Trauma-Focused Cognitive Behavioral Therapy

Intervention; Ages 3–18


(Read the criteria for this rating)
  • Effective delinquency program

Risk Factors

Antisocial/delinquent beliefs
Conduct disorders (authority conflict/rebellious/stubborn/disruptive/antisocial)
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


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.


Substance Abuse and Mental Health Services Administration, National Registry of Effective Programs and Practices: Model programs


Judith A. Cohen, M.D.
Center for Traumatic Stress in Children and Adolescents
Allegheny General Hospital
4 Allegheny Center, Eighth Floor
Pittsburgh, PA 15212
Phone: (412) 330-4321
Fax: (412) 330-4377
Web site:

Web site:


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.

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