Trauma-focused cognitive behavioral therapy (TF-CBT) addresses the mental health needs of children, adolescents, and families suffering from the destructive effects of early trauma. The treatment is particularly sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from sexual abuse, as well as from physical abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.
The trauma-focused approach to therapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced many forms of severe trauma or abuse.
Is CBT Effective for PTSD?
While cognitive behavioral therapy research continues to grow, it is one of the most widely-researched psychotherapy treatments and has been found to be effective in short- and long-term approaches as well as with a variety of populations, ranging from PTSD in young children to older adults.2,4
Here are several studies highlighting the effectiveness of CBT for PTSD:
- CBT has been researched and observed to be as effective as a number of other therapy types, and research indicates that it has been culturally validated across a variety of populations.
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- Compared to a placebo, CBT was reported to be moderately helpful in treating anxiety-related disorders. The researchers did note that drop out rates were higher in PTSD samples, especially in the exposure therapy group, which infers a need for more specialized types of CBT for PTSD.
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- A research review notes that CBT can be an appropriate, safe, and helpful intervention in the presentation of acute and chronic PTSD for people of any age.
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- Research noted a significant improvement and significant reduction in symptoms of PTSD, in addition to feelings of depression and anxiety.
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- After reviewing clinical trials ranging from 1980 to 2005, researchers noted that CBT had significantly maintained healthy behaviors after treatment in comparison to EMDR and therapies that are more supportive. CBT was equal to exposure therapy and cognitive therapy in reducing PTSD symptoms and the maintenance of healthy behaviors.
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Examples of CBT for PTSD
There are a variety of CBT treatments that exist to help someone dealing with PTSD. Everyone experiences mental health differently and PTSD is not an exception to this.
Here are a few examples regarding specific treatment options as well as how they apply to each example’s experience of PTSD:
CBT for PTSD in a Veteran
Jamie, a 36-year-old Iraq war veteran, reports having had symptoms of PTSD for the past six and a half years. He continuously avoids thoughts, memories, or images (even in media) that could be connected with the experience of his fellow unit members and himself driving over an explosive device while traveling to another base.
Jamie reports a history of difficulties attending work for a number of days out of the week, repeated nightmares of the event, higher levels of depressive moods along with some irritability, and difficulty feeling connected with his spouse and other family members.
Jamie goes to 12 to 16 sessions of cognitive behavioral therapy with a focus on prolonged exposure to process these emotions and thoughts to reduce avoidance. During these sessions, the therapist assigns Jamie weekly homework assignments to regularly practice coping skills. The therapist encourages Jamie to journal his anxiety levels each day to increase awareness of stress, anxiety, and his other symptoms. In doing so, Jamie’s therapist hopes that he will increase self-expression about how he is feeling to be able to rely both on himself and a support system. This helps Jamie to monitor and reduce the impact of his symptoms by becoming aware of his warning signs and the need to initiate his coping skills.
CBT for PTSD From Witnessing Violence
Sarah, a 22-year-old who witnessed her younger brother’s murder by gunshot, has been experiencing symptoms of PTSD for 3 years. She has recurrent nightmares of the murder, and she avoids the place where her brother died and thoughts about her brother’s death. She reports continuous increasing ruminative thought and guilt surrounding her lack of protection of her brother, as well as irritability and depression throughout the year.
Sarah’s PTSD symptoms have begun to seriously impact her work relationships and with her family. After being assessed for comorbid symptoms of grief and depression in addition to PTSD, Sarah would benefit from about 12 sessions of a combination of CBT and cognitive processing therapy.
Sarah begins seeing a therapist to process her symptoms and her traumatic experience. Her therapist begins challenging her in each session to use more healthy thinking patterns and to engage in coping techniques. When Sarah’s anxiety levels rise, the therapist helps her by pointing out the unhealthy thought or increased stress response and allowing her time to practice restructuring her thoughts and engaging in a breathing activity or to relax her muscles.
Sarah’s therapist also assigns her weekly homework of journaling her anxiety and symptom levels; she is encouraged to keep practicing thought restructuring and coping mechanisms outside of sessions and to log them as well. As Sarah and her therapist work on these tasks together, Sarah begins to communicate more about her emotions and become more aware of how blaming herself impacts her thoughts.
CBT for PTSD Caused by Abuse
Bill, a 40-year-old who was physically abused by his parents until he was 18, reports a history of PTSD symptoms beginning in his early 20’s. He experienced a heightened startle reflex to any sudden movement, avoidance of talking about the abuse he experienced, constant tenseness in his body, and significant anger with people in his life.
At around 17 years old, Bill began drinking alcohol to cope with the abuse he was experiencing at home. This led to alcohol charges for a minor for which he was placed in juvenile detention. He now drinks daily, generally at least twelve 16-oz cans of beer in a day, and has been arrested for disorderly conduct. He works infrequently but in the last three months has been unsuccessfully attempting to cut back on drinking and find regular work.
Bill agrees to complete an assessment with a local therapist who is trained in trauma and substance use treatment. The therapist diagnoses Bill with PTSD and an alcohol use disorder and informs Bill that they would like to try applying acceptance and commitment therapy (ACT) in their sessions. Bill’s therapist helps him by encouraging him to accept feelings or thoughts that come up during sessions; he hopes that Bill will begin to be able to do this at home, becoming accepting of himself in and out of session.
Bill and his therapist regularly practice mindful meditation and muscle relaxation in each session, especially if Bill’s therapist notices that he’s tense, talking about drinking cravings, or having difficulty calming his anger and anxiety in session. Over time, the therapist helps Bill to become more comfortable talking about the events of his past and his feelings. Bill begins to regularly engage in coping techniques independently in and out of session; he has begun to engage in more healthy self-expression instead of letting his anger explode onto others, and reducing his drinking as his avoidance symptoms have begun to reduce by using coping techniques.
4 At-Home CBT Exercises for PTSD
While it’s always best to find a licensed therapist if you’re experiencing PTSD symptoms, the therapist may recommend some at-home exercises to keep your symptoms under control.
Here are four CBT exercises you can use at home to reduce symptoms of PTSD:10
1. Try Practicing Cognitive Restructuring on Your Own
It can be helpful to challenge or reframe your thinking in the moment on a regular basis. It can be difficult, but it’s important to challenge negative thoughts as they come up. You can also start to notice when these thoughts come up to learn what may be triggering your PTSD symptoms.
2. Practice the ABC Technique
The ABC Model allows you to explore more about how or where a negative or maladaptive belief began.
Here are the first three steps:
- Identify the (A) activating event: The trigger that would lead to a significant emotional response or maladaptive thinking
- Identify the (B) belief: The negative thought that you experienced during this trigger or event
- Identify the (C) consequences: The negative emotions or actions that happened as a result of A & B
This gives you the chance to challenge your interpretation of the trigger or belief that influenced the consequences. By engaging in this practice in a journal, you can actively track the cognitive restructuring in a more structured manner, giving you the opportunity to challenge a belief or emotional response that may have started following a traumatic event.
3. Journaling
As a follow up, keeping a journal of your thoughts, feelings, and behaviors each day may be helpful. Through writing and monitoring your thoughts and beliefs, you may begin to learn more about yourself, about the ABC’s that may be a trigger for your PTSD symptoms. You may also identify ways that have helped manage your symptoms in the past.
4. Meditation & Progressive Body Relaxation
Meditation has become highly popular in the last few years in the physical and mental health fields. When dealing with PTSD symptoms, it may be common for you to struggle with constant tenseness in your body that you feel like you can’t release.
By engaging in guided meditations, guided breathing, grounding exercises, or guided progressive relaxation, you should be able to relax your body and maybe even your anxiety levels, especially if you’ve recently experienced a trigger.
