TF-CBT:

NAME: Trauma-Focused Cognitive

Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Treatment Acronym (abbreviation) for intervention: TF-CBT

Description
Average length/number of sessions: 12-25 sessions (60-90 minute sessions,
divided approximately equally between youth and parent/caregiver)
Aspects of culture or group experiences that are addressed (e.g., faith/spiritual
component, transportation barriers): TF-CBT has been modified to address the needs
of Latino, Native American, deaf and hearing impaired, military and many international
populations. It has been provided in group formats and in multiple settings(e.g.,
homes, foster homes, schools, residential treatment facilities) to address
transportation barriers
Trauma type (primary): Sexual abuse, domestic violence, traumatic grief, disaster,
terrorism, multiple or complex traumas
Trauma type (secondary): Other trauma types
Additional descriptors (not included above): TF-CBT addresses the multiple domains
of trauma impact including but not limited to Posttraumatic Stress Disorder (PTSD),
depression, anxiety, externalizing behavior problems, relationship and attachment
problems, school problems and cognitive problems. TF-CBT includes skills for
regulating affect, behavior, thoughts and relationships, trauma processing, and
enhancing safety, trust, parenting skills and family communication.

Target Population Age range: 3 to 21

x Both
Gender: r Males r Females r
Ethnic/Racial Group (include acculturation level/immigration/refugee history--e.g.,
multinational sample of Latinos, recent immigrant Cambodians, multigeneration African
Americans): TF-CBT has been tested in U.S. Caucasian, African American and Latino
populations as well as in European, Australian and African youth with positive out-
comes in multiple domains. Applications for childhood traumatic grief (CTG) have also
been used for multiple populations with positive outcomes.
Other cultural characteristics (e.g., SES, religion):
TF-CBT has been used with families of diverse SES and religions.
Language(s): The TF-CBT treatment book has been translated into Chinese (Mandarin),
German, Dutch, Polish, Japanese and Korean. French and Russian translations are
underway. Instruments to assess TF-CBT outcomes are available in multiple languages
including all of the above as well as Spanish and a variety of African tribal languages.
Region (e.g., rural, urban): TF-CBT has been used in urban, suburban and rural regions.
Other characteristics (not included above): TF-CBT has been modified for use in
military settings as well as for residential treatment facilities (e.g., additional training
materials are available for training direct care staff to support the use of TF-CBT skills
in the residential setting); in schools; and for youth with developmental challenges.

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TF-CBT: General Information
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Target Population TF-CBT should be provided to youth who have significant emotional or behavioral
continued difficulties related to one or more traumatic life events (including complex trauma);
youth do not have to meet PTSD criteria to receive TF-CBT. TF-CBT treatment has been
shown to result in improvement in PTSD symptoms, depression, anxiety symptoms,
externalizing behavioral problems, sexualized behavior problems, shame, trauma-
related cognitions, interpersonal trust, and social competence.

Essential Theoretical basis: Cognitive-behavioral, family, empowerment

Components
Key components:
• Establishing a therapeutic relationship with youth and parent
• Use of gradual exposure throughout treatment
PRACTICE components:
• Psychoeducation about child trauma and trauma reminders
• Parenting component including parenting skills
• Relaxation skills individualized to youth and parent
• Affective modulation skills tailored to youth, family and culture
• Cognitive coping: connecting thoughts, feelings and behaviors
• Trauma narrative and processing
• In vivo mastery of trauma reminders
• Conjoint youth-parent sessions
• Enhancing safety and future developmental trajectory
• Traumatic grief components

Clinical & Are you aware of any suggestion/evidence that this treatment may be harmful?
Anecdotal r Yes rx No r Uncertain
Evidence
Extent to which cultural issues have been described in writings about this
intervention (scale of 1-5 where 1=not at all to 5=all the time). 3
This intervention is being used on the basis of anecdotes and personal
communications only (no writings) that suggest its value with this group.
r Yes r x No
Are there any anecdotes describing satisfaction with treatment, drop-out rates
x Yes r No
(e.g., quarterly/annual reports)? r
If YES, please include citation:
All of our treatment outcome studies (cited below) include dropout statistics.
x Yes r No
Has this intervention been presented at scientific meetings? r

2 The National Child Traumatic Stress Network

www.NCTSN.org
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Clinical & If YES, please include citation(s) from last five presentations:
Anecdotal Numerous citations available upon request.
Evidence continued Are there any general writings which describe the components of the intervention
or how to administer it? rx Yes r No
If YES, please include citation: Cohen, JA, Mannarino, AP & Deblinger, E (2006).
Treating trauma and traumatic grief in children and adolescents. New York: Guilford
Press
Free online training course: TF-CBT Web: www.musc.edu/tfcbt
x Yes r No
Has the intervention been replicated anywhere? r
Other countries? (please list)
Zambia; Cambodia; Norway; Germany; Holland; Japan
Other clinical and/or anecdotal evidence (not included above):
Multiple replication studies

Research Evidence Sample Size (N) and Breakdown Citation

(by gender, ethnicity, other cultural factors)

TF-CBT has the strongest research

evidence of any treatment model
for traumatized children. Multiple
randomized controlled trials (RCT)
and replication studies including
international studies have been
conducted documenting the
effectiveness of TF-CBT for improving
a range of problems for these
children.

Pilot Trials/Feasibility N=19 Deblinger et al, 1990

Trials (w/o control groups) Gender:
female=19, male=0

Clinical Trials Foster care: TF-CBT=69, Usual care Weiner et al, 2009
(w/control groups)
N=2218 CATS Consortium, 2010
Disaster:
N=306

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TF-CBT: General Information
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Research Evidence Sample Size (N) and Breakdown Citation

(by gender, ethnicity, other cultural factors)

Randomized Controlled 921 total youth; 743 treatment Cohen & Mannarino, 1996
Trials completers
Cohen, Mannarino & Knudsen, 2005
By gender: 507 female; 236 male Cohen, et al, 2004
By self-identified ethnicity: Cohen, et al, 2011
447 Caucasian
176 African American Deblinger, et al, 1996
29 Latino Deblinger et al, 2001
42 Biracial
13 Other Deblinger et al, 2011
36 Australian children King et al, 2000
Democratic Republic of Congo: O’Callaghan & McMullen,2012
Former child soldiers: N=52
McMullen & O’Callaghan, 2012
Sex trafficked girls: N=52

Studies Describing Childhood traumatic grief: 61 Cohen, Mannarino & Knudsen, 2004
Modifications
By gender: Cohen, Mannarino & Staron, 2006
38 female, 23 male
By ethnicity:
43 Caucasian
15 African American
3 Biracial

Outcomes What assessments or measures are used as part of the intervention or for research
purposes, if any?
• PTSD: UCLA PTSD Reaction Index; CPSS and/or KSADS
• Depression: Children’s Depression Index; TSCC
• Anxiety: SCARED; STAIC; TSCC
• Externalizing and Internalizing behavior problems: CBCL
• Sexual behavior problems: CSBI or TSCC
• Trauma-related cognitions: Children’s Attribution and Perception Scale (CAPS)
• Parental support: PSQ
• Parental distress: PERQ
• Parental depression: BDI
• Parenting practices: Parenting Practices Questionnaire
• Parental conflict/violence: Conflict Tactics Questionnaire

4 The National Child Traumatic Stress Network

www.NCTSN.org
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Outcomes If research studies have been conducted, what were the outcomes?
continued TF-CBT superior to Child Centered Therapy, wait list and usual treatment on multiple
outcomes listed above

Implementation Space, materials or equipment requirements?

Requirements & Private office or other meeting room for therapy sessions
Readiness Supervision requirements (e.g., review of taped sessions)?
Approved TF-CBT training and expert consultation (web-based; 2 days of face to face
training; at least 6 months of twice monthly consultation with expert trainer) OR
participation in approved learning collaborative use of fidelity monitoring using fidelity
checklist and use of at least one standardized instrument to assess progress pre-
post treatment
To ensure successful implementation, support should be obtained from:
An approved TF-CBT trainer

Training Materials List citations for manuals or protocol descriptions and/or where manuals or
& Requirements protocol descriptions can be obtained.
TF-CBT Implementation Manual
How/where is training obtained?
TF-CBT Web (www.musc.edu/tfcbt) followed by 2 day training from approved TF-CBT
trainer and at least 6 months of consultation calls OR participation in approved
learning collaborative
What is the cost of training? Approximately $10,000/10 clinicians
Are intervention materials (handouts) available in other languages?
x Yes r No
r
If YES, what languages?
German, Dutch, Japanese, Chinese, Polish, Spanish
Other training materials &/or requirements (not included above):
• Free web-based TF-CBT for Childhood Traumatic Grief training available at
CTGWeb: www.musc.edu/ctg
• Free web-based TF-CBT consultation program (Funded by the Annie E. Casey
Foundation) available at www.musc.edu/tfcbtconsult
• National TF-CBT Certification Program will be available in spring 2012

Pros & Cons/ What are the pros of this intervention over others for this specific group
Qualitative (e.g., addresses stigma re. treatment, addresses transportation barriers)?
Impressions TF-CBT is a flexible model that includes many components that are already familiar
to many community therapists. It is relatively easy to learn in a short time and is
acceptable to most families and therapists.

Trauma-Informed Interventions | April 2012 5

TF-CBT: General Information
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

Pros & Cons/ What are the cons of this intervention over others for this specific group
Qualitative (e.g., length of treatment, difficult to get reimbursement)?
Impressions Some therapists do not like to use structured therapy approaches nor to talk directly
continued about children’s traumatic experiences. These therapists may prefer a different
treatment model.

Contact Name: Judith Cohen, M.D.; Anthony Mannarino, Ph.D. or Esther Deblinger, Ph.D.
Information
Address: 4 Allegheny Center, 8th Floor
Email: [email protected]; [email protected]; [email protected]
Website: www.pittsburghchildtrauma.net; www.musc.edu/tfcbt

References CATS Consortium (2010). Implementation of CBT for youth affected by the World Trade Center disaster:
Matching need to treatment intensity and reducing trauma symptoms. JTS, 23, 699-707.

Cohen, JA, Mannarino, AP & Deblinger, E (2006). Treating Trauma and Traumatic Grief in Children and
Adolescents. New York: Guilford Press.

Cohen, JA, Mannarino AP & Iyengar, S (2011). Community treatment of PTSD for children exposed to
intimate partner violence: A randomized controlled trial. Arch Ped Adol Med, 165, 16-21.

Cohen, JA, Deblinger, E, Mannarino, AP & Steer, R (2004). A multisite randomized controlled trial for
children with sexual abuse-related PTSD symptoms. JAACAP, 43, 393-402

Cohen, JA, Mannarino, AP (1996). Treating sexually abused preschool children: Initial treatment outcome
findings. JAACAP, 35, 42-50.

Cohen, JA, Mannarino AP & Knudsen K (2005). Treating sexually abused children: 1 year follow-up of a
randomized controlled trial. Child Abuse Neglect, 29, 135-145.

Cohen, JA, Mannarino, AP & Knudsen, K (2004). Treating childhood traumatic grief: A pilot study. JAACAP,
43, 1225-1233.

Cohen, JA, Mannarino, AP & Staron, V (2006). JAACAP. A pilot study of modified cognitive behavioral therapy
for childhood traumatic grief. JAACAP, 45, 1465-1473.

Deblinger, E, Lippmann, J & Steer, R (1996). Sexually abused children suffering posttraumatic stress
symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310-321.

Deblinger, E, McLeer, SV & Henry, DE (1990). Cognitive, behavioral treatment for sexually abused children
suffering posttraumatic stress: preliminary findings. JAACAP, 29, 747-752.

Deblinger, E, Mannarino, AP, Cohen, JA, Runyon, M & Steer, R (2011). Trauma-focused CBT for children:
Impact of the trauma narrative and treatment length. Depression and Anxiety, 28, 67-75.

Deblinger, E, Stauffer, L & Steer, RA (2001). Comparative efficacies of supportive and cognitive behavioral
group therapies for young children who have been sexually abused and their non-offending mothers. Child
maltreatment, 6, 332-343.

King, NJ, Tonge, BJ, Mullen, P, Myerson, N, Heyne, D, Rollings, S, Martin, R & Ollendick, TH (2000). Treating
sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. JAACAP, 39,
1347-1355.

6 The National Child Traumatic Stress Network

www.NCTSN.org
 TF-CBT:
NAME: Trauma-Focused Cognitive
Name Spelled Out
Behavioral Therapy
GENERAL INFORMATION

References McMullen, J & O’Callaghan, P (2012). Delivering and evaluating a group intervention with former child
soldiers and other war-affected children: A randomised controlled trial. Paper presented at the Division
continued
of Educational and Child Psychology, British Psychological Society Annual Meeting, Stratford Upon Avon,
January 2012.

O’Callaghan, P & McMullen, J (2012). Psychological and psychosocial interventions with war affected
children. Clinical trials ID NCT01509872

Weiner, D, Schneider, S & Lyons, JS (2009). Evidence-based treatments for trauma among culturally diverse
foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31,1199-1205

Trauma-Informed Interventions | April 2012 7

TF-CBT: General Information