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What is trauma-focused cognitive-behavioural therapy?

We introduce Trauma-Focused Cognitive-Behavioural Therapy, and how negative cognitions can be challenged to improve mental health.
A man attending a therapy session.
© University of Glasgow

What is trauma-focused cognitive-behavioural therapy?

Trauma-focused cognitive-behavioural therapy (TF-CBT) is a type of cognitive-behavioural therapy (CBT) that has been adapted for PTSD. It is one of the psychological therapies with the strongest evidentiary support recommended for PTSD (NICE, 2018).

CBT

CBT is a type of therapy that explores the way in which thoughts (or cognitions) affect the way individuals feel and behave. It is used in the treatment of a range of mental health disorders such as depression and anxiety.

CBT can be modified to treat other disorders such as PTSD and eating disorders like anorexia nervosa.

Thoughts, feelings, and behaviours

In CBT, the focus is on how thoughts affect feelings and behaviours. The aim of CBT is to identify how thinking styles can be challenged and modified to improve feelings and behaviours.

For example, if an individual interprets a situation negatively, a ‘negative cognition’, this can have a negative impact on their feelings, for example causing anxiety, low mood and sadness.

These negative feelings can lead to potentially unhelpful behaviours such as avoidance or reduced activity.

Negative cognitions

In some people, these negative cognitions can become repeated, engrained and automatic. This can then lead to challenges interpersonally and at school or work.

In CBT, the specially trained therapist can help individuals recognise and identify these negative cognitions. Over time, these cognitions can be challenged and feelings and behaviours altered to improve mental health and wellbeing.

Diagram showing the interconnected relationship of thoughts, behaviours, and emotions. Diagram showing the interconnected relationship of thoughts, behaviours, and emotions.

Trauma-Focused CBT

Trauma-Focused CBT (TF-CBT) is a specific type of CBT that has been modified to help treat PTSD. It can be delivered as an individual TF-CBT or as a group TF-CBT.

Individual TF-CBT

This treatment can be delivered to children, young people, and adults who have PTSD. Individual TF-PTSD should be based on a validated manual and be delivered by trained practitioners, who have regular supervision. Typically individual TF-CBT is delivered over 6 to 12 sessions, but at times individuals may require more sessions, for example, if they have experienced multiple traumas.

Individual TF-CBT specifically focuses on:

– Managing reactions to trauma
– Developing strategies for managing symptoms of hyper-arousal and flashbacks
– Safety planning
– Processing of the trauma memories
– Processing trauma-related emotions such as anger, loss, guilt and shame
– Overcoming avoidance
– Restabilising functioning be that in work, school or personal situations
– Restructuring meaning for the individual in relation to their trauma

Time is then spent preparing for the end of treatment and plans are made about possible ‘booster sessions, which can be helpful around the time of significant dates such as trauma anniversaries. If individual TF-CBT is delivered to children and young adults, it needs to be adapted to their age and stage of development. In some cases, parents or carers are included in sessions.

Group TF-CBT

Group TF-CBT can also be delivered to children, young people and adults who have PTSD. It can be used in the treatment of people who have experienced large scale trauma. Again group TF-CBT should be based on a validated manual and only be delivered by trained specialists who have regular supervision. Group TF-CBT is typically delivered over 5 to 15 sessions.

Group TF-CBT specifically focuses on:

– Managing reactions to trauma
– Developing strategies for managing symptoms of hyper-arousal and flashbacks
– Safety planning
– Processing of the trauma memories
– Overcoming avoidance
– Restructuring meaning for the individual in relation to their trauma.

It is important to be aware that much of the evidence base for the efficacy of TF-CBT is from high-income countries such as Canada, the US and parts of Europe (Bisson et al., 2013).

References

Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., Lewis, C., & Bisson, J. I. (2013). Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 2015(8), CD003388. https://doi.org/10.1002/14651858.CD003388.pub4

NICE. (2018). Recommendations | Post-traumatic stress disorder | Guidance | NICE. https://www.nice.org.uk/guidance/ng116/chapter/recommendations#disaster-pla

© University of Glasgow
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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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