Trauma-focused CBT(TF-CBT)

This is a type of CBT specifically developed for people with post-traumatic stress disorder (PTSD) that focuses on the memories of trauma; and the negative thoughts and behaviours associated with such memories. In trauma-focused CBT, the treatment concentrates specifically on the memories, thoughts and feelings that a person has about the traumatic event.

NICE (2005) defines PTSD the psychological and physical problems that can sometimes follow particular threatening or distressing events.

These events might include:

  • a major disaster
  • war
  • rape or sexual, physical or emotional abuse
  • witnessing a violent death
  • a serious accident
  • traumatic childbirth
  • other situations in which a person was very afraid, horrified, helpless, or felt life was in danger

The trauma can be a single event or a series of events taking place over many months or even years. TF-CBT is also utilised for children/adolescents suffering trauma following sexual abuse.

Key Aspects of TF-CBT
The structure and content of the intervention is based on CBT principles with a clear focus on the traumatic event that led to the disorder. TF- CBT in the context of PTSD will entail education about common reactions to trauma, relaxation training, and identification and modification of cognitive distortions. In addition TF-CBT will involve imaginal reliving/exposure to the trauma memory, graduated exposure to avoided situations and trauma re-experiences, exposure to trauma reminders, cognitive restructuring, and rescripting/imagery rescripting.

In addition, as noted, TF-CBT is utilised for children/adolescents suffering trauma following sexual abuse. The specific components of TF-CBT in this context are psychoeducation, parenting skills advice, relaxation, affective expression and modulation, cognitive coping, trauma narration (in which children describe their personal traumatic experiences), mastery of trauma reminders (used to help children overcome avoidance of situations that are no longer dangerous, but which remind them of the original trauma), conjoint child-parent sessions help the child and parent talk to each other. The final phase of the treatment looks to enhance future safety and development, addresses safety and helps the child to regain developmental momentum.

What does a course of TF-CBT consist of?
Initial sessions of TF-CBT will focus on a thorough assessment of problems, the trauma, orientation to the CBT model of trauma and the agreement of goals between the therapist and client. In essence the therapist will then encourage the individual to gradually recall and think about the trauma. This can be done in various ways including listening to recordings of an account of the trauma. The individual is given techniques to cope with any emotional distress and behavioural problems that may arise during treatment.

As the painful and traumatic memories begin to decrease, the individual is encouraged and aided to start activities that have been avoiding since the trauma, such avoiding a certain area of town if an individual was assaulted there.

In TF-CBT for children/adolescents a similar approach is taken but with (if appropriate) involvement of the parent.

Who is TF-CBT for?
TF-CBT is a type of CBT specifically developed for people with post-traumatic stress disorder (PTSD). This includes children/adolescents whom have experienced sexual abuse.

What is the evidence?
Research reveals that TF-CBT is effective for symptoms of post-traumatic stress disorder (PTSD). The National Institute for Health and Care Excellence (NICE, 2005) recommends TF-CBT for PTSD. TF-CBT is also an effective treatment for children and adolescents with a variety of trauma-related difficulties. It also offers demonstrated benefits for the parents of these children.

How many TF-CBT sessions will I need?
The number of sessions you require will depend largely on the presenting issues, the nature of the trauma and the complexity of the problem. It is also worth noting that people may find commencing TF-CBT difficult as it requires the individual to expose themselves (in a supported manner) to distressing memories. As such an eagerness to make changes and complete the home work tasks set by the therapist will inevitably improve the speed of recovery. Your therapist will be in the best position to gauge how many session you require, but this may also change throughout therapy. NICE (2005) state that Sessions should take place at regular intervals (usually at least once a week if an individual has developed PTSD recently). NICE (2005) recommends 8 to 12 sessions for a single trauma.

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