Trauma Focused Cognitive Behavioral Therapy

Therapists use trauma-focused cognitive behavioral therapy (TF-CBT) to help youth overcome the negative effects of trauma. The goal of TF-CBT is to provide psychoeducation to both the child and parents. The therapist teaches their patient healthier ways to cope with the emotions, thoughts, and behaviors that come from their trauma. The core components of TF-CBT come in the acronym PRACTICE.

Psychoeducation and Parenting Skills

In the first component of PRACTICE, the therapist goes over behavioral problems that trauma victims often have. This ensures the child and parents that their reactions are normal and understandable. The point of psychoeducation is to let the child and parents know that there is hope for recovery. Therapists also go over some parenting skills that will optimize the child’s emotional and behavioral adjustment.

Relaxation Techniques

The therapist teaches the child different relaxation techniques that will help them control the negative physiological effects that come from trauma triggers. Some relaxation skills include focused breathing, mindfulness, progressive muscle relaxation, and exercise.

Affective Regulation Skills

The therapists teach affective regulation skills to help their patient to identify, modulate, and regulate upsetting affective states that may arise. Some examples of affect regulation skills include problem-solving, anger management, present focus, obtaining social support, and positive distraction activities.

Cognitive Coping

The therapist teaches their patient to recognize the connections between their thoughts, feelings, and behaviors. The therapist teaches their patient to replace their harmful or unhelpful thoughts with more accurate and helpful ones.

Trauma Narrative

In this phase, the therapist walks the child through creating a trauma narrative. A trauma narrative is the child’s telling of the story of their traumatic experience. Telling their story is often difficult. To ease the patient into telling their story, the therapist will often begin by having the child focus on the facts, like the who, what, when, and where of the traumatic experience. From there, the child can describe their thoughts and feelings. After that, the child can talk about the most disturbing moments of their trauma. To end the narrative, the child can talk about how they feel now, what they have learned, and if they have grown from the experience. Creating a trauma narrative is important in helping the child process their experience and heal.

In Vivo Mastery of Trauma Reminders

Trauma reminders are stimuli the child may experience in their everyday life that can bring up intense, painful, and debilitating memories of their trauma. Sometimes these reminders skip the memories entirely and send the child straight into the physiological arousal that thinking about the trauma would provoke (causing the child to hyperventilate without knowing exactly why, for example). In the in vivo mastery of trauma reminders component, the therapist develops a hierarchy of reminders with the child and works with them to gradually master feared stimuli, working from least feared to most feared.

Conjoint Parent-Child Sessions

In the joint parent-child sessions, families plan for continued healing and growth. This is where the child can share their trauma narrative with their parents. The child and parents can talk about how they can improve their communication both about the trauma and in general. In these sessions, parents can address healthy sexuality and develop a family safety plan for potential future threats (things like bullying, drugs, and domestic violence).

Enhancing Safety and Future Development

This component is about taking the positive skills and insights gained through therapy and applying them to family life going forward. Families can come up with plans to deal with the stressors and trauma reminders that will arise in the future.