Trauma-focused CBT

What is trauma-focused CBT?

Trauma-focused cognitive behavioural therapy (TF-CBT) is a structured talking therapy that helps adults process distressing or traumatic experiences and reduce the symptoms that follow them, such as flashbacks, nightmares, avoidance and heightened anxiety. It combines standard CBT techniques with methods designed specifically to work through traumatic memories safely.

The trauma-focused element means sessions centre on the specific memory or memories causing difficulty, rather than staying general. In practice this usually includes psychoeducation about how trauma affects the brain and body, practical techniques for managing distressing memories and physical symptoms as they arise, and structured work on processing the memory itself, at a pace agreed between you and your psychologist. Some people come to this therapy soon after a difficult event, others years later, once symptoms have settled into a pattern that is hard to shift alone.

How it differs from general counselling

General counselling and talking therapies can be useful for working through the impact of a difficult period, but trauma-focused CBT is a more structured, time-limited approach with a specific target: the traumatic memory and the beliefs and reactions attached to it. Sessions follow an agreed plan rather than an open-ended conversation, and progress is reviewed as you go.

When it helps

Trauma-focused CBT is most commonly used for post-traumatic stress disorder (PTSD), including reactions to a single distressing event such as an accident, assault, bereavement or medical emergency. It is also used, sometimes with adaptation, for people affected by repeated or prolonged difficult experiences over time. Not everyone who lives through something frightening or distressing develops PTSD, and this therapy is aimed at people still experiencing ongoing symptoms, whether or not they have a formal diagnosis. Common signs include intrusive memories or images, avoidance of reminders, low mood, irritability, poor sleep and a sense of being constantly on edge.

It is also worth knowing that trauma-focused CBT sits alongside eye movement desensitisation and reprocessing (EMDR) as a recommended approach, and a psychologist can help you think through which fits your situation, rather than assuming one size fits all.

What to expect

Sessions take place online by secure video call, usually weekly, and typically last around fifty minutes, though sessions involving detailed memory work sometimes run longer. Early sessions focus on understanding your history and current difficulties, and on building a shared plan and some grounding and coping strategies before any detailed work on the memory itself begins. You stay in control of the pace throughout treatment, and your psychologist will explain each stage and check in with you before moving forward.

Because trauma-focused CBT works directly with difficult memories, it typically starts more gradually than standard CBT for anxiety or low mood, with extra time spent on stabilising skills such as grounding, breathing and managing distress before any detailed memory work begins. This groundwork is not a delay tactic. It gives you tools to draw on during the more demanding sessions later, and a psychologist will only move into detailed processing once you feel ready and have agreed the plan together.

Between sessions you may be asked to practise specific strategies or to notice patterns in symptoms, which are then discussed at the next appointment. Treatment length varies by individual, though many courses of trauma-focused CBT run for somewhere around eight to twelve sessions, sometimes fewer or more depending on the nature and history of the difficulty.

Will it make things worse before it gets better?

People sometimes worry that revisiting a difficult memory in detail will make things worse rather than better. Some short-term increase in distress during active memory work is common and expected, and is discussed openly as part of treatment rather than treated as a sign something has gone wrong. Your psychologist will monitor how you are managing at each stage and adjust the pace if needed, and sessions end with time to settle before you go back to the rest of your day.

If your experiences involve thoughts of self-harm or suicide, or you are in crisis right now, please note this is not a crisis service. The Samaritans offer free, confidential support any time, day or night, on 116 123.

The evidence for trauma-focused CBT

Trauma-focused CBT is recommended by the National Institute for Health and Care Excellence (NICE) as a first-line treatment for PTSD in adults, alongside EMDR. This recommendation rests on a substantial body of clinical trial evidence showing that structured, trauma-focused approaches reduce PTSD symptoms more reliably for many people than general supportive counselling or medication used alone. Research on remotely delivered CBT for trauma and anxiety-related difficulties has also found outcomes broadly comparable to in-person sessions for many people, which supports offering this therapy by video call.

As with any therapy, individual outcomes vary, and how much someone improves depends on factors including the nature of the trauma, how long symptoms have been present and what other support is in place. A psychologist will discuss what is realistic for your particular circumstances rather than promising a fixed outcome.

Working with us online

We are clinical psychologists for Maidstone and Kent, working online with adults, including those in Bearsted, Allington, Barming, Loose, Penenden Heath and Tovil. Sessions are held entirely by secure video call, so where you live within Kent, or how close you are to Maidstone East or Maidstone West station, makes no difference to whether you can access this therapy. This suits people who want appointments that fit around work, caring responsibilities or a Week Street lunch break, without travel time built in either side.

Before starting trauma-focused CBT, you will have an initial conversation to talk through what has happened and what you are hoping for, so that treatment can be tailored to you rather than following a fixed script. We will update this site as the practice develops.

Frequently asked questions

A handful of specific questions come up often before people start trauma-focused CBT, covering diagnosis, memory, pacing and what to expect if things feel harder before they feel easier. These are answered in full below.