Trauma-focused CBT

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

Last updated 26th June 2024 | Next update due 26th June 2027

Trauma-focused CBT is a type of therapy designed to help people understand and process trauma. Here, we’ll explore what trauma-focused CBT is in more detail, what it involves and what it can help with.

What is trauma-focused CBT?

To understand trauma-focused CBT (TF-CBT) it’s helpful to first understand cognitive behavioural therapy (CBT). CBT is a talking therapy that helps us recognise how our thoughts can impact our feelings and behaviour. It is a structured, skills-based approach. This means it can help people develop coping skills to support them beyond the sessions. 

Trauma-focused CBT expands traditional CBT methods. It incorporates elements of family therapy and uses a trauma-aware approach throughout. This makes it a more targeted therapy for those who have experienced trauma.

Initially, TF-CBT was developed to better support children and adolescents who had experienced sexual abuse. It was first created in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino. Since then, the therapy has adapted to support young people and adults who have experienced various forms of trauma. 

The National Institution for Health and Care Excellence (NICE) recommends trauma-focused CBT for children, young people and adults with post-traumatic stress disorder.

What can trauma-focused CBT help with?

This approach can be helpful for those who have experienced trauma. This may include abuse, grief, neglect, accidents or witnessing something traumatic. For some people, trauma can become ‘stuck’ after the incident. This can lead to a condition called post-traumatic stress disorder (or PTSD) where people might ‘relive’ the experience through flashbacks. This is something trauma-focused CBT can help with.

If the person seeking help is a child or young person, family therapy may be included in the TF-CBT approach. This is to help create a feeling of safety and help the family understand how trauma impacts their loved one and how they can help. This would not include any offending family members in cases of abuse or neglect.

If you are experiencing other problems, such as suicidal ideation or alcohol/substance abuse, you may be offered a different approach like dialectical behavioural therapy first. This can help improve the stabilisation of your mental health before addressing the trauma. Following this support, you may then be offered trauma-focused CBT.

In this Happiful podcast episode, we speak with Dr Joe Barker and Reiki teacher Sarah Wheeler about the impact of trauma and different therapies that can help. 

What does trauma-focused CBT involve?

TF-CBT is a short-term therapy which means you will have a set number of sessions. This can mean you’ll have between eight and 25 sessions, depending on your circumstances. 

Trauma can lead to a number of feelings and experiences, such as guilt, difficulties sleeping, anxiety, anger and depression. To help address your symptoms, trauma-focused CBT pulls together elements from different interventions. Some of the core features you’ll see within TF-CBT include:

  • Psychoeducation: This typically involves helping you to understand the human reactions to trauma to remove any sense of guilt.
  • Gradual exposure: Your therapist will slowly encourage you to recall memories of the traumatic event, talking you through how they make you feel. This helps to recondition your responses to the memory to remove their emotional potency.
  • Coping skills: Your therapist will share helpful coping skills to manage symptoms. This might include breathing techniques or thought redirection.
  • Cognitive processing: This may involve recontextualising any unhelpful thoughts or feelings you’re experiencing to help regulate emotions.

If the person seeking support is a child, caregivers will also be involved. The goal here is to rebuild trusting relationships with adults if the trauma comes as a result of abuse. This involvement also helps caregivers learn what they can do to support their loved ones.

Throughout your sessions, your therapist will encourage you to practise any skills learnt during your work together. This helps you to build your own skillset to support you when the therapy ends. 

“By addressing the impact of trauma on multiple levels – emotional, cognitive, and behavioural – TF-CBT empowers clients to reclaim control over their lives and build a brighter future.”

- Laura Gwilt, BSc(Hons), PGDip, Accredited 

What are the three phases of trauma-focused CBT?

There are three phases of TF-CBT: 

  1. stabilisation
  2. trauma narration and processing
  3. integration and consolidation

During the stabilisation phase your therapist can help to validate your experience and identify potential triggers. Relaxation skills are discussed here along with strategies to manage difficult emotions. Key CBT aspects are taught here too, helping you understand the relationship between thoughts, emotions and behaviours. If working with caregivers, this phase may also involve helping them develop skills to support their loved ones.

The trauma narration and processing phase involves your therapist working with you to tell the story of your traumatic experience. Talking about the events in a safe space can help you to practise skills learnt in the stabilisation phase.

The integration and consolidation phase is about taking everything you’ve learnt out into the real world. This may include facing situations or places that initially triggered a fear response. This should be done slowly as you learn to build your tolerance and master the skills you’ve learnt to overcome your triggers. 

How to find a TF-CBT therapist

When looking for support with trauma, it’s helpful to find therapists who have had training in this area. There are various trainings and courses available, so it is worth checking to see if your therapist has had training or experience to work through a trauma-focused framework. 

Discussing subjects like trauma can feel difficult. One of the most important aspects of trauma therapy therefore is feeling comfortable with your therapist. They have been trained to create a safe space for you, but if for some reason you feel uncomfortable know that you can change your therapist and find a better fit for you. You are not in this alone and there are tools, people and communities out there to give you the support you need.

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