Trauma Focused Cognitive Behavioral Therapy in Children

According to the US Department of Health and Human services two thirds of American children experience a traumatic event by the age of 16. These traumatic events include but aren’t limited to:

  • Psychological, physical, or sexual abuse
  • Community or school violence
  • Witnessing or experiencing domestic violence
  • National disasters or terrorism
  • Commercial sexual exploitation
  • Sudden or violent loss of a loved one
  • Refugee or war experiences
  • Military family-related stressors (e.g., deployment, parental loss or injury)
  • Physical or sexual assault
  • Neglect
  • Serious accidents or life-threatening illness

One of the most effective treatments for childhood trauma is Trauma Focused Cognitive Behavioral Therapy. This model includes a mixture of psycho education, coping strategy development, trauma narrative development, exposure therapy, and future safety planning. Developed by Drs. Anthony Mannarino, Judith Cohen and Esther Deblinger, TF-CBT is an evidence-based treatment that has been evaluated and refined during the past 25 years to help children and adolescents recover after trauma. According to the TF-CBT National Therapist Certification Program, TF-CBT is a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in 8-25 sessions with the child/adolescent and caregiver.


TF-CBT starts by engaging the child and supportive caregiver in what is called PRAC skills.

P- Psycho education

R- Relaxation

A-Affect Regulation

C- Cognitive Coping

These skills are aimed at helping the child and caregiver understand trauma, the effects of trauma, and symptomology, while also teaching coping strategies that the child and caregiver will use to manage symptoms and triggers during the trauma narrative.

Once the child and caregiver and displaying a consistent ability to implement PRAC skills the treatment then moves on to exposure through the development of a trauma narrative in which the child narrates their trauma history to the therapist for documentation. The therapist will then assist the child in going through the narrative and reframing any detrimental distortions related to their trauma (e.g. “this was my fault”).

Once this step is complete the child will then share the narrative with a “green light” adult. A green light adult is a caring and supportive adult in the child’s life who will believe the child’s account of their narrative. The therapist typically prepares this adult as to how to respond to the child.

The last step in this model is enhancing future safety. During this step, the therapist will assist the child in developing safety plans to effectively manage trauma triggers in the future. This step can also address how to handle things such as domestic violence or suicidal ideation if applicable to the child.


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