Trauma-Focused Cognitive Behavioral Therapy for Children and Teens

What Is Trauma-Focused CBT?

Trauma-Focused CBT (also known as TF-CBT) is a specialized form of cognitive behavioral therapy designed to help children and teens who have experienced traumatic events. Whether the trauma stems from abuse, neglect, violence, grief, or another distressing experience, TF-CBT provides tools to help youth process their feelings, understand their experiences, and build healthy coping mechanisms.

While traditional CBT focuses on the relationship between thoughts, feelings, and behaviors, trauma-focused CBT adds specific techniques to address trauma and its lasting emotional effects. This treatment is typically short-term, lasting 12–20 sessions, and involves both the child and their caregiver whenever possible.

To understand how TF-CBT fits into broader therapy options, explore our Cognitive Behavioral Therapy services for children and teens.

How Does Trauma-Focused CBT Work?

TF-CBT combines elements of cognitive behavioral therapy with trauma-sensitive interventions. Therapists trained in TF-CBT follow a structured approach that includes:

• Psychoeducation: Teaching children and caregivers about trauma and its effects on the body and mind.
• Parenting Skills: Supporting caregivers with strategies to manage behavioral challenges.
• Relaxation Techniques: Helping children learn ways to reduce stress and anxiety.
• Affective Expression and Regulation: Teaching children how to identify, express, and manage their emotions.
• Cognitive Coping: Identifying negative or unhelpful thoughts and replacing them with healthier perspectives.
• Trauma Narrative: Guiding children in creating a detailed account of their traumatic experience, helping them process and gain mastery over it.
• In Vivo Exposure: Gradually and safely confronting trauma reminders that the child may be avoiding.
• Joint Child-Parent Sessions: Encouraging communication between children and caregivers about the trauma.
• Enhancing Future Safety: Teaching personal safety skills and strategies to prevent future trauma.

Want to learn more about how trauma affects emotional regulation and anxiety in youth? Visit our guide on Anxiety and Depression in Teens.

What Is the Difference Between Trauma-Focused CBT and CBT?

While both therapies use the core principles of cognitive behavioral therapy, trauma-focused CBT includes a trauma narrative and additional components specifically tailored to address trauma in young people. TF-CBT also incorporates the child’s caregiver in treatment to build trust and support healing at home.

Trauma-Focused CBT Techniques for Children and Teens

Therapists trained in TF-CBT use a variety of trauma-focused CBT techniques based on the child’s developmental level, needs, and trauma history. These may include:

• Deep breathing and mindfulness exercises
• Art and play-based expression
• Journaling or storytelling
• Gradual exposure to trauma reminders
• Cognitive restructuring to change distorted trauma-related thoughts

For adolescents, trauma-focused CBT for teens often involves helping them regain a sense of control and self-worth while reducing feelings of guilt, shame, or helplessness related to their trauma.

How Does Trauma Affect the Brain of a Child?

Trauma can alter a child’s brain development, particularly in areas responsible for emotion regulation, memory, and decision-making. Chronic stress can lead to an overactive fight-or-flight response, making it difficult for children to feel safe or focus in school. TF-CBT helps by retraining the brain to respond more calmly and rationally to trauma triggers.

To explore broader mental health challenges in youth, see our section on Youth Mental Health.

At What Age Can a Child Remember Trauma?

While memories vary by age and development, children can often recall traumatic experiences from as early as age 2 or 3—especially if the event involved intense fear, harm, or emotional stress. Even if a child cannot fully verbalize what happened, they may show signs of trauma through behaviors such as aggression, regression, or withdrawal.

How to Help a Child with Trauma in School

Caregivers and educators play a key role in supporting children with trauma. TF-CBT-trained providers can coordinate with schools to implement coping strategies, behavior plans, and accommodations that help students feel safe and supported. NJCMO can help families access these critical care teams.

To explore all available options, visit our Mental Health Services Overview.

When to Consider Trauma-Focused CBT for Your Child

If your child has experienced a traumatic event and is showing signs of emotional distress, behavioral changes, or difficulties at home or school, TF-CBT may be an appropriate option. Signs your child may benefit from trauma-focused therapy include:

• Nightmares or trouble sleeping
• Anxiety, fearfulness, or hypervigilance
• Withdrawal from friends or activities
• Difficulty focusing or sudden changes in academic performance
• Acting out or showing aggression
• Emotional outbursts or mood swings

NJCMO helps families access trauma-focused CBT interventions and connects them to trusted community providers. If trauma is accompanied by risky behavior or substance use, your child may also benefit from CBT for Addiction.

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