Cognitive behavioral therapy for trauma

Cognitive Behavioral Therapy (CBT) for Treatment of PTSD

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.

Introduction to CBT

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or group format.

This treatment is strongly recommended for the treatment of PTSD.

How CBT Can Help with PTSD

Several theories specific to trauma explain how CBT can be helpful in reducing the symptoms of PTSD.

For example, emotional processing theory (Rauch & Foa, 2006) suggests that those who have experienced a traumatic event can develop associations among objectively safe reminders of the event (e.g., news stories, situations, people), meaning (e.g., the world is dangerous) and responses (e.g., fear, numbing of feelings). Changing these associations that lead to unhealthy functioning is the core of emotional processing. 

Social cognitive theory (Benight & Bandura, 2004) suggests that those who try to incorporate the experience of trauma into existing beliefs about oneself, others, and the world often wind up with unhelpful understandings of their experience and perceptions of control of self or the environment (i.e., coping self-efficacy). For instance, if someone believes that bad things happen to bad people, being raped confirms that one is bad, not that one was unjustly violated.

Understanding these theories helps the therapist more effectively use cognitive behavioral treatment strategies.

Using CBT to Treat PTSD

Therapists use a variety of techniques to aid patients in reducing symptoms and improving functioning. Therapists employing CBT may encourage patients to re-evaluate their thinking patterns and assumptions in order to identify unhelpful patterns (often termed “distortions”) in thoughts, such as overgeneralizing bad outcomes, negative thinking that diminishes positive thinking, and always expecting catastrophic outcomes, to more balanced and effective thinking patterns. These are intended to help the person reconceptualize their understanding of traumatic experiences, as well as their understanding of themselves and their ability to cope. 

Exposure to the trauma narrative, as well as reminders of the trauma or emotions associated with the trauma, are often used to help the patient reduce avoidance and maladaptive associations with the trauma. Note, this exposure is done in a controlled way, and planned collaboratively by the provider and patient so the patient chooses what they do. The goal is to return a sense of control, self-confidence, and predictability to the patient, and reduce escape and avoidance behaviors.

Education about how trauma can affect the person is quite common as is instruction in various methods to facilitate relaxation. Managing stress and planning for potential crises can also be important components of CBT treatment. The provider, with the patient, has some latitude in selecting which elements of cognitive behavioral therapy are likely to be most effective with any particular individual. 

Case Example

Jill, a 32-year-old Afghanistan War veteran

Jill had been experiencing PTSD symptoms for more than five years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED). This case example explains how Jill's therapist used a cognitive worksheet as a starting point for engaging in Socratic dialogue.

For Patients & Families

What is Cognitive Behavioral Therapy?

CBT has been demonstrated to be effective for a range of problems including depression, anxiety disorders, and posttraumatic stress disorder. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

References & Resources

Journal Article

Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42(10), 1129–1148.


Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work. Washington, DC: American Psychological Association.


Ehlers, A. (2013). Trauma-focused cognitive behavior therapy for posttraumatic stress disorder and acute stress disorder. In Simos, G., & Hofmann, S. G. (eds). CBT for anxiety disorders: A practitioner book (pp. 161-190). New York, NY: Wiley.

Journal Article

Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD. Journal of Contemporary Psychotherapy, 36(2), 61-65. doi: 10.1007/s10879-006-9008-y


Grey, N. (Ed.) (2009). A casebook of cognitive therapy for traumatic stress reactions. Hove, UK: Routledge.

Updated July 31, 2017

Date created: March 2017

Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

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Trauma-focused Cognitive Behavioral Therapy

  • 5 external links
  • Description

    TF-CBT is a treatment model that includes various trauma-sensitive intervention components. [5] It aims to individualize TF-CBT techniques for children and their circumstances while maintaining a therapeutic relationship with both child and parent. [6] TF-CBT treatment may be used with children and adolescents who have experienced traumatic life events. This is a short-term treatment (usually 12-16 sessions) that combines trauma-sensitive interventions with cognitive behavioral therapy strategies. [7] It can also be used as part of a larger treatment plan for children with other problems. [8] TF-CBT includes individual sessions for both the child and parents, as well as joint sessions for parents and children.

    Core components of treatment

    Core components of TF-CBT include psychoeducation about childhood trauma and individual relaxation skills. The therapeutic elements of TF-CBT are abbreviated as "PRACTICE". [9]

    • Psychological education and parental skills
    • Relaxation
    • Pressive expression and regulation
    • Cognitive copying
    • Development and processing of injury
    • Gradual impact in vivo
    • joint parent-free sessions and dosage seniorly.

    Children's sessions

    During children's therapy sessions, the therapist focuses on relaxation training such as deep breathing and muscle relaxation skills, emotion regulation (sensing feelings), trauma storytelling and processing (talking about overwhelming events and related feelings). ), as well as cognitive coping strategies (identifying and eliminating negative thoughts). [10]

    Parent sessions

    Parents or primary caregivers are considered the main therapeutic agents to improve TF-CBT. [11] During parenting sessions, the therapist discusses the appropriateness of treatment and safety plans with parents and encourages positive parenting skills to maximize parenting. [12]

    Parent-Child Joint Sessions

    During joint sessions, the therapist shares trauma stories and counters wrong/negative thoughts as a means of encouraging and facilitating parent-child communication. The therapist will intervene only when inaccurate cognitions are unresolved. [13]

    Group sessions

    Group TF-CBT is an alternative to individual TF-CBT that reduces individual therapist hours and provides care after natural disasters or in under-resourced areas. [14] Similar to the individual TF-CBT, the group TF-CBT includes both the child and the caregiver and uses elements of "PRACTICE", which are usually conducted in 12 structured sessions designed to reduce stress and feelings of shame. [15]

    Efficacy Evaluation

    Randomized clinical trials examining the efficacy of CBT-TF have shown it to be an effective treatment plan for a variety of disorders in both children and adolescents. [16] [17] TF-CBT has been shown to be effective in reducing symptoms of post-traumatic stress disorder, depression, anxiety, externalizing behavior, sexualized behavior and shame in traumatized children. [18] TF-CBT has been shown to improve positive parenting skills and child support by improving parent-child communication. [19] A study investigating the combinatorial effect of TF-CBT with sertraline found that adding sertraline to treatment provided only minimal benefits, suggesting an initial pre-drug trial of TF-CBT. [20]

    Although TF-CBT has been found to be as effective as Eye Movement Desensitization and Processing (EMDR) for the treatment of chronic post-traumatic stress disorder (PTSD) in adults, the results were preliminary given the small number of studies, high dropout rate and high risk of experimenter bias. [21]

    Access Methods


    TF-CBT can be administered by a variety of mental health professionals, from clinical social workers, counselors to psychologists and psychiatrists. [22] Qualified therapists must be registered or nationally certified with the TF-CBT. Part of the training for this treatment includes an online TF-CBT certified training course. [23] Additional criteria are required for a doctor to be listed or nationally certified. [24]

    Implementation and adaptations

    Since its inception in the 1980s, TF-CBT has been used by therapists in many countries such as Australia, Cambodia, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Pakistan, Sweden, USA and Zambia. [25] It has also been used with children in foster care, those affected by traumatic life events, including the September 11 terrorist attacks, and survivors of Hurricane Katrina. 9 Trauma Based Cognitive Behavioral Therapy (TF-CBT). Retrieved April 20, 2014.

    external links

    • show/NCT00614068

    Why CBT is not good for dealing with childhood/complex trauma: transurfer — LiveJournal

    Very simplistic, what is complex trauma? This is a consequence of when for a long time a person faced traumatic events that exceeded the ability of his psyche to digest these events. This is the inability of the psyche to cope with extreme events and this is the lack of the necessary support from the outside, which would help this psyche.

    By extraordinary events, we mean not only natural and technical disasters and military operations, but also repeated physical and sexual abuse, as well as emotional, verbal abuse and negligence that a child encounters at an early age (here we can mention families of alcoholics and drug addicts, families with mentally ill relatives and just families where the toxicity of all members goes off scale).

    The main consequence of trauma is the alienation of a person from his FEELINGS. In extraordinary events, a person’s feelings are also extraordinary. In the absence of the ability to digest feelings of such strength (and children do not have such a skill) and in the absence of support (adults should help and teach the child to live these feelings without fear), a person cannot cope with the emotional load and suppresses and modifies these feelings with the help of those psychological defenses which are closest to his temperament and mental characteristics.

    [ read more ]The most common defenses against trauma include all subtypes of acting out, intellectual and dissociative defenses. "Since I can't deal with terror through feelings, I will cut off all feelings and devalue them and try to deal with them through action and intellect." Obsessive-compulsive people run from their feelings through obsessive thoughts and actions, addicted people resort to alcohol, drugs and overeating, hysterical people fuss chaotically, schizoid people generally live only in the head.

    Essentially what a traumatized person does is force them to use a cognitive-behavioral strategy to deal with unbearable feelings and to remove them from consciousness. You know what I'm getting at, right? Appeal to the cognitive-behavioral abilities of a person when working through trauma is, in essence, repeating and strengthening those coping strategies that he already has and which he already has overdeveloped.

    What is not developed in a person with an injury? The ability to feel, the ability to differentiate feelings and the ability to live these feelings without being destroyed and without resorting to overwhelming defenses.

    A traumatized person will have many frozen and unexpressed feelings that need to be thawed piece by piece and appropriated through direct living in the presence of a supportive person. Thus, the competent and empathic therapist temporarily assumes the role of a resilient adult who (as a parent) contains the client's difficult feelings, giving them a place to be without any evaluation or intellectualization.

    So how does that help? What is the point of reopening old wounds and drowning in tears?

    It helps in this way:
    - an affect is discharged, it is lived through, ends and loses its power
    - due to the fact that the affect is discharged and the feeling is appropriated, the need to spend energy on suppressing this feeling disappears (here the client’s bodily and mental symptoms, for example, panic attacks or obsessive thoughts may stop, and there may be more physical strength)
    - but the most important thing that happens through living and appropriating feelings is building a more holistic picture of yourself and a more holistic and continuous picture of your life: in my life there was this and this, and then I felt this and this, I can be both this and that, depending on the situation, I am no longer fragmented, now I am whole and accept myself with all my feelings, reactions and experiences (respect for all your feelings -> respect and love for yourself -> whole stable personality)

    Accordingly, for a person with a complex trauma, methods of psychological assistance are most suitable, where much attention is paid to childhood experience and work with feelings.

    This article factual accuracy is disputed . A related discussion can be found on the talk page. Please help ensure that the disputed claims are a reliable source. (July 2019) (Learn how and when to remove this message template)0010 ( TF-CBT ) is an evidence-based psychotherapy or counseling session that addresses the needs of children and adolescents with post-traumatic stress disorder (PTSD) and other difficulties associated with traumatic life events. [1] The purpose of TF-CBT is to provide psychoeducation to both the child and caregivers who are not at fault, and to help them recognize and deal with emotions, thoughts, and behaviors. Studies have shown that TF-CBT is effective in treating PTSD in children and in children who have experienced traumatic events. [2] [3] [4]


    • 1 Description
      • 1.1 The main components of treatment
      • 1.2 sessions for children
      • 1.3 sessions for parents
      • 1.4 joint sessions of the parent. child
      • 1.5 Group sessions
    • 2 Performance evaluation
    • 3 Methods of access
      • 3.1 Therapist
      • 3.2 Implementation and adaptations

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