Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a structured mental health treatment for children and families who are suffering from the aftereffects of trauma.
A core principle of the TF-CBT is the gradual exposure model. It involves incremental exposure to the traumatic experience, helping children develop the necessary skills to manage distressing emotions and physiological reactions.
In this read, we understand what TF-CBT is, how gradual exposure is used through treatment, and each PRACTICE component, so you can see how the model is applied step by step.
Make Triggers Manageable With CPG
TF-CBT at CPG builds coping skills first, then helps kids face reminders without getting pulled into panic or avoidance. We offer both in-person and online visits.
The TF-CBT Components (PRACTICE)
The acronym “PRACTICE” represents the key components of TF-CBT. These components are taught to both the child and caregiver. The core elements include:
P — Psychoeducation + Parenting Skills
Therapists will explain the ways trauma can show up in children and caregivers so families understand what they’re treating and why treatment is important. Psychoeducation teaches why a child is showing symptoms and how common post-traumatic symptoms are, reducing shame and stigma.
In parallel caregiver sessions, TF-CBT includes parenting skill support because parenting routines often change after trauma and trauma-linked behaviors. Based on the family and child Caregivers learn concrete behavior strategies, like:
- Praise
- Selective attention to positive behavior
- Structured consequences (e.g., time-out)
- Contingency reinforcement (behavior charts)
R — Relaxation Skills
Therapists teach stress-management methods that directly target trauma-related physiological arousal. It helps the child regain a sense of control that was lost after the traumatic experience. Based on the developmental stage, the relaxation techniques include:
- Deep breathing
- Progressive muscle relaxation
- Blowing bubbles
- Yoga
- Mindfulness exercises
TF-CBT also lists individualized calming activities for relaxation practice:
- Music
- Sports
- Knitting
- Singing
- Reading humorous stories
- Prayer
- Relaxation recordings
Therapists will help the child practice using multiple strategies across different settings (home, school, and community) and adjust them until they work reliably for that child and context.
Help Your Child Feel Safe Again
CPG therapists use TF-CBT to reduce trauma reactions that show up as fear, shutdown, anger, sleep trouble, or school struggles. Book inp[person and online appointment.
A — Affective Modulation (Affective Expression and Regulation)
TF-CBT helps understand and identify feelings and teaches how to express & regulate them clearly, especially when trauma reminders trigger intense states. When a child is emotionally shut down, the therapist describes the emotional stability through structured activities like feeling-focused games, so the child can name and show emotions rather than disconnecting from them.
When a child becomes emotionally overwhelmed, TF-CBT targets emotion-regulation skills and analyzes what is driving the affective dysregulation, for example:
- Increased sensitivity to negative cues
- Limited access to positive experiences
- Skill gaps that block positive interactions
C — Cognitive Coping (and Cognitive Processing Skills)
Therapists teach children and caregivers to focus on the thoughts attached to upsetting situations. It is so they understand the feelings and behaviors caused by trauma.
They evaluate whether the thoughts are related to trauma and helpful. Afterwards, they help replace them with alternative positive thoughts. This skill helps children learn they can influence their internal experience by changing the way they interpret events, including trauma reminders.
T — Trauma Narrative + Cognitive Processing of the Trauma
After the early skill-building techniques, TF-CBT now works on trauma-specific events. Here, the child gradually constructs a trauma narrative about what happened during their traumatic experience, including:
- Feelings
- Body sensations
- The worst moments of the traumatic experience
The narrative is most often created in writing format, e.g.,
- Book
- Poem
- Song
- Dictated story
- Computer-typed narrative
- Art
- Dance
- Other preserved formats so it can be reviewed session to session.
The narrative work is used to do three concrete jobs:
- Reduce avoidance of traumatic memories
- Understand cognitive distortions with the child’s own wording
- “Putting the trauma into a (before/when/since this happened) so the child can see it as one part of life, not the whole identity
While the child is developing the narrative, the content is also shared with the parent in separate parent sessions, and this happens with the child’s permission, so the parent is prepared for later conjoint sessions
Once the narrative exists, the therapist uses earlier cognitive coping methods to target trauma-linked distortions like
- Self-blame
- Shame
- Feeling “damaged”
- Reduced self-esteem due to trauma
Turn the Trauma Into a Tellable Story
CPG guides the trauma narrative step-by-step, so the memory becomes something the child can talk about without falling apart.
I — In-Vivo Mastery of Trauma Reminders
In TF-CBT, there is a common problem that children start to see everyday things as dangerous because they connect them to the trauma they experienced. This can lead to them avoiding things that are actually safe, which affects their daily life, like going to school or doing their regular routines.
In-vivo mastery helps by gradually exposing the child to these feared reminders in real-life situations. The goal is for the child to learn, step by step, that these reminders are not dangerous and that they can safely return to normal activities.
For example, a child who was sexually abused in a bathroom begins to fear all bathrooms. They may then refuse to use the bathrooms at school. This avoidance can eventually result in school refusal, impairing the child’s ability to function normally.
Through gradual exposure, the child practices these feared situations, e.g., using a bathroom at school, until they can do it safely without fear. The aim is to help the child feel safe again in these everyday environments and return to their regular activities, like attending school.
C — Conjoint Child–Caregiver Sessions
When a supportive caregiver is available, therapists use conjoint sessions to shift the center of communication from child-to-therapist toward child-to-caregiver, while the therapist coaches from the background.
Commonly, in these sessions, children share the trauma narrative directly with the caregiver. The caregiver has already heard these in the caregiver sessions and is now prepared to respond with:
- Reassurance
- Clarity
- Emotional containment
- Praise that child needs
Conjoint also provides an environment for questions that families normally avoid. Moreover, therapists also provide caregivers with reliable trauma-related activities, such as:
- Public service announcement about domestic violence
- Structured discussions about healthy sexuality with therapist preparation
Caregiver Support That Actually Helps
TF-CBT includes caregiver sessions; CPG shows you what to say, what to do, and how to respond when trauma behaviors spike.
E — Enhancing Safety + Future Developmental Trajectory
Many traumatized children need specific, teachable behaviors to reduce future risk and increase confidence in daily life. That is why therapists use individualized safety skills.
For Examples
- Healthy sexuality education and prevention of sexually inappropriate behaviors after sexual abuse
- “No-go-tell” safety steps for younger children
- Domestic-violence safety plan development
- Bullying safety skills
- Drug refusal skills
Therapists explicitly encourage children and caregivers to apply the same coping and communication skills to future stressors, not only trauma-specific situations.
Typical Format and Flow of Treatment
TF-CBT was developed for children and adolescents with trauma-related difficulties, typically described as ages 3–17. It is typically delivered in individual child sessions and individual caregiver sessions. The conjoint (joint) parent–child sessions practice
skills and support the child in sharing parts of the trauma narrative. A commonly described course includes 8–25 sessions and is completed within 4–6 months, with variability based on clinical needs.
Why Choose Us
Our psychologists specialize in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to treat trauma-related conditions in children and adults.
Here are the benefits you can get from us:
- All insurance accepted
- Multi-state clinical presence
- No wait time in appointments
- HIPAA-compliant telepsychiatry
- Appointment within 24 hours
- Walk-in appointments
- Weekend appointments
- Therapy & counseling services
- Safe medication management
- Certified psychiatrists & psychologists
- Personalized treatment plans
- Patient-first approach
Final Words
TF-CBT has been extensively researched and supported in randomized controlled trials that it is effective in reducing symptoms of PTSD, depression, anxiety, and behavioral problems in children affected by trauma.
During sessions, therapists teach the child (and caregiver) practical coping tools to manage stress. Afterwards, they guide the child step-by-step to face trauma memories using the copying techniques. Over time, they learn how to manage fear and symptoms associated with PTSD.
Our licensed psychologists are dedicated to helping children and adolescents heal trauma using TF-CBT. Our commitment to providing a structured, evidence-based approach ensures that each child receives the most effective care tailored to their needs.
Get a Clear TF-CBT Treatment Plan
CPG reviews symptoms, trauma history, and caregiver needs, then maps out what TF-CBT would look like session-to-session. Book in clinic or online appointment.
How we reviewed this article:
CPG experts follow strict sourcing standards, using peer-reviewed research, academic institutions, and trusted medical journals. Only reliable, evidence-based sources are cited to maintain accuracy and integrity.
- https://gucchd.georgetown.edu/TraumaInformedCare/IssueBrief4_EvidenceBasedTreatments.pdf
- https://cwig-prod-prod-drupal-s3fs-us-east-1.s3fs-us-east-1.amazonaws.com/public/documents/trauma-focused-cbt-primer-child-welfare-professionals.pdf
- https://sdcatholic.org/wp-content/uploads/2024/10/G3-No-go-tell.pdf
- https://cwig-prod-prod-drupal-s3fs-us-east-1.s3fs-us-east-1.amazonaws.com/public/documents/trauma-focused-cbt-primer-child-welfare-professionals.pdf
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