Trauma-Focused Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a well-known therapy technique often used to treat mental health disorders, including depression and anxiety. But less well-known may be a variant of CBT called trauma-focused cognitive behavioral therapy, or trauma-focused CBT. Trauma-focused CBT is a specific type of experience-based CBT that generally focuses on helping children and adolescents move past traumatic experiences.

Research shows that online therapy can play a significant part in healing from past trauma including mental, emotional, and physical abuse. In one study, 15 youths who had been exposed to trauma participated in individual TF-CBT via videoconferencing with an online therapist. After treatment, the participants generally experienced a reduction in symptoms of post-traumatic stress disorder (PTSD). Additionally, their progress was comparable to traditional in-person therapy.

What is cognitive behavioral therapy?

Before we can understand what trauma-focused cognitive behavioral therapy is, we may benefit from first understanding cognitive behavioral therapy. Cognitive behavioral therapy is one of many types of psychological therapies that has a cognitive base (meaning it is designed around thinking and thought processes) and is generally designed to help individuals reduce bad thoughts and habits and replace them with more productive ones. For example, depression may bombard you with thoughts that you deserve what comes to you. A course of CBT may help you recognize these negative thought patterns and replace them with more positive ones, such as believing that you deserve to live a happy and fulfilled life.

CBT’s efficacy and versatility have made it one of the most popular forms of therapy today, and CBT techniques have helped many people overcome a variety of mental health concerns.

Is TF cognitive behavioral therapy similar to cognitive processing therapy (CPT)? They have many same concepts, but TF cognitive behavioral therapy was distinctively developed for teens and children. It can be especially useful in the treatment of post-traumatic stress disorder (PTSD) in adolescents and children, though it has uses for may different post-traumatic disorders and reactions to past experiences. 

Just like cognitive processing therapy for ptsd, TF-CBT may help young people manage their past trauma before it develops into a mental health disorder. Systemic reviews of this type of therapy show that it may be more effective than other forms of therapy for young people impacted by trauma. This treatment may help with sleep problems, trauma due to physical abuse, changing emotional responses to stimuli, reducing emotional distress, PTSD, and more.

How does it work?

TF-CBT typically combines cognitive behavioral therapy techniques with family and humanistic therapy approaches. TF-CBT treatment is usually less than 16 sessions, and it can be highly effective at helping young people heal from stress.

Creating a narrative

The TF-CBT approach may include systematic reviews of past experiences to help individuals address and move past thoughts that can lead to PTSD, stress, depression, and other forms of traumatic stress disorder and mental health conditions. In doing so, TF-CBT can help individuals with stress disorders manage their emotions in a healthy way. One way in which this may be accomplished is by receiving treatment in a safe, familiar environment. This may allow the impacted individual to stay present with recovery, express their emotions more comfortably, and tell their own trauma narrative. Once individuals are comfortable telling their story to their therapist, they will normally work together to discover how their past has distorted their perception of reality and how to cope with it in a healthy manner.

Managing effects from physical or sexual abuse, PTSD, and grief

TF-CBT can teach individuals new skills, so for it to be maximally effective, families and children may need to practice these skills. In some cases, therapists may assign homework to encourage opportunities to practice new skills and reach therapy goals.

Therapists may meet with families or children affected by trauma in joint family therapy sessions as well as individually to help relatives develop skills together. For TF-CBT to work, a significant relationship between all parties involved may be beneficial. Therapy may help all parties strengthen their relationships and improve their coping skills.

What can TF cognitive behavioral therapy treat?

TF-CBT is generally a trauma-based therapy, but you may be wondering what specific types of trauma TF-CBT works best for. The primary use of TF-CBT is usually to treat individuals living with PTSD. Physical, mental, or sexual abuse* may leave a child with anxiety, depression, or other unhealthy behaviors. A counselor can help these adolescents impacted by trauma to eliminate negative behaviors and move on.

Therapy may also benefit youth affected by displacement, fostering, adoption, or family abuse, as well as those who are experiencing grief or have been removed from their parents. These other kinds of experiences can be just as impactful. In cases of abuse, there may be parent or caregiver involvement; if the abuse occurred at the hands of a caregiver or family member, those individuals would not be invited to attend sessions. However, caregivers not related to the traumatic event may be requested to attend the sessions. Any non-offending parents, family members, or caregivers may also attend sessions, depending on whether the child is currently in human services and if the parent has the right to attend these psychiatric services.

Trauma-focused cognitive behavioral therapy (TF-CBT) is generally designed for individuals between ages three and 18 who have had a traumatic experience, anything from mild to severe, repeated trauma. Individuals undergoing TF-CBT will often learn techniques such as the gradual exposure treatment model, cognitive processing, deep breathing exercises, and validation techniques. While the treatment length depends on the individual, the Child Welfare Information Gateway estimates that TF-CBT treatment typically lasts between 4 and 6 months. 

Therapists 

A TF-CBT therapist may have specialized training in child development and the mental health of children and adolescents impacted by trauma. To provide TF-CBT, therapists may obtain their master’s degree before taking certified courses designed for TF-CBT. A typical course may require two days of live training followed by additional virtual training, which occurs once, twice, or every few months. Before providing services, a mental health provider usually must also pass an examination.

Effectiveness of psychological therapies

A comprehensive literature review of the research on TF-CBT confirms its efficacy for treating depression, PTSD, anxiety, and other side effects associated with trauma. The more TF-CBT sessions one has, the more effective the treatment may be.

Not every individual who has experienced trauma may be a good candidate for TF-CBT. For instance, children exhibiting behavioral problems prior to the trauma may not benefit from TF-CBT. A licensed mental health provider can work with you to determine a different treatment approach for these individuals such as group or in-patient therapy.

Youth experiencing suicidal ideation* or addiction may not be good candidates for TF-CBT because the treatment may cause their symptoms to temporarily worsen. Above all else, mental health providers generally want to defend individuals from harm, so to avoid putting individuals in a dangerous position, another therapy, such as dialectical behavior therapy, may be more appropriate.

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

The benefits of online therapy

Online therapy can be a convenient and effective way for adults to obtain cognitive behavioral therapy for trauma or to get a wide variety of support for various other mental health challenges. Parents with children who may benefit from TF-CBT may also discuss treatment options for their children with an online therapist. Online therapy may be more suitable for many people because sessions can be held virtually from the comfort of your home. 

Additionally, therapy sessions can often be scheduled after regular working hours, which can help if the individual needing support is in school or working. In cognitive behavioral therapy, the comfort level between the individual receiving treatment and the therapist is often of vital importance. Online therapy can make the therapeutic alliance between client and therapist even stronger than in-person therapy options. 

BetterHelp counselor reviews

BetterHelp has trained therapists available to support youth and families with overcoming trauma. Below are some reviews of BetterHelp counselors from people experiencing similar challenges.

"I have had many therapists in the past 10 years, and they have all been helpful, but my experience with Lauren has been transformative. She is bold when necessary and honest, but she always wants to let you make the choices you choose. She always wants you to be healthy first and foremost. She provides goal settings, cognitive behavioral therapy, help with anxiety, and will be honest if more support is needed than just online therapy."

"I enjoyed my session with Traci. She was able to give me a variety of CBT techniques in our very first session. She listened intently to what I had to say, and overall, I felt the session was well-run, and the conversation had a positive effect on my mood."