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
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.
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.
- 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
According to a
- stabilization and skill-building
- trauma narration and processing
- 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
- 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
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
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
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
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.