Trauma-Focused Cognitive Behavioural Therapy


Category: Allied Health Options

What is it?

Trauma-Focused Cognitive Behavioural Therapy (TFCBT) is a general term which refers to individually delivered psychological treatments for adults that mainly use trauma-focused cognitive, behavioural or cognitive-behavioural techniques. These treatments include cognitive processing and exposure therapies, and/ or skills training components. Treatment emphasis relates to addressing various aspects of narrative traumatic memories, rather than current life problems resulting from PTSD.

In a typical TFCBT, the client is confronted with the disturbing experience and asked to describe and relive it in their imagination. As homework, the client is normally instructed to listen daily to an audio tape recording of this trauma narrative from one of the first sessions. As part of TFCBT, imagery (recall of the traumatic event by imagining) and/or in vivo (direct confrontation of feared situations) exposure may be considered. The client may also receive training in relaxation and stress management to address distressing symptoms associated with reminders of the traumatic event, or is assisted to examine unhelpful thoughts that prevent recovery from traumatic experiences.

How does it work?

Exposure as part of TFCBT is used to support emotional processing and lessen the impact of traumatic memories and events through assisting clients to gradually confront the memories and situations associated with the trauma. The client can safely experience these reminders as they are provided with corrective information which helps them to tolerate distress and learn that feared situations or memories are not dangerous.

TFCBT also works on the principle that negative, unhelpful beliefs or irrational misconceptions associated with the trauma need to be identified and then tested to determine whether they are accurate, realistic and helpful. By challenging problematic beliefs and replacing them with more realistic interpretations TFCBT can help the client to reduce distress and enhance their ability to cope.

Is it effective?

Results from two recent reviews have consistently demonstrated the effectiveness of TFCBT in the treatment of PTSD. In both studies, this form of therapy did significantly better than the waitlist/usual care in the reduction of PTSD symptoms. There is also evidence that TFCBT is superior when compared to other forms of therapy.

Are there any disadvantages?

Whilst it is not very common, side effects consist of symptom worsening, which can occur during treatment when the client is asked to relive the traumatic experience.

Where do you get it?

TFCBT can only be administered by a registered mental health professional.

What are the evidence limitations?

Some studies included in the review had individuals with traumatic stress symptoms who were diagnosed using different criteria from DSM-IV.


Based on current evidence, TFCBT is effective in the treatment of PTSD. Therefore, it should be given as the first line of intervention to those diagnosed with PTSD.

For more information on specific Trauma-Focused Cognitive Behavioural Therapy techniques look at:

Key References

Bisson, J & Andrew, M 2007, ‘Psychological treatment of post traumatic stress disorder (PTSD)’, Cochrane Database of Systematic Reviews, Issue 3 Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub3.

Bisson, J, Ehlers, A, Matthews, R et al. 2007, ‘Psychological treatments for chronic post traumatic stress disorder’, British Journal of Psychiatry, vol. 190, pp. 97-104.

Seidler, GH & Wagner, FE 2006, ‘Comparing the efficacy of EMDR and trauma-focused cognitive behavioural therapy in the treatment of PTSD: a meta-analytic study’, Psychological Medicine, vol. 36, pp. 1515-1522.

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