Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed by Drs. Judith Cohen, Anthony Mannarino, and Esther Deblinger in 2006 (Treating Trauma & Traumatic Grief in Children & Adolescents. Guilford Press ). It is a structured and evidence-based therapeutic approach specifically designed to address the psychological needs of children and adolescents who have experienced trauma. It integrates principles of cognitive-behavioral therapy (CBT) with techniques to address trauma-related symptoms and reactions. TF-CBT is delivered over a course of 15 to 30 sessions and involves collaboration between the child, caregiver(s), and therapist. The anacronym PRACTICE describes the fundamental components of TF-CBT and includes the following.

1. Psychoeducation: The therapist provides education about trauma, its impact on the brain and body, and common reactions to traumatic experiences. Both the child and caregiver(s) learn about the goals and structure of TF-CBT.

2. Relaxation and Coping Skills: Children are taught relaxation techniques such as deep breathing, progressive muscle relaxation, or mindfulness exercises to help manage stress and anxiety symptoms that they experience in their life and will inevitably encounter during the course of therapy.

3. Affective Awareness & Modulation: The youth is taught how to recognize, routinely monitor and verbalize their feelings. In addition, they are taught methods to calm distressful feelings using their relaxation and coping skills.

4. Cognitive Coping: Children learn to identify and challenge unhelpful or distorted thoughts related to traumatic event(s). They explore alternative ways of thinking that are more adaptive and accurate.

5. Trauma Narrative: The “Trauma Narrative” is a “prolonged exposure” technique designed to help the child overcome the tendency to avoid thoughts and feelings regarding the trauma and to help the youth process the trauma in a productive manner. Children are guided in creating a narrative of their traumatic experiences, using drawings, chapter book writing, or verbal storytelling. This helps them process and make sense of their memories in a structured and supportive environment.

6. In Vivo Mastery of Trauma Reminders: Children practice approaching trauma reminders or triggers in real life with the support and guidance of their caregiver(s) and therapist. This helps them develop skills to reduce their behavioral avoidance of trauma related triggers and build confidence in their ability to cope with distressing situations.

7. Conjoint Child-Parent Sessions: The parent-child relationship is often negatively impacted as a result of the child’s trauma. Conjoint child-parent sessions are offered to help the child and parent process the trauma and its impact on their relationship and their respective lives. The child may share their Trauma Narrative with the parent if the parent is assessed as capable of providing empathic validation of the youth’s trauma experience.

8. Enhancing Safety & Future Developmental Trajectory: Children learn skills to enhance their sense of safety and self-protection. This may include assertiveness training, boundary setting, and safety planning.

David M. Pratt, Ph.D., MSW

University at Buffalo Training Faculty, School of Social Work, Office of Continuing Education

For further training on TF-CBT & treating youth who have experienced trauma, use the link below to register for my training “Evidenced Based Treatment of Trauma & PTSD with Youth”, on March 21, 2025.

Published 12/17/24