Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment model designed to assist children, adolescents, and their families in overcoming the negative effects of a traumatic experience.
This evidence-based method has been proven effective for treatment after multiple traumas or a single traumatic event, and therapists trained in TF-CBT are frequently able to help children experiencing the emotional effects of trauma address and resolve these effects.
The Development of TF-CBT
The clinical work and research of Judith Cohen, Anthony Mannarino, and Esther Deblinger led to the development of TF-CBT. Out of a desire to better understand the difficulties faced by traumatized children and adolescents, they expanded traditional cognitive behavioral methods, extending their reach by incorporating family therapy and using a trauma-sensitive approach in the therapy’s application to children and youth.
Preliminary research on this treatment model was followed by five randomized controlled trials, which demonstrated the effectiveness of the TF-CBT model on the target population. Many other researchers have gone on to replicate these results, proving the efficacy of this model in treating children and adolescents who have experienced traumatic stress.
How TF-CBT Works
In TF-CBT, interventions specifically tailored to meet the needs of children and adolescents experiencing emotional and psychological difficulties as a result of a trauma are integrated with humanistic, cognitive behavioral, and familial strategies. This treatment is short-term and generally lasts no more than 16 sessions, as more than 80% of traumatized children see improvement in this time.
Find a Therapist
Advanced Search
Both parents and children may become able to better process emotions and thoughts relating to a traumatic experience through TF-CBT, which can provide those in therapy with the necessary tools to alleviate the overwhelming thoughts causing stress, anxiety, and depression. TF-CBT can help people who have experienced trauma learn how to manage difficult emotions in a healthier way. A secure and stable environment is provided in order to enable children to disclose details of trauma. It is at this time the cognitive and learning theories of treatment are applied. Children are shown how perceptions may be distorted and are given the tools to redesign those perceptions.
TF-CBT is a skills-based model, and it requires the child and parent to practice its components in order to be optimally effective. Parents and children are commonly asked to practice skills at home. The goal of TF-CBT is to allow both child and parent to continue to develop their skills and communication techniques in a healthy manner.
Core components of TF-CBT include: Practitioners of TF-CBT strive to give parents the resources and skills necessary to help their children cope with the psychological ramifications of the abuse or other trauma.
- Psychoeducation and parenting skills
- Relaxation
- Affective regulation
- Cognitive processing of the trauma
- Trauma narrative
- In vivo mastery of trauma reminders
- Conjoint child-parent sessions
- Enhancing future safety and development
The success of TF-CBT relies heavily on a trusting, genuine therapeutic relationship between therapist, child, and parent. The therapist incorporates individual child and parent sessions as well as joint sessions using family therapy principles. Including the non-offending parent in therapy can help the parent cope, and this also allows the parent to support the child in this treatment framework. Practitioners of TF-CBT strive to give parents the resources and skills necessary to help their children cope with the psychological ramifications of the abuse or other trauma.
Issues Treated with TF-CBT
TF-CBT’s main application is the treatment of posttraumatic stress. The goal of this therapy is to help survivors of trauma, whether the trauma was a single occurrence or multiple events, address and resolve the distress resulting from these events and ultimately decrease the negative behavior patterns and emotional responses often developing as a result of sexual abuse, physical abuse, or other trauma. Children and adolescents who have experienced these traumas may find TF-CBT an effective method in the process of returning to a healthy state of functioning.
Childhood traumas such as abuse, domestic violence or neglect can often lead to symptoms of PTSD, depression, and anxiety. Children or young people between the ages of 3 and 18 who have been sexually or physically abused or exposed to domestic violence may obtain benefit from TF-CBT, whether they have experienced repeated episodes of trauma or a single occurrence of trauma. The non-offending parent or caregiver will typically also participate in the therapy. Children who are learning to cope with the death of a loved one have also been shown to obtain great benefit from TF-CBT.
Children living with their parents, in foster care, kinship care, group homes, or residential programs may all be helped by TF-CBT.
Who Provides TF-CBT?
Experienced therapists with knowledge and training in child development, who can assess and treat a wide range of child mental health conditions, are typically the recommended providers of TF-CBT. Training is required for therapists to practice from a trauma-focused framework, and therapists who have received this training are also encouraged to seek out supervisors or consultants who have experience with the TF-CBT model.
Therapists can access training in the TF-CBT treatment model through a certified introductory training course or web-based training program. To be certified, practitioners with a master’s degree or higher must participate in a 2-day live training, participate in follow-up training or consultation twice a month for six months or once a month for 12 months, participating in nine out of 12 consultation or supervisory sessions provided by a treatment developer or graduate of the TF-CBT Train the Trainer Program. Further, a practitioner is also required to complete three different TF-CBT cases, where two or more of these cases include participation from caretakers. Practitioners must also pass a knowledge-based exam once they have met the above requirements.
How Effective Is
?
Research shows children and adolescents experiencing severe emotional repercussions due to trauma frequently respond well to this technique. To date, 11 empirical studies conducted on the impact of TF-CBT on adolescent survivors of trauma have demonstrated its usefulness in reducing symptoms of depression, anxiety, and PTSD. Randomized clinical trials comparing TF-CBT to play therapy, child-centered therapy, and supportive therapy show TF-CBT to yield greater gains over fewer sessions. Studies done up to two years after the conclusion of TF-CBT demonstrated these gains to be sustained over time.
Limitations of TF-CBT
TF-CBT may not be appropriate for children and adolescents who have significant conduct or other behavioral concerns that were present before the trauma may not receive significant benefit from TF-CBT and may see greater improvement with approaches in which they are first helped to overcome these difficulties.
Adolescents who abuse substances or who are suicidal may temporarily see a worsening of symptoms with TF-CBT’s gradual exposure component. TF-CBT may still be helpful when treating children who are thus affected, but often the pace or order of interventions must first be modified. Dialectical behavior therapy or another stabilizing therapy approach is often used before TF-CBT is attempted with adolescents who have a history of running away and/or severe self-harm and other parasuicidal behaviors. TF-CBT may still be of benefit and is not necessarily contraindicated in these cases.
References:
- Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: The Guilford Press.
- Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence. Archives of Pediatrics & Adolescent Medicine, 165 (1), 16-21.
- TF-CBT Certification Criteria. (n.d.). Retrieved from https://tfcbt.org/tf-cbt-certification-criteria
- Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. (2012). Child Welfare Information Gateway, 6. Retrieved from https://www.childwelfare.gov/pubPDFs/trauma.pdf
- Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31(11), 1199 1205.
- What is TF-CBT? (n.d.). Retrieved from http://academicdepartments.musc.edu/projectbest/tfcbt/tfcbt.htm
The short-term intervention was developed to help children and adolescents who have experienced a traumatic event.
Share on Pinterest
Georgijevic/Getty Images
As the name suggests, trauma-focused CBT (TF-CBT) addresses trauma. It was developed specifically for children and adolescents who have experienced or witnessed traumatic events.
Cognitive behavioral therapy (CBT) treats several mental health conditions, such as depression and anxiety. CBT is typically a short-term intervention (8 to 12 sessions, sometimes up to 25), focusing on one specific issue.
TF-CBT aims to help both children and their nonoffending caregivers identify, understand, and address the impacts of trauma ranging from emotional symptoms to behavioral and learning challenges.
The available research, which includes numerous randomized controlled trials, has shown that TF-CBT can be an effective trauma treatment.
How does trauma-focused CBT work?
TF-CBT is a type of therapy that involves treating the child and educating and empowering their caregivers or parents. A central goal is to support parents in building skills related to positive parenting, improving communication, and managing any distress about the child’s trauma, all of which help the child feel more supported.
This therapy involves psychoeducation, a therapeutic intervention based on learning information to better understand and cope with illnesses or diagnoses. By understanding the effects of trauma, you are better equipped to cope with it, find practical solutions, and seek support.
TF-CBT can be delivered by counselors, social workers, psychologists, or psychiatrists. To be considered a TF-CBT therapist, mental health providers have to receive specialized training and supervision and obtain TF-CBT certification.
Trauma-focused CBT includes three treatment phases:
- stabilization
- trauma narration and processing
- integration and consolidation
Eight components fall within these three phases. These phases are denoted by the acronym PRACTICE:
- Psychoeducation and parenting skills. This involves providing information about trauma and trauma responses, thus validating how the child feels. Caregivers are taught techniques on coping with the child’s trauma responses and skills training related to child behavior management, positive parenting and improving communication.
- Relaxation techniques. The child is taught relaxation skills to help them cope with trauma responses.
- Affective expression and regulation. This helps the child and the parent become more comfortable managing, expressing and identifying their thoughts and feelings, to foster greater emotional regulation.
- Cognitive coping and processing. This helps the child and caregiver identify potentially inaccurate or maladaptive thoughts and behaviors and their connection to thoughts and feelings so that they can replace them with more helpful responses.
- Trauma narrative development and processing. Here, the child gradually addresses specific details about their trauma, often through a creative medium, which allows the child to process the experience and their reactions. The child shares this narrative with their caregiver in a joint session, allowing parents to process the experience and their reactions.
- In vivo exposure. Depending on the needs of the child, this component does not always take place. This involves gradually exposing the child to trauma reminders to build and develop skills to master fears rather than fostering avoidance.
- Conjoint parent-child sessions. Joint sessions provide caregivers and their child the opportunity to receive support and discuss the trauma that has occurred in a therapeutic setting.
- Enhancing safety and future development. The therapist, child, and caregiver develop strategies to improve the child’s feelings of safety and trust through training and skill-building.
TF-CBT therapy sessions can include:
- individual sessions with the child
- individual sessions with the caregiver(s)
- joint sessions with the child and caregiver(s)
- group therapy, involving both children and caregivers
Trauma-focused CBT vs. regular CBT
TF-CBT is one specific kind of CBT. A significant difference between the two is that, unlike regular CBT, trauma-focused CBT focuses specifically on the impacts of trauma.
While TF-CBT was specifically developed to help children and adolescents after trauma, regular CBT is for people of all ages.
Regular CBT isn’t only for people who have experienced trauma — it can also address anxiety, mood disorders, eating disorders, schizophrenia, and more. It can also help with stress, relationship conflict, and anger management concerns.
Regular CBT typically focuses on the individual with a challenging experience, while TF-CBT focuses on the child and involves sessions with the parents or caregiver(s).
What is it used for?
TF-CBT is effective at improving symptoms of post-traumatic stress disorder (PTSD) and preventing depression and behavioral challenges. It also may help with sexualized behaviors and feelings of shame in children who have experienced trauma.
The research on TF-CBT has found that it can be effective for numerous kinds of trauma, including experiencing or witnessing:
- physical or sexual abuse
- neglect
- traumatic loss
- domestic violence
- community violence
- accidents
- natural disasters
- war
If you’re not sure whether TF-CBT can help a child or teen in your care, it’s best to speak with a medical or mental health professional.
Next steps
Childhood trauma can have a lasting effect on a person. There are many treatments for children or adolescents who have experienced trauma, including TF-CBT.
If you would like to find help for a child or teen, consider a therapist experienced in working with their age group, as not all therapists treat children.
If you’re specifically looking for someone to administer TF-CBT, the TF-CBT Therapist Certification Program website has a Find A Therapist tool (limited to the United States).
