Trauma-Focused CBT (TF-CBT)
An evidence-based treatment for children and adolescents who have experienced trauma.
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Understanding Trauma-Focused CBT
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a highly structured, manualized, evidence-based treatment protocol designed specifically for children and adolescents who have experienced significant trauma and are exhibiting related emotional and behavioral difficulties.
The core principle integrates elements of cognitive-behavioral therapy (addressing trauma-related thoughts and behaviors) with trauma-sensitive interventions, parent/caregiver involvement, and gradual exposure to the trauma narrative.
The primary goal is to help your child process the traumatic experience, develop effective coping skills, and reduce trauma symptoms (PTSD, depression, anxiety, behavioral problems), while also supporting you as the non-offending parent/caregiver in managing your own reactions and effectively supporting your child.
Who Benefits from TF-CBT
TF-CBT is specifically designed for children and adolescents, typically ages 3-18, who have experienced one or more traumatic events and are exhibiting clinically significant symptoms related to the trauma, such as PTSD symptoms, depression, anxiety, or behavioral problems.
Traumas Addressed Include:
- Sexual abuse and physical abuse.
- Domestic violence and community violence.
- Traumatic loss or grief.
- Accidents and natural disasters.
A crucial requirement is the involvement of a supportive, non-offending caregiver who can participate in treatment sessions and support the child's healing process at home. Parent involvement is integral to the TF-CBT model.
The PRACTICE Components
TF-CBT follows a structured protocol with specific components, often remembered using the acronym PRACTICE:
- Psychoeducation: About trauma and typical reactions.
- Parenting skills: Behavior management and support strategies.
- Relaxation skills: Techniques for managing distress.
- Affective modulation: Identifying and managing emotions.
- Cognitive coping: Connecting thoughts, feelings, and behaviors; addressing unhelpful thoughts.
- Trauma Narrative: Gradual, supported creation and processing of the child's story of the traumatic event(s).
- In vivo mastery: Gradual exposure to trauma reminders.
- Conjoint sessions: Child sharing the narrative with the caregiver.
- Enhancing safety: Skills and planning for the future.
Sessions typically involve both individual child sessions and separate parent sessions, with conjoint sessions later in treatment.
What to Expect in TF-CBT
TF-CBT follows a structured, phased approach delivered over approximately 12-25 sessions, though this can vary based on complexity.
Early Sessions
Early sessions focus on psychoeducation (explaining trauma reactions to both child and parent), teaching coping skills (relaxation, emotional regulation), and building the therapeutic relationship. Parent sessions address parenting skills related to trauma behaviors and the parent's own reactions.
Middle Phase
The middle phase involves the gradual development of the Trauma Narrative—your child creating a detailed account of their traumatic experience(s), often through writing, drawing, or verbal storytelling—while the therapist helps process distorted cognitions as they arise. You'll review the narrative privately with the therapist before conjoint sessions.
Later Phases
Later phases include conjoint parent-child sessions where your child shares their narrative, addressing future safety, and consolidating skills. Your involvement throughout is a key feature of this model.
Evidence Base
TF-CBT is considered one of the most rigorously researched and widely supported treatments for childhood trauma. It is recognized as a gold-standard, evidence-based treatment.
Numerous randomized controlled trials (RCTs) have demonstrated its efficacy in significantly reducing PTSD symptoms, depression, anxiety, and behavioral problems in children and adolescents who have experienced various types of trauma.
It is endorsed by multiple major organizations and clinical practice guidelines as a first-line treatment for traumatized youth. Research supports its effectiveness across diverse trauma types, ages (within its range), and cultural backgrounds.
Additional Support
Looking for more guidance? Visit our Learn center for information about starting therapy, or explore helpful resources including crisis support, recommended reading, and wellness tools.
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Related Information
Related Information
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Systematic approach to reducing trauma-related anxiety through gradual exposure
EMDR
Eye Movement Desensitization and Reprocessing for trauma treatment
Cognitive Behavioral Therapy
Structured, goal-oriented therapy proven effective for anxiety, depression, and many other conditions
Post-Traumatic Stress Disorder
Understanding PTSD symptoms, causes, and treatment options