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Trauma-Focused Cognitive Behavior Therapy

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Trauma-focused cognitive behavioral therapy (TF-CBT) addresses the mental health needs of children, adolescents, and families suffering from the destructive effects of early trauma. The treatment is particularly sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from sexual abuse, as well as from physical abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.

The trauma-focused approach to therapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced many forms of severe trauma or abuse.

When It’s Used

TF-CBT was originally geared toward helping children who were the victims of sexual abuse, but its scope has widened to include children and adolescents who have experienced a single or repeated experience of sexual, physical, or mental abuse or who have developed post-traumatic symptoms, depression, or anxiety.

If a child or adolescent also exhibits serious behavioral, substance abuse, or suicidal ideation, other forms of treatment, such as dialectical behavior therapy, may be more appropriate as an initial intervention and can be followed up with a trauma-sensitive approach.

What to Expect

TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community center, hospital, school, or in-home setting. Treatment takes place with a non-offending parent or caregiver. Often, the treatment will begin where the child and non-offending caregiver have separate therapy sessions and advance to engaging in joint sessions.

Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors. Learning to challenge invasive thoughts of guilt and fear can help a patient to reorganize their thinking in a healthier and happier way.

The family therapy aspect of trauma-focused CBT attends to the problems family members may have in dealing with the trauma suffered by the child, including the use of various stress management, communication, and parenting skills.

Research comparing TF-CBT to other treatment models shows significantly greater gains in well-being for children and parents.

How It Works

Early trauma can lead to guilt, anger, feelings of powerlessness, self-harm, acting out, depression, and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in a number of ways, such as negative recurring thoughts about the traumatic experience, emotional numbness, sleep problems, difficulty concentrating, and extreme physical and emotional responses to anything that triggers a memory of the trauma.

By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in youth. Core features of TF-CBT treatment include:

  • Psychoeducation, which teaches the victim about the normal reactions to traumatic experiences. This can help them reduce feelings of guilt or culpability for what happened.
  • Coping skills, including relaxation exercises like deep breathing, mindfulness, acceptance, identifying and redirecting thoughts, and other methods.
  • Gradual exposure, which involves gradually introducing the patient to memories of their traumatic experience, with the goal of reconditioning their response to triggers and easing emotional distress.
  • Cognitive processing, which can include developing skills to recontextualize unhelpful feelings and thoughts, and regulate emotions.
  • Caregiver involvement, which may include rebuilding trusting adult relationships for the child and training the caregiver in how to best be a resource for the child.

The goal of the treatment is to help the patient develop a sense of safety and security, to repair or develop healthy social skills, and for the caregiver to feel more confident in their ability to help the child in a productive manner.

What to Look for in a Trauma-Focused Cognitive Behavioral Therapist

There is no official accreditation for trauma-focused cognitive behavioral therapy, though supplemental trainings and courses exist. It’s most important to look for someone with experience in the practice and someone with whom you feel comfortable discussing personal problems.

Some helpful questions to ask a TF-CBT therapist include:

  • The extent of their experience with trauma-focused CBT treatment.
  • Whether there is an assessment process to track the functioning of the patient and family, in order to monitor the progress of the treatment.
  • Whether there will be joint therapy sessions with the child and parent, and to what degree.
References
U.S. Department of Health and Human Services. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. August 2012.
Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Evidence-Based Child Health. May 2013;8(3):1004–1116.
Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews. 2013;12.
Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program website
de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence. Psychiatric Services, 65(5), 591–602. https://doi.org/10.1176/appi.ps.201300255
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depression and anxiety, 28(1), 67–75. https://doi.org/10.1002/da.20744
Last updated:
06/21/2022

Types of Therapy