Trauma-focused CBT

Trauma-focused CBT works directly with the memory of a traumatic event, using a structured protocol to reduce flashbacks, avoidance and the constant sense of alertness that often follows trauma. NICE recommends it as a first-line treatment for post-traumatic stress disorder, delivered here online by an HCPC-registered clinical psychologist.

What trauma-focused CBT is and the evidence for it

Trauma-focused CBT, sometimes shortened to TF-CBT, adapts the core principles of cognitive behavioural therapy into a specific protocol for processing traumatic memories. NICE guideline NG116 recommends it as a first-line treatment for post-traumatic stress disorder in adults, alongside EMDR, and the evidence supporting it spans decades of controlled trials with consistently large effects on trauma symptoms.

The approach rests on a well-supported idea: traumatic memories that have not been fully processed keep intruding because the brain has not filed them away as belonging to the past. Revisiting the memory in a structured, supported way, together with updating the beliefs that formed around it, ‘it was my fault’, ’the world is not safe’, ‘I cannot cope’, allows the memory to be processed properly and lose much of the grip it has been holding. This is active, deliberate work rather than simply talking about what happened, and it asks more of you in the room than many other therapies, which is why the preparation phase matters so much before it begins.

Several specific protocols sit under the trauma-focused CBT umbrella, including prolonged exposure, which works through repeated, structured recounting of the memory, and cognitive processing therapy, which focuses more on the beliefs that formed around the event. Your psychologist selects the version, or the combination, that best fits your history and how you respond to the early sessions, rather than applying a single fixed template regardless of what you need.

What trauma-focused CBT helps with

Trauma-focused CBT has the strongest evidence for PTSD and trauma, including single-incident trauma such as an accident, an assault or a frightening medical experience, and repeated or complex trauma with the right pacing and preparation. Trauma connected to pregnancy, birth or loss is covered under our perinatal work, where an adapted version of this approach is sometimes used. Trauma-related panic, where specific past events appear to be driving current panic symptoms, can also respond well, since much of the underlying mechanism is the same unprocessed memory pattern.

What a course of trauma-focused CBT sessions looks like

Early sessions focus on stabilisation and preparation before any detailed trauma work begins: understanding your history, teaching grounding techniques, and making sure you have the tools to manage distress that might arise between sessions. This groundwork is not skipped, however keen you are to get started, because it makes the harder phase that follows safer and more effective.

The central phase involves recalling the traumatic memory in detail, usually through structured recounting or, in some protocols, writing, while your psychologist helps you process it and update unhelpful beliefs that formed around it, checking in with you closely throughout rather than leaving you to work through it alone. This is done gradually and always with your agreement, building up rather than starting with the most difficult material. A single traumatic event commonly responds within eight to twelve sessions including preparation. More complex or repeated trauma takes longer, reflecting more stabilisation work and, often, more than one memory to work through.

How trauma-focused CBT works online

The structured, conversation-based nature of trauma-focused CBT translates to video without much loss, and any written or diagrammatic exercises, a trauma timeline, a thought record, share easily on screen. Sessions run over secure video, usually fifty minutes, in a private room where you will not be interrupted, since concentration and a sense of safety both matter for this kind of work.

Being in a familiar space for detailed trauma recall suits some people particularly well, because you are not then travelling home afterwards feeling raw, and you have your own grounding resources close to hand if you need them after the session ends, whether that is a particular object, a piece of music or simply a quiet room to sit in. Your psychologist will agree a plan with you in advance for what to do if you feel very distressed after a session, whether online or in person.

Trauma-focused CBT and life in Islington

Detailed trauma work benefits from privacy and a settled environment more than almost any other therapy on this site, and for people in Islington that usually means a choice between a clinic visit bookended by a trip on the Victoria or Northern line, or a session at home in N1 where you can close the laptop afterwards and stay exactly where you are. Many people find the second option makes the harder parts of this work considerably more manageable.

Who trauma-focused CBT may not suit right now

This approach is not usually the right starting point where there is significant ongoing danger, active dependence on alcohol or drugs used to manage distress, or a recent period of high risk, since stabilisation needs to come first in those situations. If detailed recall of the memory feels too much to consider at the moment, EMDR is worth discussing as an alternative, since it works with the memory without requiring a full verbal account. Your psychologist will talk through both options with you honestly at assessment, and there is no requirement to commit to one approach before that conversation has happened.

If you need support right now

Trauma-focused CBT is not a crisis service. If you are thinking about ending your life or harming yourself, please call 999, call NHS 111 and select the mental health option, or contact the Samaritans free, any time, on 116 123.

Getting started

Trauma-focused CBT here is delivered online. If a distressing memory keeps intruding on your present, our get started page is the quickest way to tell us what has been going on.