Trauma Focused Cognitive Behavior Therapy (TF-CBT)

Trauma Focused Cognitive-Behavior Therapy

Cognitive behavioral therapy (CBT) is based on the theory that upsetting emotions (e.g., anxiety) are associated with physiological symptoms (e.g., racing heart), negative thoughts (e.g., “Everyone will laugh at me when I give my presentation”), and problematic behavior (e.g., not going to school to avoid doing the presentation).  For children and adults exposed to trauma, the physiological, cognitive, and behavioral responses are often reactions to thinking and feeling they are in danger.  During a traumatic experience, the danger is real.  Problems arise when the person perceives they are still in danger, even when it is over and they are safe.  This can happen when they are triggered, which means something reminds them of the trauma.  Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen, Deblinger, & Mannarino, 2017) incorporates CBT principles with a trauma perspective.  TF-CBT uses a PRACTICE acronym to describe the treatment components:

  • Psychoeducation about trauma and parenting strategies
  • Relaxation training in portable techniques that children and caregivers can use anywhere when feeling anxious
  • Affect identification to help children and caregivers label and identify emotions and teach them the connection between emotions, thoughts, and behaviors
  • Cognitive processing to systematically identify and challenge negative or distorted thoughts that may be lead to emotional and behavioral problems
  • Trauma narration to helps children learn to manage reactions to trauma reminders (e.g., smells, sights, sounds) without the feared consequences
  • In vivo exposure to people and places that have been avoided
  • Conjoint caregiver-child sessions to discuss the trauma and other family stressors
  • Enhancing safety to prepare for situations that might put children at risk

When the traumatic event is associated with a death, the trauma work is followed by grief work.  CBT techniques learned during PRACTICE are applied to promote coping with grief.  Children and caregivers address any feelings about the deceased and current and future relationships, with the goal of increasing social connections.  Additional activities enable the child to make meaning of the death.  Joint child-parent time helps the caregiver practice communicating with the child about the deceased and plan together for upcoming challenging events like holidays and anniversaries.

What Happens in TF-CBT Sessions

TF-CBT is designed to be a short-term therapy, typically completed in 6-9 months (16-24 sessions).  Children and caregivers meet separately with the same therapist for the psychoeducation, skill-building, parenting, and exposure components of treatment.  Then, children and caregivers meet together for family work.  Sessions include:  planning the agenda for session, home practice review, focus on specific PRACTICE component, and home practice assignment.

Parents/caregivers are vital partners in a child’s TF-CBT work.  They are taught the same coping skills because they may be experiencing their own stress, and they play an important role in coaching their child to use their new skills.

Family Stories

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CHP’s Impact

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Served at our clinic

Outcome / Research Results

More than 20 randomized clinical trials have demonstrated the efficacy of TF-CBT compared to other forms of therapy in the reduction of PTSD, depression, and behavior problems in children who have experienced sexual abuse, domestic violence, natural disasters, terrorism, and other forms of trauma.  At Child HELP Partnership, we want to ensure that our families have the same rates of improvement as those families who participated in the randomized trials.

The chart below presents our own outcomes at each stage of therapy at Child HELP Partnership.

Percentage of Children with Mental Health Problems at Each Stage of PARTNERS Therapy

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As the chart shows, the percentages of children with PTSD, depression, and conduct problems decrease significantly over the course of therapy.  Additionally, each phase of TF-CBT is important for recovery.  By reducing rates of PTSD, depression, and conduct problems, we are not only easing the current pain of the children served, but preventing the need for long-term, expensive mental health care.

Contact Us about Trauma-Focused Cognitive-Behavior Therapy

For more information about Child HELP Partnership’s Trauma Focused Cognitive Behavior Therapy, contact us or fill out a referral form.