What is Trauma-Focused Cognitive Behavioral Therapy?

TF-CBT is treatment for children who have PTSD

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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is considered a cognitive-behavioral treatment for children who have posttraumatic stress disorder (PTSD). It was initially developed to address symptoms related to childhood sexual abuse, although it has since been adapted to treat other traumatic experiences of childhood as well.

TF-CBT targets unhealthy thoughts and behaviors that a victim of sexual abuse might experience.

For example, TF-CBT may help children modify inaccurate beliefs that lead to unhealthy behaviors, such as beliefs that they are to blame for the abuse. It also identifies unhealthy patterns of behaviors (for example, acting out or isolating) or fear responses to certain stimuli and attempts to modify these by identifying healthier ways of responding to certain stimuli, or in particular situations.

TF-CBT is also unique in that it incorporates an intervention for parents or caregivers who were not involved in the abuse. Children and parents each participate in therapy, first separately and then together. Parents learn stress management techniques, healthy parenting techniques, and how to better communicate with their child. TF-CBT recognizes that the support of the parent or caregiver is very important to the recovery of the child, and it also recognizes that parents may experience considerable distress as a result of their child's sexual abuse, and this distress needs to be addressed so it doesn't interfere with parenting.

How Does TF-CBT Address PTSD Symptoms?

TF-CBT is considered a short-term treatment: it generally lasts about 12 to 18 sessions, and each session may last 60 to 90 minutes. TF-CBT addresses PTSD symptoms by taking children and parents/caregivers through the following components:

  • Psychoeducation and parenting skills. Therapists provide children and parents with information on sexual abuse and the types of symptoms that may come up in response to this kind of traumatic event. Parents are taught ways to effectively manage behavioral problems, as well as how to better communicate with their child.
  • Relaxation. Children are taught ways to manage their anxiety through relaxation.
  • Emotional expression and regulation. The therapist assists the child and parents in how to manage emotions related to the abuse in a healthy and effective way. For example, children are taught how to identify and express their emotions, as well as engage in self-soothing exercises when experiencing intense emotions.
  • Coping with thoughts. Children are assisted in identifying maladaptive thoughts about the sexual abuse (for example, self-blame) and how to work through these thoughts.
  • Creation of a trauma narrative. Children are taken through exposure exercises, such as talking about the event or writing about the event. Children may also create a symbolic representation of the event through drawing or play.
  • In vivo exposure. The therapist gradually exposes the child to trauma reminders so that the child learns how to effectively manage her fear response, as well as reduce avoidance behaviors.
  • Joint parent-child sessions. The parent and child work together to improve communication and learn how to discuss the abuse in a healthy and therapeutic manner.
  • Staying safe and maintaining recovery. The therapist provides the child and parents with information on how to be safe in future situations in order to avoid future abuse. Information on how to maintain and continue in the recovery process is also discussed.

Is TF-CBT Effective?

Overall, studies have found that TF-CBT is effective in reducing symptoms of PTSD, as well as other problems (for example, depression, behavioral problems, shame) among children exposed to sexual abuse. In addition, TF-CBT appears to be more effective than other types of treatment approaches that may be used with children with a history of sexual abuse, such as supportive therapy or play therapy. In addition, gains made in TF-CBT have been found to be maintained up to two years following the end of therapy.

TF-CBT also appears to help parents and caregivers who were not involved in the child's abuse. Parents report lower levels of depression, distress about the abuse, and symptoms of PTSD. It has also been found that TF-CBT increases parents' ability to support their child.

If you are interested in learning more about TF-CBT, you can visit the website of the Medical University of South Carolina National Crime Victims Research and Treatment Center. Information on TF-CBT is also provided on the website of the United States Department of Health and Human Services.


Cohen, J. A., Berliner, L. & March, J. S. (2000). Treatment of children and adolescents. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatment for PTSD (pp. 106-138). New York: Guilford Press.

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

Deblinger, E., Behl, L., & Glickman, A. (2006). Treating children who have experienced sexual abuse. In P. Kendall (Ed.), Child and adolescent therapy, 3rd ed.. New York: The Guilford Press.

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