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Trauma-Focused Cognitive Behavioral Therapy



Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a treatment intervention designed to help 3- to 18-year-olds and their parents overcome the negative effects of traumatic life events such as child sexual or physical abuse. TF-CBT was created for young people who have developed significant emotional or behavioral difficulties following exposure to a traumatic event (e.g., loss of a loved one, physical abuse, domestic or community violence, motor vehicle accidents, fires, tornadoes, hurricanes, industrial accidents, terrorist attacks). The program targets boys and girls from all socioeconomic backgrounds, in a variety of settings, and from diverse ethnic groups. It has been adapted for Hispanic/Latino children.

TF-CBT was developed by integrating cognitive and behavioral interventions with traditional child abuse therapies to help children talk directly about their traumatic experiences in a supportive environment. The program operates through the use of a parental treatment component and several child-parent sessions. The parent component teaches parents effective parenting skills to provide optimal support for their children. The parent-child session encourages children to discuss the traumatic events directly with the parent, and both parent and child learn to communicate questions, concerns, and feelings more openly.

In one study, children in the treatment group showed significantly more improvement in their Post-Traumatic Stress Disorder (PTSD) symptoms (reexperiencing, avoidance, and hyper-arousal) than their counterparts in the control group. Their parents also showed greater improvement (than the control parents) in their own self-reported levels of depression, abuse-specific distress, support of the children, and effective parenting practice.

These findings confirm the results of numerous earlier (and smaller) studies, which have repeatedly demonstrated TF-CBT’s efficacy in reducing multiple PTSD symptoms in abused children and their parents. In general, randomized controlled trials have found that, compared with children who received supportive therapy, children who received TF-CBT:

  • Had significantly less acting-out behavior.
  • Had significantly reduced PTSD symptoms.
  • Had significantly greater improvement in depressive symptoms.
  • Had significantly greater improvement in social competence.
  • Maintained these differential improvements over the year after treatment ended.

In recent studies, TF-CBT has been evaluated for children experiencing PTSD symptoms related to traumatic grief and terrorism. TF-CBT showed promising effectiveness in reducing PTSD symptoms for these children as well.

Risk Factors


Antisocial/delinquent beliefs

Conduct disorders (authority conflict/rebellious/stubborn/disruptive/antisocial)

Developmental trauma exposure

Early and persistent noncompliant behavior

Early onset of aggression/violence

General delinquency involvement

High alcohol/drug use


Life stressors

Medical/physical condition

Mental health problems

Physical violence/aggression

Poor refusal skills

Victim of child maltreatment

Victimization and exposure to violence

Violent victimization


Abusive parents

Antisocial parents

Broken home/changes in caretaker

Child maltreatment (abuse or neglect)

Family history of problem behavior/criminal involvement

Family violence (child maltreatment, partner violence, conflict)

Having a teenage mother

High parental stress/maternal depression

Lack of orderly and structured activities within the family

Low parental attachment to child/adolescent

Parental use of physical punishment/harsh and/or erratic discipline practices

Poor parental supervision (control, monitoring, and child management)

Poor parent-child relations or communication

Unhappy parents


Low achievement in school

Poor school attitude/performance; academic failure


Availability of firearms

Community disorganization

Economic deprivation/poverty/residence in a disadvantaged neighborhood

Exposure to violence and racial prejudice

High-crime neighborhood

Low neighborhood attachment


Crime Solutions: Effective


Dr. Judith A. Cohen
Professor of Psychiatry; Medical Director
Allegheny General Hospital, Center for Traumatic Stress in Children and Adolescents
4 Allegheny Center, 8th Floor
Pittsburgh, PA 15212
Phone: (412) 330-4321
Fax: (412) 330-4377
Web site: https://www.ahn.org/specialties/mental-health/ctsca


Cohen, J. A., and Mannarino. A. P. (1996). “A Treatment Outcome Study for Sexually Abused Preschool Children: Initial Findings.” Journal of the American Academy of Child and Adolescent Psychiatry, 35(1):42–43.

———. (1997). “A Treatment Study for Sexually Abused Preschool Children: Outcome During a One-Year Follow-Up.” Journal of the American Academy of Child and Adolescent Psychiatry, 36(9):1228–36.

———. (1998). “Interventions for Sexually Abused Children: Initial Treatment Outcome Findings.” Child Maltreatment, 3(1):17–27.

Cohen, J. A.; Mannarino, A. P.; Berliner, L.; and Deblinger, E. (2000). “Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: An Empirical Update.” Journal of Interpersonal Violence, 15(11):1202–24.

Cohen, J. A.; Deblinger, E.; Mannarino, A. P.; and Steer, R. A. (2004). “A Multisite Randomized Trial for Children With Sexual Abuse-Related PTSD Symptoms.” Journal of the American Academy of Child and Adolescent Psychiatry 43:393–402.

Cohen, J. A.; Mannarino, A. P.; and Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. Treatment Manual. New York: Guilford Press.

Cohen, J. A.; Mannarino, A. P.; and Knudsen, K. (2004). “Treating Childhood Traumatic Grief: A Pilot Study.” Journal of the American Academy of Child and Adolescent Psychiatry, 43:1225–33.

Cohen, J. A.; Mannarino, A. P.; and Staron, V. R. (2006). “A Pilot Study of Modified Cognitive Behavioral Therapy for Childhood Traumatic Grief (CBT-CTG).” Journal of the American Academy of Child and Adolescent Psychiatry, 43:1465–73.

Cohen, J. A., Mannarino, A. P.; and Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: Guilford Press.

Kliethermes, M., and Murray, L.A. (2012). Trauma-Focused CBT for Youth with Complex Trauma. Child Abuse & Neglect, 36, 528–41.

Date Created: April 7, 2021