Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Type of Approach:
Provider Education Level:
Type of services:
Cognitive behavior therapy to address childhood posttraumatic stress disorder (PTSD) symptoms through individual therapy sessions with child and parent and joint parent-child sessions. Integrates standard behavior management and skills training for parents within the context of trauma-focused therapy for the child.
Type of service provider:
Therapist with a master’s degree or higher
Specialty trauma treatment clinics, usual care settings, community health settings, residential foster care setting, and homes. TF-CBT has been adapted for domestic violence shelters.
Length of program/number sessions:
12-16 weeks; sessions are 60 to 90 minutes long; TF-CBT adapted for domestic violence shelters is 8 sessions.
Type(s) of trauma addressed:
Sexual abuse, traumatic grief, domestic violence, disasters, terrorism, multiple traumatic events
TF-CBT has been adapted for and evaluated in the domestic violence shelter setting with women staying at the shelter and their children.
TF-CBT can be provided in a variety of settings including home, school, clinics, and residential settings. While the model ideally involves parents or caretakers in the treatment, it has been provided to children only when parents are unwilling or unable to participate.
An adaptation of TF-CBT has been developed for American Indian/Alaska Native children.
Information for this summary was abstracted from the NCTSN publication, Trauma-Informed Interventions: Clinical and Research Evidence and Culture-Specific Information Project and other publications.
Ethnic Racial Group:
Age range of children:
3 to 18 years old
Parent/adult caregiver included in intervention:
Ethnic/racial and other groups served:
Evaluated with African American and Latino/a children.
Specific cultural adaptations:
TF-CBT has been culturally adapted for Native American children, HIV-affected children in Zambia, sex-trafficked children in Cambodia, and traumatically bereaved children in Tanzania.
The Indian Country Child Trauma Center at the University of Oklahoma Health Sciences Center developed an American Indian and Alaska Native (AI/AN) adaptation of the TF-CBT called “Honoring Children, Mending the Circle” (HC-MC) which guides the therapeutic process through a blending of AI/AN traditional teachings with cognitive-behavioral methods (see reference below).
BigFoot DS & Schmidt SR. Honoring Children, Mending the Circle: Cultural adaptation of Trauma-Focused Cognitive-Behavioral Therapy for American Indian and Alaska Native Children. Journal of Clinical Psychology. 2010:66(8):847-856.
Manual has been translated into Dutch, German, Korean, Chinese (Mandarin). Japanese and Polish versions are in progress. Some instruments available in Spanish.
Integrates cognitive-behavioral interventions with trauma treatment. Components include:
- Psycho-education about childhood trauma and PTSD
- Parenting component including parent management skills
- Relaxation skills individualized to child and parent
- Affective modulation skills, cognitive coping, and trauma narrative
- Joint parent-child sessions
- Enhancing personal safety and social skills
A randomized controlled trail was conducted in a domestic violence shelter for children (45% White, 41% Black, 14% Biracial) with domestic violence exposure-related PTSD symptoms. Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or child-centered therapy (usual care) from shelter-based social workers. TF-CBT was shorted to 8 sessions (45-minutes in length) to accommodate the usual duration of treatment at the shelter. Revisions were made to the TF-CBT model to focus on how children could feel safer in the face of ongoing danger. Brief TF-CBT was more effective than child-centered therapy in improving children’s DV-related PTSD (driven by greater decreases in hyperarousal and avoidance symptoms) and anxiety. TF-CBT was also associated with fewer serious adverse effects compared to child-centered therapy.
Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence. Archives of Pediatric and Adolescent Medicine. 2011;165(1):16-21.
A series of other randomized controlled trials indicate that TF-CBT has been proven to be effective in improving PTSD, depression, anxiety, externalizing behaviors, sexualized behaviors, feelings of shame and mistrust among traumatized children and that the results are maintained over time.
The parenting component has demonstrated improvements in parents’ depression, emotional distress about their children’s victimization, supporting their children, and positive parenting practices.
Evaluation studies include:
Cohen JA, Mannarino AP, Knudsen K. Treating sexually abused children: One year follow-up of a randomized controlled trail. Child Abuse and Neglect. 2005; 29:135-145.
Cohen JA, Deblinger E, Mannarino AP. A multisite randomized controlled trail for multiply traumatized children with sexual abuse-related PTSD. Journal of the American Academy of Child and Adolescent Psychiatry. 2004;43(4):393-402.
Deblinger E, Stauffer LB, Steer RA. Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their non-offending mothers. Child Maltreatment. 2001; 6;332-343.
Cohen JA, Berliner L, Mannarino AP. Trauma-focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect. 2010;34;215-224.
Rated/Reviewed by Evidence Based Registries:
TF-CBT was rated or reviewed by the following registries:
NREPP: SAMSHA’s National Registry of Evidence-Based Programs and Practices
Promising Practices Network on Children, Families, and Communities
California Evidence-Based Clearinghouse for Child Welfare
Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases
OJJDP Model Programs Guide
National Child Traumatic Stress Network Empirically Supportive Treatments and Promising Practices
Dr. Judith Cohen; e-mail: email@example.com
Cohen JA, Mannarino AP, & Deblinger E. 2006. Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.
- Judy Cohen, MD
- Alleghany General Hospital