Trauma-Focused Cognitive Behavior Therapy

Written by BetterHelp Editorial Team
Medically reviewed by Dr. Andrea Cziffer Paul, MD, Dr. April Brewer, DBH, LPC, Julie Dodson, MA, LCSW, and Majesty Purvis, LCMHC

Overview

Judith Cohen, Anthony Mannarino, and Esther Deblinger developed trauma-focused cognitive-behavioral therapy (TF-CBT) in 1997. TF-CBT combines traditional cognitive behavioral therapy methods with a trauma-focused approach. It can also include family therapy. 

Though it is a relatively new model of therapy, TF-CBT is an effective intervention for individuals, particularly children and adolescents living with trauma,1 including post-traumatic stress disorder (PTSD)2 and other disorders caused by trauma. By implementing relaxation techniques and exposure therapy, TF-CBT may help individuals process their trauma and develop healthy coping mechanisms3 for dealing with the effects of trauma. 

Trauma-focused cognitive-behavioral therapy, or TF-CBT, can be effective in treating the effects of a single trauma or for those who have experienced multiple traumas. This modality was initially intended to support children who were survivors of sexual abuse, but it is now used for children and adolescents who have experienced various types of early trauma. In some cases, TF-CBT might be used with adults. 

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
For those experiencing trauma, support is available. Please see our Get Help Now page for more resources.

How it works

Trauma-focused cognitive behavioral therapy focuses on flashbacks. The memories and flashbacks individuals can experience as side effects of trauma or post-traumatic stress disorder can be more vivid and overwhelming than other memories. They may relive their traumatic experiences in ways that seem so realistic that it seems like they’re going through the event again. Flashbacks can lead individuals to experience symptoms like anxiety, fear, irritability, depression, anger, difficulty concentrating, hopelessness, and other mood changes that negatively impact their quality of life.

Knowing this, therapists who practice TF-CBT focus on providing interventions that lessen the occurrence of flashbacks or memories and provide coping tools for PTSD symptoms. TF-CBT involves the following:

  • Psychoeducation: Teaching a client about reactions to trauma, which may lessen shame or guilt
  • Coping skills education: Teaching breathing exercises, acceptance, and reframing thoughts 
  • Exposure therapy: Reintroducing the traumatic memory to a client and helping them learn to react to it more productively 
  • Cognitive interventions: Focusing on catching negative thoughts and replacing them with more positive thoughts

TF-CBT for caregivers

Raising a child who has experienced trauma may benefit from parenting that looks different than that for children who have not experienced trauma. With this in mind, TF-CBT may also involve some therapy for the caregivers of a child. This process may help caregivers better cope with their own emotions and understand how to use compassionate parenting skills to best support their child’s welfare.

Often, children and teens who receive TF-CBT can work through their trauma by lessening their emotional response to traumatic memories and creating more positive beliefs about themselves and their lives.

What to expect

Trauma-focused CBT, or TF-CBT is commonly used to treat children. It can provide a safe and supportive environment for children and adolescents to discuss their challenges and express their feelings. Though TF-CBT is designed to manage trauma, it can also help individuals better cope with daily stressors, improve interpersonal relationships and emotional regulation skills, and lessen behavioral problems. 

TF-CBT is often a short-term therapy that lasts anywhere from eight to 25 sessions. Children and adolescents who attend this type of therapy are often accompanied by a parent or guardian. Treatment can take place in a mental health facility, school, community center, hospital, or, in some cases, in an at-home setting. 

Therapists can use cognitive-behavioral techniques, like reframing and challenging negative thoughts, to help children and teens shift their thinking into a more positive and healthier frame. Depending on the age of the child or adolescent, therapists may use activities and other teaching materials to help children understand therapeutic concepts. 

Who it benefits

Trauma-focused cognitive-behavioral therapy was developed for children and adolescents, although adult family members of the child or adolescent may be present for therapy or receive individual sessions. 

Trauma-informed cognitive behavioral therapy, or TF-CBT is an evidence-based treatment geared toward children who have experienced severe trauma. Initially, the modality was intended for children who have experienced sexual abuse.

PTSD symptoms in children

Currently, it is used to treat children who have experienced physical, emotional, or sexual abuse or who are experiencing anxiety, depression, or PTSD symptoms. PTSD symptoms in children can include:

  • Lack of smiling or positive emotions
  • Nightmares or sleep conditions 
  • Irritability or anger
  • Flashbacks of traumatic events
  • The reliving of events through playtime behaviors 
  • Distress4 when memories of the event arise
  • Ongoing sadness or distress
  • A quick startle response 
  • Withdrawal
  • Thoughts of helplessness 
  • Avoidance of people, places, or topics associated with the traumatic event
  • Numbness and disconnect 

Anxiety symptoms in children may include:

  • Persistent worrying
  • Difficulty concentrating
  • Sleep problems
  • Extreme emotional outbursts
  • Eating too much or too little
  • Excessive crying
  • Stomachaches or other physical ailments

Depression symptoms in children might include:

  • Lack of energy
  • Depressed or sad mood
  • Lack of interest in usual hobbies or activities
  • Sleep problems
  • Bodily aches and pains
  • Excessive complaining or self-criticism

Goals for trauma-focused cognitive-behavioral therapy

Often, the goals of TF-CBT are to address the PTSD, depression, or anxiety symptoms that a child or teen is experiencing, help them heal from their traumatic event, and teach healthier ways to deal with stress and emotions. The child receiving TF-CBT is often educated about responses to trauma, which may alleviate feelings of guilt or shame around the traumatic event. The child’s caregiver may also work with the therapist to learn how to better care for a child with trauma. 

Once TF-CBT is completed, the child may better understand how to decrease their stress levels in response to traumatic memories, express and regulate their emotions, process and heal from trauma healthily, and view stressful or traumatic experiences in a new light. Additionally, children and teens who receive TF-CBT may work with a therapist to better understand and implement personal boundaries5 and understand how to identify safe spaces and people. 

Research

This therapeutic modality is evidence-based. For children who have experienced trauma, TF-CBT has been proven to be a viable option in reducing trauma-related symptoms. Studies also indicate that displaced refugee children can benefit from trauma-focused cognitive behavioral therapy. This type of therapy may be especially beneficial when practitioners and translators practice TF-CBT in a culturally sensitive manner. 

Recent reviews of TF-CBT showed that sexually abused children who received TF-CBT showed improvements in PTSD symptoms, as well as improvements in depression, behavioral challenges, shame, and other trauma-related symptoms when compared to child-centered supportive therapy.

Finding trauma-focused cognitive-behavioral therapy

Therapists certified in trauma-focused cognitive-behavioral therapy must have a master’s degree or higher, be licensed in their state, and complete several trauma-focused cognitive-behavioral therapy classes, courses, tests, or training sessions. If a therapist is certified in TF-CBT, they often have experience working with children and adolescents who have experienced trauma. 

To ensure you find a mental health practitioner who offers trauma-focused cognitive-behavioral therapy, ask them about their background and accreditation. You can also find a TF-CBT-accredited therapist online through the TF-CBT website. 

Finding therapy that works for you or your child may be challenging. Some individuals may find it difficult to fit in-person therapy into their schedule. Online therapy platforms like BetterHelp can provide individuals with the same effective treatment as they would receive from in-office therapy, including trauma-focused cognitive behaviour therapies, and can be accessed from the comfort of home. Children can also access online therapy with parental permission via platforms like TeenCounseling for those aged 13 to 19. 

Associated terms

Updated on September 20, 2024.
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