Trauma-focused cognitive behavioral therapy (TF-CBT) is a type of psychotherapy for children who have experienced a traumatic event or series of traumatic events.

TF-CBT involves safe participation from a parent or caregiver. Initially, children and caregivers have separate sessions and then sessions together.

While psychologists initially developed TF-CBT for children, it also benefitsTrusted Source adults with post-traumatic stress disorder (PTSD).

This article discusses TF-CBT, including who it can help and whether it can help adults. It also examines components, techniques, benefits, and when to seek help.

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TF-CBT is a type of cognitive behavioral therapy. This group of talk therapies stems from the idea that thoughts, emotions, and behavior all affect one another and that this interaction can be helpful or unhelpful.

When it is helpful, a person’s thoughts and behaviors help them effectively manage their feelings in a healthy way. When it is unhelpful, someone may not know how to manage their feelings, have distorted beliefs, or engage in harmful behaviors as a way of coping.

TF-CBT adapts these principles specifically to trauma, which is an emotional and physical response to a shocking or dangerous event. This could be a single incident, multiple incidents, or an ongoing experience.

Therapists created TB-CBT for children and adolescents aged 3–18Trusted Source who have trauma-related symptoms, such asTrusted Source:

  • nightmares
  • difficulty sleeping
  • feeling persistently nervous or on edge
  • being easily startled or scared
  • irritability, anger, or unpredictable emotions
  • intrusive thoughts
  • flashbacks, which can be emotional or visual

For children, TF-CBT involves the participation of a safe parent or caregiver. The therapist spends time with the child individually, the caregiver individually, and the child and caregiver together.

However, TF-CBT is not for:

  • dangerous acting-out behaviors
  • active suicidal behavior
  • active use of harmful substances by the child or caregiver

Healthcare professionals tailor TF-CBT to children and adolescents, and most research on the subject focuses on this age group. However, a 2018 reviewTrusted Source includes TF-CBT as an option for adults with PTSD. Previous research has found that it is more effective than no treatment, supportive therapy, and relaxation techniques.

According to a 2017 reviewTrusted Source, TF-CBT involves three phases:

  1. stabilization and skill-building
  2. trauma narration and processing
  3. integration and consolidation of lessons learned

The acronym “PRACTICE” summarizes the components, which include:

  • Parenting and psychoeducational: This involves educating the accompanying caregiver about the reasons for treatment, what they can do to participate, and how their participation will help. It also entails helping caregivers discern the difference between childhood behaviors that are typical and atypical.
  • Relaxation: This may include focused breathing or visualization of relaxing scenes. These exercises help teach people how to control bodily sensations, which can be reassuring.
  • Affect expression and modulation: This involves promoting the recognition of different emotions and understanding that emotions have different degrees. It encourages the expression of feelings in words.
  • Cognitive coping: This first involves understanding thoughts, emotions, and behaviors and the relationships between them. Next, it includes learning to identify unhelpful thoughts and replace them with more helpful thoughts.
  • Trauma narration and processing: In this part, the therapist reads a portion of a developmentally appropriate book about the traumatic event. Afterward, the child dictates a narrative or story for the therapist to type, which may help process trauma and reduce avoidance.
  • In vivo mastery: The goal of this intervention is to reduce a child’s avoidance of trauma reminders. The therapist works with the caregiver to provide exposure to the feared situation or object gradually. Caregivers encourage small steps in the right direction with praise.
  • Conjoint sessions: These are sessions that include the child and caregiver at the same time. They reinforce skill development, as the child can demonstrate to the caregiver focused breathing, and the caregiver can practice parenting skills.
  • Enhancing safety and future development: This includes teaching skills relating to assertiveness and safety.

Examples of some of the exercises or techniques TF-CBT might employ includeTrusted Source:

  • age-appropriate ways of lowering tension in the body, such as hugging a teddy bear
  • “feeling charades,” which is a game where a person depicts an emotion via body language and facial expressions for others to guess
  • listening to music and asking a child to repeat positive lyrics when they are upset
  • reading a story and then asking a child to identify the unhelpful thoughts of a character and suggest more helpful perspectives
  • reviewing what body parts are acceptable and unacceptable for others to touch

A 2015 reviewTrusted Source evaluated 15 clinical trials to determine the value of TB-CBT for treating children who experienced trauma. It found strong support that this type of psychotherapy can improve:

A 2018 reviewTrusted Source looked at clinical trials to explore the benefit of TB-CBT and two other psychotherapies for treating adults with PTSD. It discovered that a large evidence base indicates TB-CBT is effective.

Any adult who has experienced a traumatic event, currently has mental health symptoms, or has concerns about the well-being of a child can seek help by speaking with a mental health professional.

Depending on the complexity of the case, treatment with TF-CBT usually involves 8–20 sessionsTrusted Source. People may be able to access TF-CBT via their medical insurer. Alternatively, private options are available. Some therapists offer low cost options or a sliding scale for those who need it.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Trauma-focused cognitive behavioral therapy (TF-CBT) may help children who experience significant emotional or behavioral difficulties after undergoing a shocking or dangerous event. Some researchTrusted Source indicates that TF-CBT may also help adults with PTSD.

TF-CBT has eight components, including psychoeducation, relaxation techniques, identifying and expressing emotions, and replacing negative thoughts with more helpful ones.

TF-CBT has strong evidence supporting its effectiveness, but it may not be right for everyone. If people cannot access TF-CBT where they are or would prefer to try something else, other types of therapy may help with trauma.