers’ goals for the study were threefold: to see whether providers trained in AF-CBT were more likely to treat families experiencing abuse or aggression (even when faced with the challenges of a less controlled, real-world setting); to find out if AF-CBT improved clinical outcomes in families for a full year following treatment; and to examine whether AF-CBT was associated with a decrease in official reports of physical abuse. 

Across 10 participating agencies in southwestern Pennsylvania, 182 providers were randomly assigned to one of two groups: to be trained in and then provide AF-CBT, or to receive routine agency training and provide treatment based on their own preferences. The providers then worked with 195 adult parents who agreed to participate in the study, and who met at least one of four criteria related to the use of physical force within the family. 

Dr. Kolko explained the research team’s belief that AF-CBT would be more effective than routine treatment: “AF-CBT was specifically designed to address the risk factors for child physical abuse and the clinical consequences of exposure to physical force in the family by teaching skills to minimize distress and enhance adaptive behavior, so we thought AF-CBT would be more likely to impact these specific outcomes than routine care.”  

The researchers found that providers trained in AF-CBT were more likely than those who received routine training to treat families who demonstrated anger and aggression, and more likely to focus on anger and aggression during intervention. Those families who received AF-CBT also showed greater improvements in child, caregiver and family functioning. For example, they found a greater reduction in caregiver abuse risk and family conflict, child post-traumatic stress, and general family dysfunction in AF-CBT. Several improvements were also found in the long-term. Further, AF-CBT showed reductions in the rates of child physical abuse reports alone or when combined with emotional abuse. 

Regarding these results, Dr. Kolko remarked, “Our positive findings further support the potential benefit of training community providers to serve those challenging families who engage in a range of physically and emotionally abusive behaviors using CBT strategies that can alter their individual coping repertoires and their interactional patterns.”    

AF-CBT for Families Experiencing Physical Aggression or Abuse Served by the Mental Health or Child Welfare System: An Effectiveness Trial
Kolko DJ, Herschell AD, Baumann BL, Hart JA, Wisniewski SR

Child Maltreatment 2018, Vol. 23(4). DOI: