Trauma focused cognitive-behavioral therapy (TF-CBT)
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a specialized psychosocial treatment designed to help children aged three to eighteen who have experienced significant trauma, such as abuse, violence, or natural disasters. The therapy aims to alleviate the emotional and behavioral issues that arise from these traumatic experiences by equipping both the child and their caregivers with coping skills and understanding of trauma's impact. TF-CBT involves 8 to 25 sessions that begin with separate meetings for the child and caregiver, eventually culminating in joint sessions to strengthen their relationship and support system.
Key components of TF-CBT include psychoeducation, relaxation techniques, emotional regulation, trauma narrative processing, and strategies for enhancing safety and future growth. The acronym PRACTICE summarizes these components, emphasizing the importance of skill-building and narrative sharing in healing. TF-CBT has shown effectiveness in addressing symptoms associated with trauma, such as anxiety, depression, and post-traumatic stress disorder (PTSD). This therapy is facilitated by certified professionals who undergo extensive training to support children and families in overcoming the challenges posed by trauma. While TF-CBT is a powerful tool for recovery, it may not be the first line of treatment if more severe mental health issues, such as suicidal behavior or aggression, are present.
On this Page
Subject Terms
Trauma focused cognitive-behavioral therapy (TF-CBT)
Trauma-focused cognitive behavioral therapy, or T-F CBT, is a psycho-social treatment for children who have been affected by a significant physical or emotional trauma. These traumas include exposure to physical or sexual abuse, violence, natural disasters, terrorism, war, or the traumatic loss of a loved one; children may be affected by more than one trauma at the same time. This specialized treatment model supports and educates the child and caregivers on the impact of trauma and provides coping skills for both. By providing a safe place for the child to share the story of the trauma and teaching coping, stress-reduction, and relaxation techniques, T-F CBT helps the child reach a place where the effects of the trauma are minimized. The child is also taught to deal with situations that might prompt memories or fears associated with the trauma, and to stay safe in future situations.
Background
Childhood trauma has long been considered a source of psychological problems. Austrian psychologist Sigmund Freud (1856–1939), considered the father of psychoanalysis, believed that many of the problems that plague adults have their roots in childhood experiences and traumas. He believed that helping people come to terms with these experiences eases the symptoms that are troubling them in adulthood.
In the last decade of the twentieth century, three American psychiatrists, Anthony Mannarino, Judith A. Cohen, and Esther Deblinger, developed T-F CBT as a way to help children ages three through eighteen who had been victims of sexual assault. T-F CBT has since been modified to also treat child victims of other traumas. It has been tested in more than a dozen clinical trials in multiple countries and used to treat children who were affected by the September 1, 2001, terrorist attacks and Hurricane Katrina in 2005. T-F CBT has proven to be effective in treating children coping with many kinds of trauma. As a result of its success in both clinical tests and real situations, T-F CBT has been recognized as a model program by the US Substance Abuse and Mental Health Services Administration.
Overview
T-F CBT is used to treat children between the ages of three and eighteen who have developed serious behavioral or emotional problems in the aftermath of trauma. This trauma is specific and can be identified, so the specially trained therapist can help the child and caregiver(s) address it. The caregiver who is involved in the therapy is never the caregiver who inflicted the trauma, and the therapy has been shown to work with foster children and others who do not have a consistent caregiver.
The treatment requires between eight and twenty-five sessions and is usually conducted on an outpatient basis. Initially, the child and the caregiver have separate sessions as each learns specific skills that are part of the program. In the latter stages of the therapy, both child and caregiver attend the same sessions.
There are eight specific components to T-F CBT therapy, which can be remembered through the use of the acronym PRACTICE. "P" is for psychoeducation for the child and caregiver and parenting skills for the caregiver; "R" is for relaxation techniques used to help the child address residual stress; "A" is for affective expression and regulation, or expressing and controlling emotions; "C" is for cognitive coping, or using conscious efforts such as deep breathing or distraction to deal with stress and anxiety; "T" is for trauma narrative and processing, or sharing the story of the trauma and discussing aspects of it, especially how the child sees it; "I" is for in vivo exposure, or intentionally exposing the child to things that evoke memories of the traumatic experience; "C" is for conjoint parent-child sessions, or shared therapy for the child and caregiver; and "E" is for enhancing personal safety and future growth, or helping to prepare the child to deal with situations that resulted in the trauma if they are encountered again.
These cognitive behavioral techniques address three specific areas: (1) skill-building and stabilization of the child's symptoms; (2) telling, retelling, and processing of the child's trauma story (narrative); and (3) integration and consolidation of the skills that have been learned. Throughout the sessions, the child is repeatedly exposed to reminders of the trauma because this is considered essential to a favorable outcome. T-F CBT is said to be 100-percent successful in treating symptoms such as trouble concentrating, irritability, depression, anxiety, acting out, dreams or traumatic memories, avoidance of things that remind the child of the trauma, age-inappropriate sexual behavior, issues of shame and lack of trust, and other signs of post-traumatic stress disorder (PTSD) or coping problems.
The treatment is administered by specially certified therapists who already have graduate-level degrees in psychology or psychiatry. These therapists complete an additional ten hours of training online and two days of intensive in-person training, as well as follow-ups with T-F CBT experts. They can then become certified to help children and caregivers through scheduled weekly sessions.
Although T-F CBT has a good success rate in helping children recover from the effects of trauma, it is not always the first treatment of choice. In situations where depression is the primary symptom and has led to the child becoming suicidal or engaging in self-abuse or substance abuse, treatments for these conditions should be the first priority. When the child's primary symptoms are related to aggressive or defiant behavior, such as instances of breaking parental or school rules or violating the law, other treatments can be used to address these symptoms first. Once the more immediate and serious problems are treated, the child and caregiver can enter T-F CBT to learn how to minimize the effects of the trauma.
Bibliography
"About Trauma-Focused Cognitive Behavior Therapy (TF-CBT)." TF-CBT: Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program, 2024, tfcbt.org/about-tfcbt/. Accessed 5 Aug. 2024.
"How to Implement Trauma-Focused Cognitive Behavioral Therapy (T-F CBT)." National Child Traumatic Stress Network, 2004, www.nctsn.org/sites/default/files/resources//how‗to‗implement‗tfcbt.pdf. Accessed 5 Aug. 2024.
Isaac, Lauren. "The Origins and Practice of Trauma-Focused Cognitive Behavioral Therapy." Social Justice Solutions, 29 July 2015, www.socialjusticesolutions.org/2015/07/29/origins-practice-trauma-focused-cognitive-behavioral-therapy-tf-cbt/. Accessed 5 Aug. 2024.
Kliethermes, M.D., et al. "Trauma-Focused Cognitive Behavioral Therapy." In Evidence-Based Treatments for Trauma Related Disorders in Children and Adolescents, edited by M. Landolt et al., Springer, 2017, doi.org/10.1007/978-3-319-46138-0‗8. Accessed 5 Aug. 2024.
"Sigmund Freud (1856-1939)." Public Broadcasting Service, 1998, www.pbs.org/wgbh/aso/databank/entries/bhfreu.html. Accessed 5 Aug. 2024.
"Trauma-Focused Cognitive Behavioral Therapy (TF CBT)." EPIS, Penn State University, 2020, www.episcenter.psu.edu/newvpp/tfcbt. Accessed 5 Aug. 2024.
"Trauma-Focused Cognitive Behavioral Therapy: A Primer for Child Welfare Professionals." Child Welfare Information Gateway, US Department of Health and Human Services, Oct. 2018, www.childwelfare.gov/resources/trauma-focused-cognitive-behavioral-therapy-primer-child-welfare-professionals/. Accessed 5 Aug. 2024.
"Understanding Childhood Trauma." SAMHSA: Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, 24 May 2024, www.samhsa.gov/child-trauma/understanding-child-trauma. Accessed 5 Aug. 2024.