Apr 29, 2025
Trauma-Focused Cognitive Behavioral Therapy, also known as TF-CBT, is an evidence-based treatment modality designed to help children, adolescents, and families deal with childhood trauma.
This therapy modality is highly effective at helping young people through adverse and traumatic childhood experiences. Read on to learn more about how trauma-focused CBT works and if it is a good choice for you.
What is trauma-focused CBT?
Trauma-focused CBT was developed in the 1990s by Judith Cohen, Esther Deblinger, and Anthony Mannarino, who wanted to find a better way to help children and adolescents who were victims of sexual assault. It has since expanded into an effective treatment for children who have experienced all kinds of trauma.
Trauma-focused CBT brings in non-offending family members to help the child heal. Trauma affects the whole family unit, and children especially often need the support of caregivers and family members as they work through their trauma. Research has shown that TF-CBT results in significantly more positive outcomes in children's and caregivers' well-being compared to other therapy approaches.
Although trauma-focused CBT is focused on children and adolescents, it is one of the factors that has influenced the idea of “trauma-informed care”. Trauma-informed care is a set of techniques used across health professions that take into account the widespread negative effects of trauma. Healthcare providers, therapists, chiropractors, nutritionists, childcare providers, and many other professionals use trauma-informed care. This article will focus on trauma-focused CBT and its therapeutic effects in mental health therapy.
What are the three stages of trauma-focused CBT?
There are three stages of trauma-focused CBT: Stabilization, Trauma Narration and Processing, and Integration and Consolidation. These are:
- Stabilization: The initial period of TF-CBT can take as long as it needs to. This is the initial period of introducing both child and caregiver to trauma-informed care. It involves psychoeducation and parenting skills for the caregivers, and relaxation and emotional and cognitive processing for the child. By the end, both parents and child should feel comfortable discussing trauma and be prepared to process it. During this stage, caregiver and child usually have separate individual sessions.
- Trauma Narration and Processing: During this stage, the child and therapist will begin talking about their trauma. They will start to construct a narrative about the child’s life, where they speak about all the unspeakable things done to them and unlearn unhealthy thinking patterns that may have developed because of their abuse (examples: “I deserved to be abused.” or “It was my fault.”). They will begin to construct a narrative in which the child is centered, not the trauma, while still acknowledging the awful effects of trauma. During this stage, caregivers will also learn how to address their maladaptive coping mechanisms. The therapist will usually share the child’s trauma to the parents in individual sessions, giving the parent plenty of time to adjust to the child’s truth before their conjoined child and caregiver session.
- Integration and Consolidation: During this stage child and caregiver will have their first conjoined sessions, during which they will continue working through the trauma together, practice coping skills, and address any avoidance behaviors (like not going to school, not sleeping in their own bed, etc.) This stage will also work on building trust and safety between caregivers and children. The abused child may not feel like they can trust adults anymore, and this stage will help the caregiver rebuild that trust.
Most of these stages are required in traditional TF-CBT. Adjustments may be made for individual circumstances.
What are the principles of trauma-focused CBT?
Trauma-focused CBT is a shorter form of therapy, generally ranging from 12 to 25 sessions. During these sessions the therapist may use techniques such as:
- Gradual Exposure: The child will gently be asked to remember parts of their abuse and explain it to the therapist. This process is taken slowly during the Stabilization period. The therapist will prompt the child to talk about their experiences from least distressing to most distressing over the course of many sessions.
- Psychoeducation and parenting skills: Psychoeducation involves educating the parents on the effects of childhood trauma. It may also involve educating the child about the effects of trauma to relieve guilt and shame around their reactions. This can help caregivers understand why their child is acting the way they do and respond with empathy instead of frustration, a vital part of the recovery process. Parenting skills in response to trauma responses are also important to teach, as they differ from normal parenting skills.
- Relaxation and Coping Skills: The child is likely to experience intense emotional reactions to reliving their trauma by talking about it, so it’s important to equip them with effective relaxation and coping mechanisms. These skills will help them stay grounded and work through trauma responses.
- Cognitive processing of the trauma: Involves working through the trauma while reconstructing harmful, untrue narratives. For example, it’s a common experience of trauma survivors to believe the abuse was their fault or that they somehow deserved it. This is horribly false and can be damaging to their sense of self and well-being. Cognitive processing encourages people to examine why they think like that and see how it is a trauma response and not the truth.
- Trauma narrative: Trauma informs how we see ourselves and the story we tell about ourselves. This is especially true in children who are still forming a solid identity. Childhood trauma can poison that sense of identity and create a harmful narrative about themselves that they will carry for years to come. By constructing a trauma narrative, children can see how what happened to them may have affected them, but that they are still their own powerful individual.
- Caregiver Involvement: For a child that experiences abuse, positive caregiver involvement is crucial to stop any future harm being done and to help them heal. This involves positive parenting skills, empathy, understanding, and helping the child through trauma responses. A good TF-CBT therapist will equip parents with these necessary skills.
These are the main techniques in trauma-focused Cognitive Behavioral Therapy, but they are not the only ones. A therapist may bring in techniques from other modalities depending on the type of abuse and the symptoms exhibited.
What is the difference between CBT and trauma-focused CBT?
CBT stands for Cognitive Behavioral Therapy and is a very popular and effective therapy modality. It can be used to treat most disorders including anxiety, depression, stress, eating disorders, and trauma, among many others. The core teaching of CBT is that our thoughts influence our behaviors and emotions, so if we can change our thoughts we can build better well being for ourselves. A lot of CBT exercises involve noting negative, untrue thought patterns and replacing them with positive, true thoughts.
The main difference between CBT and trauma-focused CBT is that TF-CBT is used specifically to treat trauma. The skills taught are trauma-specific skills and will not be as effective treating other disorders. However, TF-CBT has been shown to be effective in treating comorbid anxiety and depression.
Is Trauma-Focused CBT the same as EMDR?
No. Trauma-Focused CBT is a form of talk therapy in which a therapist will meet one on one with a client and later with the client and the client’s caregivers. EMDR is an effective trauma therapy. It stands for Eye Movement Desensitization and Reprocessing. It involves moving your eyes from left to right (or tapping left rather than right or listening to alternating left and right beeps) while processing trauma. They are both effective trauma treatments, but Trauma-Focused CBT is specifically designed for children and adolescents and takes the whole family structure into account, whereas EMDR is individual therapy that is less talk therapy and can be used on all ages.
When is TF-CBT not appropriate?
TF-CBT may not be appropriate when children are experiencing self-harm, suicidal ideations, or substance abuse. In these cases, Dialectical Behavioral Therapy (DBT) can be helpful, followed up by a trauma-informed approach like TF-CBT. This is because these severe behaviors need to be addressed before the trauma can be addressed, and DBT is better equipped to handle these intense experiences in a way that is healthy and long-lasting.
If you are a guardian of a child who has experienced abuse and trauma, TF-CBT can help. Talk to a Lifebulb therapist about how to start trauma-focused CBT today.
