Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

When bad things happen It takes a while to accept the pain and feel safe again. Particularly, when your child faces trauma it disrupts his /her sense of safety, which he or she carries into adulthood. It tears them apart and they learn to abandon themselves. There’s hope, however. We’ve got a treatment that works”. You can indeed speed up your child’s recovery using trauma-focused cognitive behavioral therapy (TF-CBT) for adults and children.

During TF-CBT you will get to draw, write, talk, and play! Also, you will learn a lot about confusing events, feelings, relaxation, and how to stay safe.


Defining Trauma

Trauma is a result of unexpected, stressful events. When a child feels threatened by an event, we call that event trauma. It makes them feel overwhelmed, isolated and helpless.

There is a range of trauma types to which children and teenagers can be exposed. These include but are not limited:

  • Physical or sexual abuse

  • Childhood trauma

  • Complex trauma

  • Traumatic grief

  • Disasters ,or violence


How can Trauma affect You?

I was no longer me. I was in transition between who I was and who I needed to become. And my body couldn’t accept either version of myself. So, I just became an empty shell, desperately needing any ray of light to inhabit me. I was homeless”

~Welcome Home

Trauma exposure can have serious and long-term negative outcomes. It raises the risk of mental and physical health problems including PTSD, depression, anxiety, and substance abuse. Trauma can impact you on different levels. It has an impact on your physical, cognitive, and social well-being.


What are Some Common Responses to Trauma?

Children may present with PTSD symptoms, depression, acting out behaviors, and a host of difficulties. Following are some common responses to trauma:

  • Anxiety and fear
  • Shock and denial
  • Flashbacks
  • Sadness and hopelessness
  • Guilt and self-blame
  • Self-harm
  • Heightened arousal
  • Poor sleep
  • Headaches, and other somatic problems
  • Emotional reactions to triggers
  • Relationship problems
  • Social withdrawal
  • Poor concentration
  • Confusion, loss of security, and sense of safety

Consider speaking with your GP about symptoms above that you have experienced since the upsetting event. They can put you in touch with an Austrian accredited psychologist or psychiatrist. Our psychologists understand the effects of complex trauma. They are here to provide professional, trauma-focused care.


Trauma Therapy Interventions

There are many trauma therapy treatments that exist today. Each is developed to meet the different needs of individuals. Among them are CBT, EMDR, psychodynamic, hypnotherapy, and movement therapy. The goal of each therapy is to integrate the trauma and develop healthier ways of coping.


What is Trauma Focused Cognitive Behavioral Therapy (TF-CBT)?

Trauma-focused cognitive behavioral therapy (TF-CBT) is a treatment developed for children and adults who have experienced trauma. It is defined as ” Treating Trauma and Traumatic Grief in Children and Adolescents“. TF-CBT is a short-term, strength based approach that improves a range of trauma-related symptoms.

TF-CBT helps process difficult emotions and thoughts relating to a traumatic experience. It changes the association with the trauma by reframing the understanding of the traumatic event. It also creates a healthier and more adaptive meaning of the experience that took place. Furthermore, it provides a safe environment where one can disclose his/her trauma. The goal is to make clients feel safe and return a sense of control.

TF-CBT duration is 8-25 sessions. For complex trauma, the duration can be longer. Generally, it works with the parent as well as the child.


Is TF-CBT Effective?

Trauma-focused Cognitive Behavioral Therapy (TF-CBT) works because it addresses emotional effects of trauma and resolves those effects

Trauma-focused cognitive behavioral therapy for adults and children is a viable treatment for reducing trauma-related symptoms. While, it was at first developed to meet the needs of children who were sexually abused, over many years it has been used for other kinds of traumatized youth.

Furthermore, studies show that TF-CBT is effective for diverse and complex traumas. It is helpful for the youth of different ages, and across different cultures too. Infact, 80% of the children who receive this treatment show improvements. Hence, it is the strongest evidence-based treatment today.


How TF-CBT Works?

TF-CBT essentially works in three phases. The therapist meets with the child each week. Likewise, he meets with the parent to work on the same component. It is equally important for parents to learn skills to support the child at home, and also to process their own feelings. Moreover, there are joint child-parent sessions too.

The three phases of TF-CBT are as follows:


1. Stablization Phase:


This type of learning helps the parent understand why certain feelings and behaviors might occur. The therapist also normalizes and validates these as trauma responses.

The first part of trauma-focused therapy for adults and children involves psychoeducation. Generally, it includes both the parent and the child. During the session children and their families learn more about normal trauma responses. Parents are also learn ways to respond to these responses. Importantly, the therapist helps the parent begin to identify potential trauma reminders.

Trauma reminders are things that remind you about the trauma. They can include certain places, people, sounds, smells, sensations, etc. They can make you feel unsafe or as if you are living through the event over again.

TF-CBT therapist may educate the client and his family about sexual abuse. Firstly, he may let them know some common reactions on part of the victim and their families. Secondly, the therapist can include a sex education component i.e., healthy sexuality and body awareness. Hence, the goals are:

  • To normalize exposure to trauma: “You’re not alone/not the only one”.
  • Explain PTSD symptoms: “You’re not crazy”.
  • “It’s not your fault and you did the best you could”.
  • Describe TF-CBT (phases, process, and homework).
  • Explain how treatment works.


Relaxation :

You can use your coping and relaxation skills learned in trauma-focused cognitive behavioral therapy to gain control over these pesky reminders!

Relaxation is about feeling calm and peaceful. After traumatic events happen, we often feel tense, jumpy, and worried. Relaxation skills help children and families regulate stress systems. We feel better when we learn to relax our bodies and minds.

TF-CBT therapist provides relaxation strategies to the child. Parents are also encouraged to support the child in using them. These may include progressive muscle relaxation, deep breathing, positive imagery, or using their favorite music. In addition, it can include fun games such as decorating belly breathing balloon and using it for relaxation. So, the goal is :

  • To change from a state of tense to state of relaxation.


Parenting Skills:

During parenting skills, parents gain powerful ways for responding to a child’s behavior. Trauma-focused cognitive behavioral therapy for adults and children helps parents to attend to the positive behaviors of a child. Overall, parenting goals include:

  • Improve the relationship (e.g. increase closeness, warmth, and support)
  • Support child in the use of PRAC skills in the home.
  • Apply positive parenting.

When the parents begin to respond to the child’s requests for support, the troublesome behaviors begin to decrease.


2. Trauma Narrative Phase:

It is about ‘speaking the unspeakable’

One of the things people often do after they have experienced trauma is avoidance. They try to avoid thinking about what happened or talking about it. This seems logical but it stops people to get over the event that has happened to them. During this phase, the child talks about the most fearful traumatic memories.


You and your therapist can talk about creative ways to tell about the bad things that happened to you. You get to decide what form you want your story to take.

A TF-CBT therapist will have the child retell the story of what happened. The goals thus are to:

  • Child would be able to “face up” to his trauma, talk and think about it.
  • Identify changed views of self
  • Identify more helpful ways to think about trauma, self, family, the world, and the future.


Affect Regulation:

As a result of trauma, many children learn to suppress and withdraw themselves. This is a self-defense mechanism. TF-CBT therapists help the child become comfortable with expressing negative feelings. During therapy, the child rates his feelings from 0-10 on a scale. He/she learns how to identify strong emotions, talk about them, express them, and also how to deal with them. In fact, the child learns to be in charge of his feelings.

Importantly, trauma-focused cognitive behavioral therapy provides the child with a toolkit of skills. Children can use the feeling survival toolkit when they feel very sad, scared, or worried. The toolkit can include things like seeking social support, helping others, journaling, or playing with a pet. Hence, the goals include:

  • Identify range of feelings
  • Normalize bad feelings
  • Learning strategies to improve calm

The TF-CBT therapist also takes in parallel sessions with the parent. Since it is important for parents to learn how to cope with emotions positively at home.


Cognitive Coping:

Because the way we talk to ourselves in our heads also affects how we feel and what we do. You’re in charge!

Trauma-focused cognitive behavioral therapy works on changing unhelpful trauma-related thoughts.

‘I’m forever damaged because of what happened. People cannot be trusted. Nothing is safe. ‘

These types of thoughts are very common among parents and children who have gone through a traumatic event. This phase helps parents and children identify what thoughts they are having about the event that are inaccurate. It helps them reframe those thoughts so that they are able to think about them in a new way.

Thus, the goals are to:

  • Teach the CBT traingle_ How can you change your thoughts to feel good.
  • Get buy into the idea that thoughts drive feelings and they can be changed
  • Make positive coping statements.


3. Integration Phase:

In Vivo Exposure

Some children develop ongoing fears. Under those circumstances, TF-CBT therapist helps master the fear through gradual exposure. The parent and child develop a fear ladder list and also strategies to face each fear. Fear tends to reduce as a result. Hence, the goals are to:

  • Separate trauma reminders and triggers from real danger.
  • Reduce avoidance that interferes with day-to-day functioning.


Enhancing Safety

Since trauma involve loss of safety and betrayal of trust. It is important to develop strategies that enhance a child’s sense of safety. In the final stage of trauma therapy, the TF-CBT therapists make strategies to enhance the child’s sense of safety in the future. The goals thus are to:

  • Create a safety plan to help child and parent be safer.
  • Teach safety skills for use in risky situations that may arise in the future.


Joint Child-Parent Sessions:

Lastly, the therapist gives sessions to the parents and child jointly. These sessions provide a chance of an open communication about a child’s traumatic experiences before therapy concludes. In the joint sessions, the child also tells the reframed story about the event. Hence, some important goals are:

  • Provide chance for child to: ”face up” and share his/her story.
  • Receive praise and support.
  • Allow parent to learn about child’s view.

When you can remember your trauma without reliving it, that is the day you are freed.



Who Provides Trauma-focused Cognitive Behavioral Therapy (TF-CBT)?

TF-CBT is often provided by a therapist trained in trauma-informed care. Therapists have been able to facilitate TF- CBT online due to an increase in demand for trauma therapy during Covid-19. Virtual TF-CBT therapy costs less and has increased access to trauma therapy.


A Piece of Advice:

Trauma is a normal response to stressful life events. Healing from trauma takes time and everyone heals at their own pace. Know that it’s normal to grieve and have these feelings. Children often react to traumatic events with anxiety and emotional outbursts.

Many times as grown-ups we don’t give permission to our children to feel things. Saying, ‘Don’t worry about it doesn’t help the child. They are going to worry, nonetheless. To heal they must feel those emotions that they’ve long been suppressing.

True emotional healing doesn’t happen without feeling. The only way out is through.

~Jessica Moore

While these feelings are normal especially within the first few weeks of facing a traumatic event, they can also become problematic if not resolved in good time. Some people may find it difficult to move on with their lives. It causes their ability to function fall through. Therefore, it is important to process these feeling.


Acknowledge, reassure and be there for the child. Validate the feelings that they are experiencing.

In short, trauma-focused cognitive behavioral therapy (TF-CBT) for adults and children can help them find more helpful ways of managing their emotions. As always, reach out for help, and remember that your children do not need to go it alone.

Remember that you are not your trauma! Trauma creates changes you don’t choose, but healing is about creating changes you do choose.

Begin your healing today with the help of a qualified trauma specialist. To find specific trauma therapy treatments based on your child’s needs, you can also talk to one of our psychologists.

You can reach our friendly support team via webchat, phone, or email. You will need a referral (Mental Health Care Plan) from your GP to see one of our psychologists.