[2][3] The goal of TF-CBT is to provide psychoeducation to both the victim and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors.
Generally, the amygdala, or the "fear center" of the brain, is hyper-responsive, and the prefrontal cortex, which is involved in processing, decision making, and down-regulation, is less active, or even reduced in volume.
This component assists the child in becoming more comfortable or knowledgeable regarding the expression of feelings and thoughts, so that they may practice and develop skills in order to manage their stress response.
[2] During the child therapy sessions, the therapist focuses on relaxation training such as deep breathing and muscle relaxation skills, emotion regulation (identifying feelings), a trauma narrative and processing (discussing the overwhelming events and associated feelings), as well as cognitive coping strategies (identifying and replacing negative thoughts).
[20] These sessions are important in helping the caregiver use and model specific coping skills for their own psychopathology for their child to show how they can manage their own symptoms.
[21] During the conjoint sessions, the therapist shares the trauma narratives and challenges to incorrect/negative thoughts as a means to encourage and facilitate parent-child communication.
[24] Randomized clinical trials examining the efficacy of TF-CBT have found it to be an effective treatment plan for a variety of disorders in both children and adolescents.
[31] TF-CBT can be delivered by a variety of mental health professionals ranging from clinical social workers, counselors to psychologists and psychiatrists.
[35] Since its development in the 1980s, TF-CBT has been used by therapists in many countries such as Australia, Cambodia, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Pakistan, Sweden, United States, and Zambia.
[36] In some US states, implementation has been done in collaboration with the Substance Abuse and Mental Health Services Administration National Child Traumatic Stress Network.
[35] It has also been used with children in the foster care system, with those who have suffered from traumatic life events, including the 9-11 terrorist attacks, and those who experienced Hurricane Katrina.
[38] Because TF-CBT can be implemented by local lay counselors, it makes it a feasible mental health resource option in low and middle income countries, or in areas with low-resources.
[41] These persistent experiences of traumatization impact a child's ability to form primary attachments, which may lead to an array of difficulties and is often referred to as "complex trauma.
"[41] Complex trauma has sometimes been viewed as more difficult to treat, as its characterized by heightened levels of affective dysregulation, difficulties with attachment security, dissociation, and a fragmented sense of self.
[10] In the United States, the concept of complex trauma is recognized, but it is not considered a distinct diagnosis based on the text revised version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR).
[42] Countries other than the United States who use the International Classification of Diseases (ICD) have recently recognized complex PTSD (CPTSD) as its own disorder in the ICD-11 revised edition.
[43] The benefits of its inclusion in the ICD-11 are that it may lend to more individualized treatments that better address the nature of the trauma, as well as contribute to the research pool surrounding stress-related disorders.
[43] Some listed challenges, especially in light of its consideration to be added to the DSM-5, were that complex trauma may function better as a purely dimensional disorder, which is not reflective of the current diagnostic system, and that there is not enough identified psychometric properties to warrant its inclusion.