TF-CBT Clinical Overview

What Is TF-CBT?

​TF-CBT is a structured yet flexible therapeutic intervention, specifically designed for children, adolescents, and their parents/guardians to overcome the impact of traumatic events. TF-CBT is primarily for post-traumatic stress symptoms, but can also help with depression, other anxieties, and some behaviour problems that may be accompanying the traumatic reaction.
The average length of TF-CBT treatment is 12 to 16 sessions. These sessions may be structured as follows:

• Individual sessions for the child or adolescent
• Individual sessions for the parents/guardians
• Conjoint sessions between child or adolescent and their parents/guardians

​A diagnosis is not required in order to participate in this treatment, although it can certainly be helpful. A diagnosis can be sought from a psychologist, psychiatrist, or your family doctor. Whether a child or teen is diagnosed or not, a comprehensive assessment of symptoms will be one of the first steps when beginning TF-CBT.​​​

How Does TF-CBT Work?

​No two people experience trauma in exactly the same way, and skilled TF-CBT therapists are trained to respond to the unique needs of individuals and families while moving through TF-CBT components. These components include:

• Education and Parenting Support. The child/adolescent and their parents/guardians learn about typical trauma responses and post-traumatic stress. They learn about what is involved in treatment, and that the majority of children and teens will recover, especially if they are given effective treatment. Any questions and concerns are taken seriously, and strategies are developed at this earliest stage of treatment to manage current symptoms.
• Relaxation Strategies. This component focuses on effective strategies to manage the physical effects of traumatic stress, such as elevated heart rate, increased startle response, hypervigilance, agitation, difficulty sleeping, restlessness, irritability, and anger/rage reactions. These strategies are important for managing trauma reminders and working through later components of TF-CBT.
• Expressing and Regulating Emotions. This component continues the process of building skills and confidence and can help to reduce the child’s or teen’s need to use avoidant strategies to cope with traumatic stress. The child or teen identifies typical trauma-related emotions and learns to express and manage these emotions more effectively.
• Cognitive Coping and Processing. Due to their age and sometimes limited life experience, children and teens can sometimes be more prone to inaccurate or unhelpful thoughts about traumatic events. Life experience and knowledge can help individuals make sense of traumatic experiences. This component is an important step for the child or teen to learn about and explore thinking strategies that are more accurate and helpful.
• Trauma Story. This is the main part of TF-CBT. Using a narrative (story) approach, the child or adolescent gains the ability to remember and talk about what they went through without becoming overwhelmed or avoiding their memories. They are supported to put the traumatic events into a perspective that fits with the totality of their life. The trauma becomes one part of their self-concept and life experience, rather than a negative defining feature of both.
• Combined Parent-Child/Adolescent Session(s). The child or adolescent is able to share aspects of their story, or the whole story, with their parents/guardians. Parents are supported by the therapist to develop appropriate responses and strategies to feel confident in their ability to support their child or adolescent with this important process. 

What Happens Next?

​There are several options at this stage of therapy. Symptoms are reassessed, and successes are celebrated. Often, this is the end of treatment.
Occasionally, a few more sessions are planned if further goals are identified. These may include:

• Safety Planning. Children or adolescents may have reasonably come to fear specific situations in their lives and can be supported to explore practical and helpful strategies to cope with their fears. Or they may have adopted risky or unsafe coping skills and can benefit from support to reduce or eliminate these behaviours.
• Real-life exposure to trauma reminders. Sometimes fears can have a restrictive effect on the tasks or situations that the child or teen is willing to face. For example, a teen who was in a car accident may feel afraid to get back behind the wheel of a car. They can be supported to gradually face these types of fears to successfully regain their skills and confidence.
• Grief and bereavement. At this stage, a child or teen who has experienced a traumatic loss is often ready to engage in healthy steps to express their grief and remember their loved one in a healthy manner. 

How Do I Know that TF-CBT is Effective?

​TF-CBT has been demonstrated in numerous clinical studies to be highly effective at improving PTSD symptoms.
​As of 2018, 21 randomized controlled research trials have been conducted worldwide comparing TF-CBT to other active treatment conditions. All of the studies documented that the TF-CBT results were superior to the comparison conditions for improving child and adolescent trauma symptoms.

References

About Trauma-Focused Cognitive Behavior Therapy (TF-CBT). (2018). Retrieved July, 2018, from
https://tfcbt.org/about-tfcbt/
 
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in
Children and Adolescents. New York: The Guilford Press.
 
Kolk, B. V. (2014). The Body Keeps the Score. New York: Penguin Books.
 
TF-CBT Information. (2008). Retrieved March, 2012, from
http://depts.washington.edu/hcsats/PDF/Temp TF- CBT/pages/traumafocused_cbt.html#         
 
Trauma-Focused Cognitive Behavioral Therapy for Children Affected by Sexual Abuse or
Trauma. (2012, August). Retrieved September, 2018, from https://www.childwelfare.gov/pubs/trauma/