Cognitive Behavioral Therapy (CBT) is a structured, evidence-based form of psychotherapy that focuses on the relationship between thoughts, emotions, behaviors, and physical responses.
The basic idea is: What we think → influences how we feel → influences what we do → which can reinforce what we think.
CBT helps clients identify patterns that may be keeping them stuck and develop healthier, more effective ways of responding.
Situation → Thoughts → Feelings → Behaviors → Consequences
For example:
Situation:
A person doesn't respond to your text.
Thought:
"They're mad at me. I must have done something wrong."
Emotion:
Anxiety, sadness, rejection.
Behavior:
Repeatedly checking the phone or sending multiple messages.
Consequence:
Short-term relief may occur when they respond, but the anxiety can become reinforced.
CBT helps the client slow down this cycle and examine whether the thought is accurate, helpful, or based on an assumption.
CBT is commonly used because it gives clients practical skills they can use both inside and outside of therapy.
It can help people:
Cognitive Restructuring
Examining and challenging unhelpful thoughts. Instead of: "I'm a complete failure."
Working toward: "I made a mistake, but that doesn't mean I'm a failure."
Behavioral Activation
Encouraging meaningful or rewarding activities when depression or withdrawal has caused someone to stop engaging with life.
Exposure
Gradually approaching feared situations rather than consistently avoiding them.
Behavioral Experiments
Testing whether a person's prediction or belief actually happens.
Problem-Solving
Breaking overwhelming problems into manageable steps.
Skills & Homework
Clients may practice specific skills between sessions so therapy becomes something they apply, rather than something that only happens in the therapy room.
CBT Recap:
"What is happening?"
↓
"What are you thinking?"
↓
"What are you feeling?"
↓
"What are you doing?"
↓
"Is this pattern helping you or keeping you stuck?"
↓
"What could we try differently?"
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based therapy specifically designed to help children and adolescents who have experienced trauma, along with their non-offending caregivers.
TF-CBT combines cognitive-behavioral strategies with trauma-focused interventions to help young people process what happened, develop healthy coping skills, and reduce trauma-related symptoms.
The goal isn't to make the client forget the trauma.
It's to help them understand that what happened to them does not have to control how they feel, think, or function moving forward.
TF-CBT addresses the connection between:
Trauma → Thoughts → Emotions → Behaviors → Physical responses
Trauma can change the way a child understands themselves and the world.
For example:
Trauma:
A child experiences abuse.
Thought:
"I should have stopped it."
Emotion:
Shame, fear, guilt.
Behavior:
Avoidance, withdrawal, aggression, difficulty trusting others.
Trauma response:
The child continues to feel unsafe even when they are no longer in danger.
TF-CBT is commonly described using the PRACTICE components:
P — Psychoeducation & Parenting Skills: The therapist teaches the child and caregiver about trauma and trauma responses. Caregivers also learn strategies for supporting the child.
R — Relaxation: Children learn skills for managing physiological responses to stress.
Examples include:
A — Affect Modulation: Children learn to identify, understand, and regulate emotions.
C — Cognitive Coping: Children learn how thoughts influence feelings and behaviors.
They begin identifying thoughts such as:
"It was my fault." and working toward more accurate beliefs.
T — Trauma Narrative & Processing: The child gradually develops a narrative about their traumatic experience and processes the thoughts and emotions associated with it. This is an important part of TF-CBT—but it is not simply asking a child to repeatedly tell the story of their trauma.
I — In Vivo Mastery: When appropriate, the therapist helps the child gradually face trauma-related fears or avoided situations in a safe and structured way.
C — Conjoint Child-Parent Sessions: The child and caregiver may work together to communicate about the trauma and practice skills.
E — Enhancing Safety & Future Development: The therapist helps the child and caregiver develop strategies for recognizing danger, increasing safety, and moving forward. One important distinction between traditional CBT and TF-CBT is the active role of the caregiver.
The caregiver can help the child:
The caregiver also receives support and education because a child's recovery doesn't happen in isolation.
TF-CBT is specifically designed around the developmental needs of children and adolescents.
It recognizes that children may communicate trauma through:
TF-CBT helps children and adolescents process traumatic experiences, develop healthy coping skills, and change trauma-related thoughts and behaviors—with caregivers playing an important role in the healing process.
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