Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a therapeutic intervention for families with a child aged between 3 and 18 years old who has been exposed to a traumatic event, including child maltreatment and domestic abuse. TF-CBT is delivered by therapists through 12 to 18 sessions to children individually or to children and their parents together. During these sessions, family members learn cognitive strategies for managing negative emotions and beliefs stemming from highly distressing and/or abusive experiences.
The information above is as offered/supported by the intervention provider.
7 to 18 years old
Individual
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a therapeutic intervention for children and families who have been exposed to a traumatic event.
TF-CBT is delivered by a single therapist to parents and their children via 12 to 16 weekly sessions depending on the severity of the child’s symptoms and the family’s needs.
During the initial phases of the therapy, the therapist works individually with the parents and child to establish a trusting therapeutic relationship that, in turn, provides the context in which difficult experiences and emotions can be discussed.
Within this safe therapeutic environment, the child learns to manage a variety of negative feelings and behaviours, including reoccurring and intrusive thoughts, difficulty sleeping or concentrating, depression, anxiety, and negative and/or aggressive behaviour.
The parent sessions provide parents with strategies for managing any stress or anxiety they may experience, as well as strategies for communicating with their child and managing their child’s behaviour. Parents also receive homework assignments to practise concepts covered during treatment at home with their children.
The joint parent–child sessions are designed to help parents and children practise and use the skills they learned and for the child to share the trauma narrative while also fostering effective parent–child interaction.
TF-CBT can also be delivered individually with the child when it is not possible to work with the parents or other caregivers.
TF-CBT is typically delivered individually to parents and their children. TF-CBT may also be provided in groups; however, the evidence presented here reflects delivery of TF-CBT on an individual therapy format.
3 to 18 years old
Children and families who have been exposed to a traumatic event.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Unresolved emotions stemming from traumatic experiences in childhood and adolescence
Increases the risk of physical and mental health problems occurring in adulthood.
Science-based assumption
The re-examination of traumatic events within a psychologically safe, therapeutic environment can help children process and manage difficult emotions associated with traumatic events
Supportive parenting practices further helps children process the difficult emotions associated with traumatic experiences.
Science-based assumption
Children and families who have been exposed to a traumatic event.
Intervention
TF-CBT aims to create an emotionally supportive environment in which children and their parents learn cognitive strategies for managing the difficult emotions that arise from a traumatic event.
Short-term
Parents are better able to support the needs of their child
Family relationships improve
Children are better able to manage the negative feelings associated with traumatic experiences.
Medium-term
Children are better able to manage their emotions
Children have fewer behavioural problems.
Long-term
Children experience greater emotional wellbeing and improved mental health as they develop.
Children and families who have been exposed to a traumatic event.
TF-CBT is delivered to parents and their children via 12 to 16 weekly sessions depending on the severity of the child’s symptoms and the family’s needs.
Parents and their children attend separate 30- to 45-minute sessions during which they engage in parallel educational, skill-building, and trauma-processing activities.
Parents and their children attend conjoint sessions together (10 to 40 minutes) to practise skills and enhance general and trauma-related communication as needed.
TF-CBT can also be delivered individually with the child when it is not possible to work with the parents or other caregivers.
During the initial phases of the therapy, the therapist works individually with the parents and child to establish a trusting therapeutic relationship that, in turn, provides the context in which difficult experiences and emotions can be discussed.
See the model description for further details.
The practitioner who delivers this intervention typically has a master’s qualification or higher in a mental health profession, such as psychology, family therapy, or social work.
The practitioner has 10 hours of intervention training. Booster training of practitioners is recommended.
The mental health professional receives a minimum of two days’ face-to-face training with a minimum of 12 hours of case consultation during implementation.
It is recommended that practitioners are supervised by one host-agency supervisor, with the same level of intervention training as practitioners, for one hour per week.
Intervention fidelity is maintained through the following processes:
Organisation: Trauma Focused CBT
Email address: tfcbt@musc.edu
Websites: www.musc.edu/tfcbt
www.tfcbt.org
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
TF-CBT qualifies for a Level 3+ rating, as it has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.
The first study was conducted in the United States and has evidence consistent with Foundations’ Level 3 evidence strength criteria. This study observed statistically significant improvements in TF-CBT parents’ reports of their children’s symptoms of PTSD and depression three months post-treatment in comparison to families not receiving the intervention.
The second study was also conducted in the United States and has evidence consistent with Foundations’ Level 2+ criteria. This study observed statistically significant improvements in TF-CBT parents’ reports of their children’s symptoms of PTSD and anxiety in comparison to parents whose children did not receive TF-CBT.
A third study was conducted in Norway and has evidence consistent with Foundations’ Level 2+ evidence strength criteria. This study observed statistically significant improvements in diagnostic assessments of TF-CBT children’s symptoms of PTSD immediately after intervention completion compared to children not receiving the intervention. Additionally, this study observed significant improvements in TF-CBT children’s self-reported anxiety symptoms compared to children not receiving the intervention.
A fourth study was conducted in Germany and has evidence consistent with Foundations’ Level 2+ evidence strength criteria. This study observed statistically significant improvements in independent assessments of TF-CBT children’s psychological functioning compared to children not receiving the intervention. These assessments were confirmed by TF-CBT children’s self-reports of PTSD symptoms, as well as their reports of depression, anxiety and cognitive distortions. TF-CBT parents also reported improvements in their child’s behaviour compared to parents not receiving the intervention.
TF-CBT can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
Reduced PTSD
3 months later
Improvement index
Interpretation
Study
Reduced PTSD
Improvement index
Interpretation
Study
Reduced depression
Improvement index
Interpretation
Study
Reduced depression
Improvement index
Interpretation
Study
Improved daily functioning
Improvement index
Interpretation
Study
Improved psychological functioning
Improvement index
Interpretation
Study
Improved cognitive distortions
Improvement index
Interpretation
Study
Reduced PTSD symptoms
Improvement index
Interpretation
Study
Reduced anxiety
Improvement index
Interpretation
Study
Improved behaviour
Improvement index
Interpretation
Study
| Identified in search | 26 |
| Studies reviewed | 5 |
| Meeting the L2 threshold | 1 |
| Meeting the L3 threshold | 1 |
| Contributing to the L4 threshold | 1 |
| Ineligible | 21 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 100 children aged 7 to 13 years old with experience of sexual abuse and PTSD and their parents. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | None reported |
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 3 |
| Citations | Deblinger, E., Lippmann, J. & Steer, R. (1996) Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment. 1 (4), 310–321. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 124 children aged 7 to 14 years old with intimate partner violence (IPV)-related post-traumatic stress disorder (PTSD) symptoms |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing | Post-intervention |
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 2+ |
| Citations | Cohen, J. A., Mannarino, A. P. & Iyengar, S. (2011) Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine. 165 (1), 16–21. |
| Study design | RCT |
| Country | Norway |
| Sample characteristics | 156 children aged 10 to 18 years old who have experienced at least one traumatising event and suffered from significant PTSD reactions. |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 2+ |
| Citations | Jensen, T. K., Holt, T., Silje, M., Ormhaug, K. E., et al. (2013) A randomized effectiveness study comparing Trauma-Focused Cognitive Behavioral Therapy with therapy as usual for youth. Journal of Clinical Child & Adolescent Psychology. 43 (3), 356–369. |
| Study design | RCT |
| Country | Germany |
| Sample characteristics | 159 children aged 7 to 17 years old with PTSD symptoms. |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 2+ |
| Citations | Goldbeck, L., Muche, R., Sachser, C., Tutus, D. & Rosner, R. (2016) Effectiveness of Trauma-Focused Cognitive Behavioral Therapy for children and adolescents: A randomized controlled trial in eight German mental health clinics. Psychotherapy and Psychomatics. 16, 159–170. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Cohen, J. A. & Mannarino, A. P. (1996) A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child & Adolescent Psychiatry. 35 (1), 42-50.
Cohen, J. A. & Mannarino, A. P. (1996) Factors that mediate treatment outcome of sexually abused preschool children. Journal of the American Academy of Child & Adolescent Psychiatry. 35 (10), 1402–1410.
Cohen, J. A. & Mannarino, A. P. (1997) A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child & Adolescent Psychiatry. 36 (9), 1228–1235.3.
Cohen, J. A. & Mannarino, A. P. (1998) Factors that mediate treatment outcome of sexually abused preschool children: Six- and 12-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry. 37 (1), 44–51.
Cohen, J. A. & Mannarino, A. P. (1998) Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children. 3 (1), 17–26.
Cohen, J. A., Mannarino, A. P., Jankowski, K., Rosenberg, S., Kodya, S. & Wolford II, G. L. (2016) A randomized implementation study of Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Teens in Residential Treatment Facilities. Child Maltreatment. 21 (2), 156–67.
Cohen, J. A., Mannarino, A. P., Perel, M.D. & Staron, V. (2007) A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry. 46, 811–819.
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K. & Steer, R. A. (2011) Trauma-focused Cognitive Behavioral Therapy for Children: Impact of the trauma narrative and treatment length. Depression and Anxiety. 28, 67–75.
Deblinger, E., Stauffer, L. & Steer, R. (2001) Comparative efficacies of supportive and cognitive behavioral group therapies for children who were sexually abused and their nonoffending mothers. Child Maltreatment. 6 (4), 332–343.
Deblinger, E., Steer, R. A. & Lippmann, J. (1999) Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse & Neglect. 23 (12), 1371–1378.
Diehle, J., Opmeer, B. C., Boer, F., Mannarino, A. P. & Lindauer, R. J. L. (2014) Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. European Child & Adolescent Psychiatry. 24 (2).
Dorsey, S., Kerns, S. E., Trupin, E., Conover, K. A. & Berliner, L. (2012) Child welfare social workers as service brokers for youth in foster care: Findings from Project Focus. Child Maltreatment. 17 (1), 22–31.
Dorsey, S., Pullmann, M. D., Berliner, L., Koschmann, E., McKay, M. & Deblinger, E. (2014) Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies. Child Abuse and Neglect. 38, 1508–1520.
Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., et al. (2010) Children’s mental health care following Hurricane Katrina: A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress. 23, 223-231.
King, N. J., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., Martin, R. & Ollendick, T. H. (2000) Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry. 39 (11), 1347–1355.
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K. & Steer, R. A. (2012) Trauma-focused Cognitive Behavioral Therapy for children sustained impact of treatment 6 – 12 months later. Child Maltreatment. 17 (3) 231–241.
McMullen, J., O’Callaghan, P., Shannon, C., Black, A. & Eskin, J. (2013) Group Trauma-focused Cognitive-Behavioural Therapy with former child soldiers and other war-affected boys in the DR Congo: A randomized controlled trial. Journal of Child Psychology and Psychiatry. 54 (11).
Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., Michalopoulos, L. T., Imasiku, M. & Bolton, P. A. (2015) Effectiveness of Trauma-Focused Cognitive Behavioral Therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial,’ JAMA Pediatrics. 169 (8), 761–769 .
O’Callaghan, P., McMullen, J., Shannon, C. , Rafferty, H., Black, A. (2013) A randomized controlled trial of Trauma-focused Cognitive Behavioral Therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry. 52 (4), 359–369.
Salloum, A., Small, B. J., Robst, J., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2015) Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice. 27 (6).
Salloum, A., Wang, W., Robst, J., Murphy, T. K., Scheeringa, M. S., Cohen, J. A. & Storch, E. A. (2015) Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. Journal of Child Psychology and Psychiatry. 57 (5), 614–622.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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