Issue brief

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

Child Welfare Information Gateway

Children’s Bureau/ACYF

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

703.385.7565 or 800.394.3366

Email: info@childwelfare.gov

www.childwelfare.gov

Trauma-Focused Cognitive 

Behavioral Therapy: 

Addressing the Mental 

Health of Sexually 

Abused Children

May 2007

Promising Practices in 

Child Welfare

This issue brief was developed by 

Child Welfare Information Gateway, 

in partnership with the Chadwick 

Center for Children and Families at 

Rady Children’s Hospital San Diego. 

Contributing authors include Judith 

Cohen, M.D., Esther Deblinger, 

Ph.D., Anthony P. Mannarino, 

Ph.D., Charles Wilson, M.S.S.W., 

Nicole Taylor, Ph.D., and Robyn 

Igelman, Ph.D.

The conclusions discussed here 

are solely the responsibility of the 

authors and do not represent the 

official views or policies of the 

funding agency. The Children’s 

Bureau does not endorse any 

specific treatment or therapy.

What’s Inside:

What makes TF‐CBT unique

Key components 

Target population

Effectiveness of TF‐CBT

What to look for in a therapist

Resources for further information

•

•

•

•

•

•
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Trauma-focused cognitive behavioral therapy 

(TF‐CBT) is an evidence-based treatment 

approach shown to help children, adolescents, 

and their caretakers overcome trauma-related 

difficulties. It is designed to reduce negative 

emotional and behavioral responses following 

child sexual abuse and other traumatic 

events. The treatment—based on learning 

and cognitive theories—addresses distorted 

beliefs and attributions related to the abuse 

and provides a supportive environment in 

which children are encouraged to talk about 

their traumatic experience. TF‐CBT also 

helps parents who were not abusive to cope 

effectively with their own emotional distress 

and develop skills that support their children. 

This issue brief is intended to build a better 

understanding of the characteristics and 

benefits of TF‐CBT. It was written primarily 

to help child welfare caseworkers and other 

professionals who work with at-risk families 

make more informed decisions about when to 

refer children and their parents and caregivers 

to TF‐CBT programs. This information also 

may help biological parents, foster parents, 

and other caregivers understand what they 

and their children can gain from TF‐CBT and 

what to expect during treatment. In addition, 

this issue brief may be useful to others with 

an interest in implementing or participating 

in effective strategies for the treatment of 

children who have suffered from sexual abuse 

or other childhood traumas. 

	 While TF‐CBT is effective in addressing the effects of

traumatic events (e.g., the loss of a loved one, domestic or

community violence, accidents, hurricanes, terrorist attacks, etc.),

the focus of this issue brief is the treatment of sexual abuse.

Another issue brief in this series addresses abuse-focused

cognitive behavioral therapy (AF-CBT) for the treatment of

physical child abuse.

What Makes TF‐CBT Unique

TF‐CBT addresses the negative effects of 

sexual abuse and other traumatic events by 

integrating several therapeutic approaches 

and treating both child and parent in a 

comprehensive manner.

Addresses the Effects of Sexual 

Abuse and Trauma

In the immediate as well as long-term 

aftermath of sexual abuse, children are at 

risk of developing significant emotional and 

behavioral difficulties (see, for example, 

Briere & Elliott, 2003; Berliner & Elliott, 2002; 

Chadwick Center, 2004). For example, victims 

of sexual abuse often experience:

Maladaptive or unhelpful beliefs and 

attributions related to the abusive events, 

including: 

A sense of guilt for their role in the abuse 

Anger at parents for not knowing about 

the abuse 

Feelings of powerlessness 

A sense that they are in some way 

“damaged goods”

A fear that people will treat them 

differently because of the abuse

Acting out behaviors, such as engaging in 

age-inappropriate sexual behaviors

Mental health disorders, including major 

depression

Posttraumatic stress disorder (PTSD). 

PTSD symptoms are characterized by: 

•

○

○

○

○

○

•

•

•
Trauma-Focused Cognitive Behavioral Therapy

 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

Intrusive and reoccurring thoughts of the 

traumatic experience 

Avoidance of reminders of the trauma 

(often places, people, sounds, smells, 

and other sensory triggers) 

Emotional numbing 

Irritability 

Trouble sleeping or concentrating

Physical and emotional hyperarousal 

(often characterized by emotional 

swings or rapidly accelerating anger or 

crying that is out of proportion to the 

apparent stimulus)

These symptoms can impact the child’s 

daily life and affect behavior, school 

performance, attention, self-perception, 

and emotional regulation. 

To date, numerous studies have documented 

the effectiveness of TF‐CBT in helping 

children overcome these and other symptoms 

following child sexual abuse and similar 

traumatic experiences (e.g., Deblinger, 

Lippman, & Steer, 1996; Cohen & Mannarino, 

1996a, 1996b, 1998a, 1998b; Deblinger, 

Stauffer, & Steer, 2001; Cohen, Deblinger, 

Mannarino, & Steer, 2004). The program helps 

children to process the traumatic memories, 

overcome problematic thoughts and 

behaviors, and develop effective coping and 

interpersonal skills. (See also Effectiveness of 

TF‐CBT, below.)

Treats Nonoffending Parents in 

Addition to the Child

Recognizing the importance of parental 

support in the child’s recovery process, 

TF‐CBT includes a treatment component 

for parents (or caregivers) who were not 

○

○

○

○

○

○

abusive. Children and parents first participate 

separately in therapy and then attend several 

joint child-parent sessions. The parent 

component teaches stress management, 

parenting, and communication skills. As a 

result, parents are better able to address their 

own emotional distress associated with the 

child’s trauma, while also supporting their 

children more effectively. 

Integrates Several Established 

Treatment Approaches

TF‐CBT combines elements drawn from:

Cognitive therapy, which aims to change 

behavior by addressing a person’s thoughts 

or perceptions, particularly those thinking 

patterns that create distorted views

Behavioral therapy, which focuses on 

modifying habitual responses (e.g., anger, 

fear) to identified situations or stimuli

Family therapy, which examines patterns 

of interactions among family members to 

identify and alleviate problems

TF‐CBT uses well-established cognitivebehavioral therapy and stress management 

procedures originally developed for the 

treatment of fear, anxiety, and depression 

in adults (Wolpe, 1969; Beck, 1976). These 

procedures have been used with adult 

rape victims with symptoms of PTSD (Foa, 

Rothbaum, Riggs, & Murdock, 1991) and have 

been applied to children with problems with 

excessive fear and anxiety (Beidel & Turner, 

1998). The TF‐CBT protocol has adapted 

and refined these procedures to target the 

specific difficulties exhibited by children who 

are experiencing PTSD symptoms in response 

to sexual abuse or other childhood traumas. 

In addition, well-established parenting 

•

•

•
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

approaches (e.g., Patterson, 2005; Forehand 

& Kotchick, 2002) also are incorporated into 

treatment to guide parents in addressing their 

children’s behavioral difficulties. 

Successful in Various 

Environments and Appropriate 

for Multiple Traumas

TF‐CBT has been implemented successfully in 

urban, suburban, and rural environments and 

has demonstrated success with Caucasian, 

African-American, and Hispanic children 

from all socioeconomic environments. It 

has been adapted for Latino and hearingimpaired populations. In addition, recent 

research findings suggest that TF‐CBT may 

be preferable to less directive treatment 

approaches for children who have a history of 

multiple traumas (e.g., sexual abuse, exposure 

to domestic violence, physical abuse, as well 

as other traumas) and those with high levels 

of depression prior to treatment (Deblinger, 

Mannarino, Cohen, & Steer, in press). The 

model also has been tested with children 

who are experiencing traumatic grief after the 

death of a loved one (Cohen, Mannarino, & 

Knudsen, 2004; Cohen, Mannarino, & Staron, 

in press). 

Key Components

TF‐CBT is a short-term treatment typically 

provided in 12 to 18 sessions of 60 to 90 

minutes or longer, depending on treatment 

needs. The intervention is typically provided 

in outpatient mental health facilities, but it has 

been used in hospital, group home, school, 

community, and in-home settings. 

The treatment involves individual sessions 

with the child and parent (or caregiver) 

separately and joint sessions with the child 

and parent together. Each individual session is 

designed to build the therapeutic relationship 

while providing education, skills, and a 

safe environment in which to address and 

process traumatic memories. Joint parentchild sessions are designed to help parents 

and children practice and use the skills they 

learned, while also fostering more effective 

parent-child communication about the abuse 

and related issues. 

Goals

Generally, the goals of TF‐CBT are to:

Reduce children’s negative emotional and 

behavioral responses to the sexual abuse

Correct maladaptive or unhelpful beliefs 

and attributions related to the abusive 

experience (e.g., a belief that the child is 

responsible for the abuse)

Provide support and skills to help 

nonoffending parents cope effectively with 

their own emotional distress

Provide nonoffending parents with skills 

to respond optimally to and support 

their children

Protocol Components

Components of the TF‐CBT protocol can be 

summarized by the word “PRACTICE”:

P - Psychoeducation and Parenting 

skills—Discussion and education about 

child abuse in general and the typical 

emotional and behavioral reactions to 

sexual abuse. Training for parents in child 

•

•

•

•

•
Trauma-Focused Cognitive Behavioral Therapy

 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

behavior management strategies and 

effective communication.

R - Relaxation techniques—Teaching 

relaxation methods, such as focused 

breathing, progressive muscle relaxation, 

and thought stopping.

A - Affective expression and regulation—

Helping the child and parent manage 

their emotional reactions to reminders 

of the abuse, improve their ability to 

express emotions, and participate in 

self-soothing activities.

C - Cognitive coping and processing—

Exploration and correction of inaccurate 

attributions about the cause of, 

responsibility for, and results of the 

abusive experience(s).

T - Trauma narrative—Gradual exposure 

exercises, including verbal, written, or 

symbolic recounting of abusive events.

I - In vivo exposure—Gradual exposure 

to nonthreatening trauma reminders in the 

child’s environment (for example, basement, 

darkness, school), so the child learns to 

control his or her own emotional reactions.

C - Conjoint parent/child sessions—Family 

work to enhance communication and create 

opportunities for therapeutic discussion 

regarding the abuse.

E - Enhancing personal safety and 

future growth—Education and training 

on personal safety skills, interpersonal 

relationships, and healthy sexuality; 

encouragement in the use of new 

skills in managing future stressors and 

trauma reminders. 

•

•

•

•

•

•

•

Target Population

TF‐CBT is most appropriate for use with 

sexually abused children ages 3 to 18 and 

parents or caregivers who did not participate 

in the abuse.

Appropriate Populations for Use 

of TF‐CBT

Appropriate candidates for this program 

include: 

Children and adolescents with a history of 

sexual abuse who:

Experience PTSD 

Show clinically significant levels of 

depression, anxiety, shame, or other 

dysfunctional abuse-related feelings, 

thoughts, or developing beliefs

Demonstrate behavioral problems, 

especially age-inappropriate 

sexual behaviors

Children and adolescents who have been 

exposed to other childhood traumas (e.g., 

exposure to domestic violence, traumatic 

loss of a loved one)

Nonoffending parents (or caregivers) of the 

victims of sexual abuse or trauma

Meaningful assessment is important in 

selecting which children may benefit 

from TF‐CBT and to inform the focus of 

the intervention. The assessment should 

specifically address PTSD, depressive and 

anxiety symptoms, and sexually inappropriate 

behaviors, as these have been found to be 

most responsive to TF‐CBT in multiple studies. 

•

○

○

○

•

•
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Limitations for Use of TF‐CBT

TF‐CBT may not be appropriate or may need 

to be modified for:

Children and adolescents whose primary 

problems include conduct problems or 

other significant behavioral problems that 

existed prior to the trauma, and who may 

respond better to an approach that focuses 

on overcoming these problems first.

Children who are acutely suicidal or who 

actively abuse substances. The gradual 

exposure component of TF‐CBT may 

temporarily worsen symptoms. However, 

other components of TF‐CBT have 

been used successfully to address these 

problems. It may be that for these children, 

the pace or order of TF‐CBT interventions 

needs to be modified (as has been done in 

the Seeking Safety model; Najavits, 2002), 

rather than that TF‐CBT is contraindicated 

for these populations. 

Adolescents who have a history of running 

away, cutting themselves, or engaging 

in other parasuicidal behavior. For these 

teens, a stabilizing therapy approach such 

as dialectical behavior therapy (Linehan, 

1993) may be useful prior to integrating 

TF‐CBT into treatment.

Effectiveness of TF‐CBT

The effectiveness of TF‐CBT is supported 

by outcome studies and recognized 

on inventories of model and promising 

treatment programs.

•

•

•

Demonstrated Effectiveness in 

Outcome Studies

To date, at least eight empirical investigations 

have been conducted evaluating the impact 

of TF‐CBT (Cohen & Mannarino 1996a; 

Deblinger et al., 1996; Stauffer & Deblinger, 

1996; Cohen & Mannarino 1997; Deblinger, 

Steer, & Lippmann, 1999; King et al., 2000; 

Deblinger et al., 2001; Cohen, Deblinger, 

et al., 2004). The findings consistently 

demonstrate TF‐CBT to be useful in reducing 

symptoms of PTSD, as well as symptoms 

of depression and behavioral difficulties in 

children who have experienced sexual abuse 

and other traumas. In randomized clinical trials 

comparing TF‐CBT to other tested models 

and services as usual (such as supportive 

therapy, nondirective play therapy, childcentered therapy), TF‐CBT resulted in greater 

gains in fewer clinical sessions. Follow-up 

studies (up to 2 years following the conclusion 

of therapy) have shown that these gains are 

sustained over time.

Studies reveal that more than 80 percent 

of children show marked improvement in 

symptoms within 12 to 16 sessions (using 

one 60- to 90-minute session per week). The 

children typically:

Experience significantly fewer intrusive 

thoughts and avoidance behaviors

Are able to cope with reminders and 

associated emotions

Show reductions in depression, 

anxiety, disassociation, behavior 

problems, sexualized behavior, and 

trauma-related shame 

Demonstrate improved interpersonal trust 

and social competence

•

•

•

•
Trauma-Focused Cognitive Behavioral Therapy

 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

Develop improved personal safety skills 

Become better prepared to cope with 

future trauma reminders (Cohen et al., 2004)

Research also demonstrates a positive 

treatment response for parents (Cohen, 

Berliner, & Mannarino 2000; Deblinger et 

al., 1996). In TF‐CBT studies, parents often 

report reduced depression, emotional distress 

associated with the child’s trauma, and PTSD 

symptoms. They also report an enhanced 

ability to support their children (Deblinger et 

al., 2001; Cohen, Deblinger, et al., 2004).

Recognition as an EvidenceBased Practice 

Based on systematic reviews of available 

research and evaluation studies, several 

groups of experts and Federal agencies have 

highlighted TF‐CBT as a model program or 

promising treatment practice. This program is 

featured in the following sources:

Closing the Quality Chasm in Child Abuse 

Treatment: Identifying and Disseminating 

Best Practices (Chadwick Center, 2004)

www.chadwickcenter.org/Documents/

Kaufman%20Report/ChildHospNCTAbrochure.pdf

The National Child Traumatic Stress 

Network (Empirically Supported Treatments 

and Promising Practices, supported by 

The Substance Abuse and Mental Health 

Services Administration (SAMHSA), 2005)

www.nctsnet.org/nccts/nav.do?pid=ctr_

top_trmnt_prom

Child Physical and Sexual Abuse: 

Guidelines for Treatment (Saunders, 

Berliner, & Hanson, Eds., National Crime 

Victims Research and Treatment Center 

and The Center for Sexual Assault and 

•

•

•

•

•

Traumatic Stress; Office for Victims of 

Crime, U.S. Department of Justice, 2004)

www.musc.edu/ncvc/resources_prof/OVC_

guidelines04-26-04.pdf

The California Evidence-Based 

Clearinghouse for Child Welfare (2006)

www.cachildwelfareclearinghouse.org/

SAMHSA Model Programs: National 

Registry of Evidence-based Programs 

and Practices

www.modelprograms.samhsa.gov

What to Look for in a Therapist

Caseworkers should become knowledgeable 

about commonly used treatments before 

recommending a treatment provider to 

families. Parents or caregivers should receive 

as much information as possible about the 

treatment options available to them. If TF‐CBT 

appears to be an appropriate treatment model 

for a family, the caseworker should look for a 

provider who has received adequate training, 

supervision, and consultation in the TF‐CBT 

model. If feasible, both the caseworker and 

the family should have an opportunity to 

interview potential TF‐CBT therapists prior to 

beginning treatment.

TF‐CBT Training

TF‐CBT training sessions are appropriate 

for therapists and clinical supervisors with 

a master’s degree or higher in a mental 

health discipline, experience working with 

children and families, and knowledge of child 

sexual abuse dynamics and child protection. 

Therapists may benefit from sequential 

exposure to different types of training:

•

•
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Reading the program developer’s treatment 

book(s) and related materials

Participating in intensive skills-based 

training for 1 to 2 days

Receiving ongoing expert consultation from 

trainers for 6 months

Participating in advanced TF‐CBT training 

for 1 to 2 days

See Training and Consultation Resources, 

below, for contact information.

Questions to Ask Treatment 

Providers

In addition to appropriate training and 

thorough knowledge of the TF‐CBT model, 

it is important to select a treatment provider 

who is sensitive to the particular needs of 

the child, caregiver, and family. Caseworkers 

recommending a TF‐CBT therapist should ask 

the treatment provider to explain the course 

of treatment, the role of each family member 

in treatment, and how the family’s specific 

cultural considerations will be addressed. 

The child, caregiver, and family should feel 

comfortable with and have confidence in the 

therapist with whom they will work.

Some specific questions to ask regarding 

TF‐CBT include: 

What is the nature of the therapist’s TF‐CBT 

training (when trained, by whom, length of 

training, access to follow-up consultation, 

etc.)? Are they clinically supervised by (or 

did they participate in a peer supervision 

group for private practice therapists with) 

others who are TF‐CBT trained?

Is there a standard assessment process 

used to gather baseline information on 

the functioning of the child and family 

•

•

•

•

•

•

and to monitor their progress in treatment 

over time?

What techniques will the therapist use to 

help the child manage his or her emotions 

and related behaviors?

How and when will the therapist ask the 

child to describe the trauma?

Will the therapist use a combination of 

individual and joint child-parent sessions?

Is the practitioner sensitive to the cultural 

background of the child and family?

Is there any potential for harm associated 

with treatment?

Conclusion

TF‐CBT is an evidence-based treatment 

approach for children who have experienced 

sexual abuse or similar traumas. Despite 

the impressive level of empirical support for 

TF‐CBT and an established publication track 

record, many professionals remain unaware 

of its advantages, and many children and 

parents who could benefit do not receive 

such treatment. Further, in many communities 

around the nation, there may not yet be 

any TF‐CBT trained therapists. The current 

demand for such evidence-based treatments, 

however, will encourage other professionals to 

acquire the needed training and to implement 

the TF‐CBT model. Increased availability 

of TF‐CBT, along with increased awareness 

among those making treatment referrals, can 

offer significant results in helping children to 

process their trauma and overcome emotional 

and behavioral problems following sexual 

abuse and other childhood traumas.

•

•

•

•

•
Trauma-Focused Cognitive Behavioral Therapy

 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

Resources for Further Information

References Cited

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Oxford, England: International 

Universities Press.

Beidel, D. C., & Turner, S. M. (1998). Shy children, phobic adults: Nature and treatment of social 

phobia. Washington, DC: American Psychological Association.

Berliner, L., & Elliott, D. M. (2002). Sexual abuse of children. In J. E. B. Myers, L. Berliner, J. Briere, 

C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 

55-78). Thousand Oaks, CA: Sage Publications.

Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood 

physical and sexual abuse in a general population sample of men and women. Child Abuse & 

Neglect, 27, 1205-1222.

Chadwick Center. (2004). Closing the quality chasm in child abuse treatment: Identifying and 

disseminating best practices. San Diego, CA: Author.

Cohen, J. A., Berliner, L. & Mannarino, A. P. (2000). Treatment of traumatized children: A review 

and synthesis. Journal of Trauma, Violence and Abuse, 1(1), 29-46.

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. (2004). A multisite, randomized controlled 

trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy 

of Child & Adolescent Psychiatry, 43, 393-402.

Cohen, J. A., & Mannarino, A. P. (1996a). A treatment outcome study for sexually abused preschool 

children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 

35(1), 42-50.

Cohen, J. A., & Mannarino, A. P. (1996b). Factors that mediate treatment outcome in sexually 

abused preschool children. Journal of the American Academy of Child and Adolescent 

Psychiatry, 35(10), 1402-1410.

Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: 

Outcome during one year follow-up. Journal of the American Academy of Child and Adolescent 

Psychiatry, 36(9), 1228-1235.
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

10 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Cohen, J. A., & Mannarino, A. P. (1998a). Interventions for sexually abused children: Initial 

treatment findings. Child Maltreatment, 3(1), 17-26.

Cohen, J. A., & Mannarino, A. P. (1998b). Factors that mediate treatment outcome in sexually 

abused preschool children: Six and 12-month follow-up. Journal of the American Academy of 

Child and Adolescent Psychiatry, 37(1), 44-51.

Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004) Treating childhood traumatic grief: A pilot 

study. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1225-1233.

Cohen, J. A., Mannarino, A. P., & Staron ,V. (In press). A pilot study of modified cognitive 

behavioral therapy for childhood traumatic grief (CBT-CTG). Journal of the American Academy 

of Child & Adolescent Psychiatry.

Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic 

stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310-321. 

Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (In press). A multisite, randomized 

controlled trial for children with sexual abuse-related PTSD symptoms: Examining predictors of 

treatment response. Journal of the American Academy of Child and Adolescent Psychiatry.

Deblinger, E., Stauffer, L., & Steer, R. (2001). Comparative efficacies of supportive and cognitive 

behavioral group therapies for children who were sexually abused and their nonoffending 

mothers. Child Maltreatment 6(4), 332-343.

Deblinger, E., Steer, R. A., & Lippmann, J. (1999). Two year follow-up study of cognitive behavioral 

therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse and 

Neglect, 23(12), 1371-1378. 

Foa, E., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic 

stress disorder in rape victims: A comparison between cognitive-behavioral procedures and 

counseling. Journal of Consulting & Clinical Psychology, 59(5), 715-723.

Forehand, R., & Kotchick, B. A. (2002). Behavioral parent training: Current challenges and potential 

solutions. Journal of Child & Family Studies, 11(4), 377-384.

King, N., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., et al. (2000). Treating 

sexually abused children with post-traumatic stress symptoms: A randomized clinical trial. 

Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1347-1355. 

Linehan, M. M. (1993). Cognitive-behavioral therapy for borderline personality disorder. New York: 

The Guildford Press. 
Trauma-Focused Cognitive Behavioral Therapy

11 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

Najavits, L. M. (2002). Treatment of posttraumatic stress disorder and substance abuse: Clinical 

guidelines for implementing Seeking Safety therapy. Alcoholism Treatment Quarterly, 22(1), 

43-62.

Patterson, G. R. (2005). The next generation of PMTO models. Behavior Therapist, 28(2), 27-33.

Saunders, B. E., Berliner, L., & Hanson, R. F. (Eds.) (2003). Child physical and sexual abuse: 

Guidelines for treatment (Final Report: January 15, 2003). Charleston, SC: National Crime 

Victims Research and Treatment Center.

Stauffer, L., & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their 

young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 

1(1), 65-76.

Wolpe, J. (1969). Basic principles and practices of behavior therapy of neuroses. American Journal 

of Psychiatry, 125(9), 12-42-1247.

Other References

Cohen, J. A., Berliner, L. & March, J. S. (2000). Treatment of children and adolescents. In E. B. Foa, 

T. M. Keane, & M. J. Friedman (Eds.), Effective treatment for PTSD (pp. 106-138). New York: 

Guilford Press. 

Cohen, J. A., & Mannarino, A. P. (1993). A treatment model for sexually abused preschoolers. 

Journal of Interpersonal Violence, 8(1), 115-131.

Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive 

behavioral therapy: An empirical update. Journal of Interpersonal Violence, 15(11), 1203-1223.

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2003) Child and parent trauma-focused cognitive 

behavioral therapy manual.

Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005) Treating sexually abused children: One year 

follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-146.

Deblinger, E., Behl, L., & Glickman, A. (2006). Treating children who have experienced sexual 

abuse. In P. Kendall (Ed.), Child and adolescent therapy, third edition. New York: Guildford 

Publications, Inc. 

Deblinger, E., Hathaway, C. R., Lippmann, J., & Steer, R. (1993). Psychosocial characteristics and 

correlates of symptom distress in nonoffending mothers of sexually abused children. Journal of 

Interpersonal Violence, 8(2), 155-168.
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

12 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Deblinger, E., & Heflin, A. H. (1996). Treating sexually abused children and their nonoffending 

parents: A cognitive behavioral approach. Newbury Park, CA: Sage Publications.

Deblinger, E., Kolar, R., & Ryan, E. (2006). Trauma in childhood. In V. Follette & J. Ruzek (Eds.), 

Cognitive-behavioral therapies for trauma. New York: Guilford Publications. 

Deblinger, E., McLeer, S. V., & Henry, D. (1990). Cognitive behavioral treatment for sexually abused 

children suffering post-traumatic stress: Preliminary findings. Journal of the American Academy 

of Child and Adolescent Psychiatry, 29,747-752.

Feiring, C., Taska, L., & Chen, K. (2002). Trying to understand why horrible things happen: 

Attribution, shame, and symptom development following sexual abuse. Child Maltreatment, 

7(1), 26-41.

Finkelhor, D., & Berliner, L. (1995). Research on the treatment of sexually abused children: A review 

and recommendations. Journal of the American Academy of Child and Adolescent Psychiatry, 

34(11), 1408-1422.

McLeer, S. V., Deblinger, E., Henry, D., & Orvashel, H. (1992). Sexually abused children at high risk 

for PTSD. Journal of the American Academy of Child and Adolescent Psychiatry, 31(5): 875-879.

Reynolds, C. R., & Richmond, B. O. (1985). Revised Children’s Manifest Anxiety Scale manual. Los 

Angeles, CA: Western Psychological Services.

Runyon, M. K., Ryan, E., Kolar, R., & Deblinger, E. (2004). Cognitive-behavioral treatment of child 

physical abuse: Developing an integrated parent-child approach. Trauma, Violence, & Abuse: A 

Review Journal, 5, 65-85. 

Internet Resources

Center for Traumatic Stress in Children & Adolescents 

www.pittsburghchildtrauma.com

Medical University of South Carolina

Guidelines for Treatment of Physical and Sexual Abuse of Children

www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf

Chadwick Center for Children and Families

Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices

www.chadwickcenter.org/Documents/Kaufman%20Report/ChildHosp-NCTAbrochure.pdf
Trauma-Focused Cognitive Behavioral Therapy

13 This material may be freely reproduced and distributed. However, when doing so, please credit

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

www.childwelfare.gov

National Child Traumatic Stress Network

Empirically Supported Treatments and Promising Practices 

www.nctsnet.org/nccts/nav.do?pid=ctr_top_trmnt_prom

University of Medicine & Dentistry of New Jersey, School of Osteopathic Medicine

CARES Institute

www.caresinstitute.org

SAMHSA Model Programs

National Registry of Evidence-Based Programs and Practices 

www.modelprograms.samhsa.gov

The California Evidence-Based Clearinghouse for Child Welfare

www.cachildwelfareclearinghouse.org/

Training and Consultation Resources

Web-Based Training

Medical University of South Carolina (MUSC). Distance learning course on TF‐CBT:

www.musc.edu/tfcbt

Web-based training in TF‐CBT is available as an adjunct or precursor to attending training 

workshops. The website training may be accessed free of charge. Therapists typically benefit from 

a 1- to 3-day intensive initial training course, as well as advanced training seminars after some 

experience implementing the model. Access to written resources such as books and treatment 

manuals (listed below), ongoing consultation or clinical mentoring, and regular clinical supervision 

are important complements to any web-based training. 

Onsite Training Contacts

Judith Cohen, M.D.

Center for Traumatic Stress in Children & Adolescents 

Allegheny General Hospital

Pittsburgh, PA

Phone: 412.330.4321 

Email: JCohen1@wpahs.org

Anthony P. Mannarino, Ph.D.

Center for Traumatic Stress in Children & Adolescents 

Allegheny General Hospital

Pittsburgh, PA

Phone: 412.330.4312 

Email: amannari@wpahs.org
Trauma-Focused Cognitive Behavioral Therapy www.childwelfare.gov

14 This material may be freely reproduced and distributed. However, when doing so, please credit 

Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/trauma.

Esther Deblinger, Ph.D.

CARES Institute

University of Medicine & Dentistry of NJ - School of Osteopathic Medicine

Stratford, NJ

856.566.7036

Email: deblines@umdnj.edu

Practitioner’s Guides

Clinicians are encouraged to read one or both of the practitioners’ guides below. 

Cohen, J. A., Mannarino A. P. & Deblinger, E. (2006). Treating trauma and traumatic grief in 

children & adolescents. New York: Guilford Press.

Deblinger, E. & Heflin, A. H. (1996). Treating sexually abused children and their nonoffending 

parents: A cognitive behavioral approach. Newbury Park, CA: Sage Publications.

The following children’s books by Stauffer & Deblinger also may be useful in teaching personal 

safety and other coping skills:

Stauffer, L. B., & Deblinger, E. (2003). Let’s talk about taking care of you: An educational book 

about body safety. Hatfield, PA: Hope for Families, Inc.

Stauffer, L., & Deblinger, E. (2005). Let’s talk about coping and safety skills: A workbook about 

taking care of you. Hatfield, PA: Hope for Families, Inc.

This document is made possible by the Children’s Bureau, Administration on Children, Youth and Families, 

Administration for Children and Families, U.S. Department of Health and Human Services.

Suggested citation: Child Welfare Information Gateway. (2007). Trauma-focused cognitive behavioral 

therapy: Addressing the mental health of sexually abused children. Washington, DC: U.S. Department of 

Health and Human Services.