Trauma focused cognitive behavioral therapy for adults

What is TF-CBT?

TF-CBT is a conjoint child and parent psychotherapy approach for children and adolescents who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.

Children and parents learn new skills to help process thoughts and feelings related to traumatic life events; manage and resolve distressing thoughts, feelings, and behaviors related to traumatic life events; and enhance safety, growth, parenting skills, and family communication.

Who is TF-CBT for?

TF-CBT has proved successful with children and adolescents (ages 3 to 18) who have significant emotional problems (e.g., symptoms of posttraumatic stress disorder, fear, anxiety, or depression) related to traumatic life events.

This treatment can be used with children and adolescents who have experienced a single trauma or multiple traumas in their life.

Children or adolescents experiencing traumatic grief can also benefit from this treatment.

TF-CBT can be used with children and adolescents residing in many types of settings, including parental homes, foster care, kinship care, group homes, or residential programs.

How Long does TF-CBT Typically Last?

TF-CBT is best delivered by creative, resourceful therapists who have developed close therapeutic alliances with their clients.

This treatment is designed to be provided in a flexible and developmentally appropriate manner to address the unique needs of each child and family.

It has been evaluated with Caucasian and African American children, and it has been adapted for Latino and hearing-impaired/deaf populations. It is currently being adapted for Native American children and for children in many other countries (e.g., Zambia, Uganda, South Africa, Pakistan, the Netherlands, Norway, Sweden, Germany, and Cambodia).

Does TF-CBT Work?

TF-CBT is the most well-supported and effective treatment for children who have been abused and traumatized. Multiple clinical research studies consistently have found it to help children with PTSD and other trauma-related problems. It has been rated aModel Program and Best Practice for use with abused and traumatized children. TF-CBT currently is being used successfully in community service agencies across the country.

TF-CBT has proven to be effective in addressing post-traumatic stress disorder, depression, anxiety, externalizing behaviors, sexualized behaviors, feelings of shame, and mistrust. The parental component increases the positive effects for children by reducing parents' own levels of depression and emotional distress about their child's abuse and improving parenting practices and support of their child.

TF-CBT was rated a "1-Well-supported, efficacious treatment", the highest level of empirical support in the U.S. Department of Justice sponsored report Child Physical and Sexual Abuse: Guidelines for Treatment (PDF). The California Evidence-Based Clearinghouse for Child Welfare rated TF-CBT a "1-Well-supported, effective practice" its highest score for Scientific Rating and its highest score for Relevance to Child Welfare Rating. TF-CBT was selected as a "Best Practice" for cases of child abuse in the Kaufman Best Practices Task Force Final Report sponsored by the National Child Traumatic Stress Network.

Who Can Deliver TF-CBT?

This treatment can be used by a variety of mental health professionals, including clinical social workers, professional counselors, psychologists, psychiatrists, or clinical counselors.

Where Can I Get More Information About TF-CBT & Child Trauma?

• California Evidence-Based Clearinghouse for Child Welfare
• TF-CBT Fact Sheet from the NCTSN (PDF) 
• Review of TF-CBT from the Child Welfare Information Gateway
• NREPP Definition of TF-CBT (PDF)
• CARES Institute

Treatment Manual

Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guilford Press.

Trauma Survivors and Their Limbic System

In normal circumstances, the nervous system turns the body back into its usual status once the threat has passed. It does this by lessening stress hormones and enabling the brain to go back to its normal function. However, that reaction does not happen for some survivors of trauma. Instead, it keeps them in a responsive state.

The traumatic event is never given access to the neomammalian brain, which is the section of the brain that controls decision-making, cognitive processing, self-awareness and memory. It is also the area of the brain that enables us to process traumatic events and enables us to heal. For trauma survivors, the event stays stuck in the limbic brain, and the amygdala remains overly stimulated. Trauma survivor then become trapped in a circle of endless arousal, searching for and sensing threats everywhere.

Since the memory of the traumatic event stays in the limbic brain, which does not recognise the notion of time, events that occurred many years ago can seem as though they are happening right now. That is why people with PTSD continue to relive the trauma through nightmares and flashbacks and appear like they are stuck in the past.

What are the Benefits of TF-CBT?

Trauma-Focused CBT is based on the idea that our behaviours and feelings are a result of our thoughts and not external things such as situations, people or events. TF-CBT allows us to change and improve the way we think and act, regardless of what is happening externally. TF-CBT can involve numerous benefits including:

• Identifying negative emotions and thoughts
• Preventing addiction relapse
• Coping with loss and grief
• Managing anger
• Managing chronic pain
• Dealing with PTSD and overcoming trauma
• Overcoming sleep disorders
• Resolving relationship problems

TF-CBT’s underlying concepts are also based on other treatment methods and philosophies, including family therapy, behavioural therapy, cognitive therapy and humanistic psychology.

What are the Treatment Goals of TF-CBT?

Trauma can impact individuals in various ways. Even though some are resilient and do not develop serious behavioural or emotional problems, that is not the case for everyone. The main focus of TF-CBT is to address the symptoms activated by the trauma, along with any associated issues.

TF-CBT treatment goals include:

• Help the individual recognise and accept that they are not responsible for the trauma
• Decrease the person’s sense of shame and embarrassment
• Reduce symptoms related to or triggered by the trauma
• Assist the person in improving all areas of functioning that were affected by the trauma
• Lessen any acting out behaviour connected to the trauma
• Help mend and strengthen relationships, including communication and attachment

What are the Main Components of TF-CBT?

Trauma-Focused CBT has several main components, which are often represented by using the acronym PRACTICE.

P – Psychoeducation and Parenting

The therapist educates the person and help them realise what trauma is and what its effects are, including the behavioural and emotional responses that it tends to trigger in people. This also involves helping them with behaviour management strategies.

R – Relaxation Methods

The therapist teaches the individual effective and healthy relaxation methods to reduce and manage stress. These relaxation techniques may include breathing exercises, guided imagery and progressive muscle relaxation.

A – Affective Expression and Regulation Skills

Trauma frequently causes intense emotions including anger, fear and sadness. The therapist addresses this by assisting the person in learning to identify and express these overwhelming emotions. The therapist also helps them develop healthy ways to soothe anxiety and other negative emotions on their own.

C – Cognitive Coping Skills and Processing

People often find trauma to be quite confusing, and they may have a tough time processing things in a healthy way. Therapists can help them understand the link between behaviours, thoughts and feelings along with recognising and rectifying inaccurate thoughts about it.

T – Trauma Narrative and Processing

Sharing the traumatic event and its effect can be done through verbal, written, artistic or symbolic narratives. This offers the person a way to express and process the trauma and connected experiences. The therapist guides them in creating their narrative by using exposure exercises.

I – In Vivo Exposure

One of the most effective ways to overcome fear and anxiety is through exposure instead of avoiding anything that is linked to the trauma. In vivo exposure involves gradually exposing the individual to things that remind them of the trauma. This approach helps decrease their negative emotional responses to those reminders. It also helps them find ways to manage their emotional reactions to unexpected or future reminders.

C – Conjoint Therapy Sessions

These therapy sessions concentrate on creating and maintaining a healthy relationship within a family setting. It gives both parties an opportunity to practice communication skills and talk about the trauma in a therapeutic environment.

E – Enhancing Personal Safety and Future Growth

It is crucial for individuals who have experienced trauma to develop personal safety skills and learn how to form healthy relationships. Ways to avoid future trauma and stay safe, as well as means to keep healing and growing, are all discussed.

What Should You Expect in TF-CBT?

TF-CBT is designed to be a comparatively short-term treatment. Most cases of TF-CBT involve 12 to 18 therapy sessions, though it can also last anywhere from 8 to 25 sessions depending on the case. Likewise, the duration of each session can be from 50 to 90 minutes. In some circumstances, longer treatment may be necessary.

Cognitive behavioural techniques are used to adapt unhelpful or distorted thinking and negative behaviours and reactions. A family therapy may also be used at the same time to examine interactions between family members as well as other family dynamics that could be part of the problem. This approach can also help all parties develop better communication and stress management skills.

How Effective is TF-CBT?

Esther Deblinger, Judith Cohen and Anthony Mannarino originally developed trauma-focused CBT, all of whom are experienced doctors of medicine and psychology. The therapeutic treatment method has been carefully studied and polished over the last 25 years. 14 randomised and controlled trials have already been conducted in countries throughout Europe, the US and Africa, comparing the outcomes of completed TF-CBT sessions with those of other therapeutic approaches. 

Each one of these studies established that this specific method was superior in providing trauma survivors and their immediate families with the support and direction required to overcome destructive traumatic experiences and associated disorders.

Trauma Histories and Co-occurring Disorders

Dual diagnosis is a term that describes a person who has two independent illnesses, such as addiction and PTSD. Trauma and addiction often co-occur for several reasons. A person with unresolved trauma may develop an alcohol, drug or behavioural addiction as a way to numb their emotions. Studies have found that up to 50% of adolescents with PTSD develop an addiction. Sadly, PTSD often makes it harder for them to quit using, resulting in a vicious cycle.

In cases of dual diagnosis, Trauma-Focused CBT can be used as a part of a more comprehensive treatment plan. Each illness requires a dedicated treatment plan for effective treatment to occur.

Trauma and Addiction Treatment at The Dawn

The Dawn offers an integrated treatment model to co-treat trauma disorders and addiction. We also have specialist trauma treatment programme that focuses exclusively on PTSD. If you or someone you love are suffering with trauma and PTSD, now is the best time to reach out. Contact us today to receive a no-obligation assessment to find out how we can help. 

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