Trauma-Focused CBT Techniques for Therapists

The trauma-focused CBT (Cognitive Behavioral Therapy) approach to psychotherapy was first developed by Judith Cohen in the 1990s. Designed to help children and adolescents work through trauma experiences, TF-CBT has been adopted and is practiced by mental health organizations all over the world. 

What is Trauma-Focused Cognitive Based Therapy and When is It Used? 

Trauma-Focused Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for children and adolescents that have been impacted by trauma and their parents or caregivers. It is a flexible component-based model that offers children and their caregiver’s skills to navigate stress, engage in discussion, and work through the processing of a child’s traumatic experiences. 

The original intention of trauma-focused CBT was to help children and adolescents who had experienced sexual abuse. Now, this approach is applied to a broader umbrella of youths including children and adolescents who have experienced any form of trauma or abuse. 

For children, trauma at a young age can have a huge impact on their perspective of the world, themselves, and those around them as they age. Early trauma can cause feelings of guilt, anger, and powerlessness. It can also lead to other issues like adult depression, PTSD, anxiety, as well as other mental health or even medical issues. 

Providers are using trauma-focused CBT to help children and adolescents avoid these issues as their minds and bodies continue to develop. 

Trauma-Focused CBT Components: 

Psychoeducation 

Once the decision has been reached between a child and their caregiver that trauma-focused CBT is the best approach for their needs, the first step is psychoeducation. This is the process of educating the family about what is ahead of them. At the first session, therapists should use this time to inform the caregivers about their role, the child’s role, the child’s symptoms, and the treatment plan. Psychoeducation should continue as each part of the treatment plan is unveiled. 

Parenting Component 

A parallel session should be held with parents to help them adjust and optimize their parenting skills to the needs of the child. For parents that are unfamiliar with healthy parenting skills, child trauma can exacerbate their ill-equipped skill set. Therapists should use trauma-focused CBT to review basic parenting skills and contingency plans for reinforcing the child’s care. 

Relaxation Skills 

Tailored to the needs of each specific family, relaxation sills with trauma-focused CBT are meant to reverse psychological changes that have occurred within the child due to their trauma. This is the process of teaching a child how to have ownership over their experiences and manage stress with effective strategies. This might include breathing techniques, mindfulness exercises, focusing their energy constructively, (hobbies, interests, etc.) and more. 

Affective Modulation Skills 

Affective modulation skills are a component of trauma-focused CBT that focuses on improving a child’s emotional expression. The first step is to identify where the child might be struggling. Then, the therapist will help the client and their caregiver by giving them tools to strengthen these skills, encouraging them to practice. 

Cognitive Coping Skills 

Cognitive coping skills involve the recognizing of connections between thoughts, feelings, and behaviors in everyday situations. This is a time in trauma-focused CBT that therapists should encourage children and their caregivers to identify upsetting situations and tie them to behaviors, thoughts, and feelings surrounding that event. This part of trauma-focused CBT is meant to teach the family that they have control over their thoughts, feelings, and behaviors even when they feel out of control. 

Processing Trauma Experiences 

This component of trauma-focused CBT involves the therapist helping the child develop a trauma narrative or the telling of the story of what took place. This should be a written or creative exercise in which the purpose is to stop avoiding the memories around the event, identify distortions, and relate the child’s trauma to the rest of their life. This can be reviewed and used in later trauma-focused CBT sessions to help the child process their trauma. 

In Vivo Mastery of Trauma Reminders 

In vivo mastery of trauma is the process of helping children avoid generalized trauma reminders. This might include a child avoiding spaces that remind them of their trauma. It follows that same practice of other graduated exposure programs. 

Conjoint Child-Parent Sessions 

While the parent and child both benefit from parallel individual sessions, conjoint sessions are also a critical part of the trauma-focused CBT approach. This is the time that children and caregivers get to share and connect the experience together. This helps with healthy discussion and coping techniques down the road. 

Safety and Developmental Trajectory 

This component of trauma-focused CBT helps a child identify and establish safety behaviors for the future. This might include the identification and communication of abuse in the future. 

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