PTSD is estimated to affect one in three people after a traumatic event. If you are struggling with trauma symptoms it can be useful to begin considering your support options. There are many different therapies available to support trauma and one of those is Trauma-Focused Cognitive Behavioural Therapy, or TF-CBT for short, but what is this type of therapy, and what does it involve?
Psychologists Ehlers and Clark (2000), in their Cognitive Model of PTSD, propose that there are certain factors that keep the vicious cycle of trauma going, and these factors essentially prevent the trauma memory/memories from being processed. These factors include:
Poorly elaborated memory of the trauma and that the memory has not been contextualised (the memory does not equal the situation within which it existed or happened).
Excessive negative beliefs and meanings attached to the trauma memory.
Behavioural and cognitive strategies. Cognitive strategies include pushing thoughts away (suppression) and dwelling on events (rumination). Behavioural strategies may include withdrawing socially, avoiding internal and external reminders of the event/s, little or no engagement in previous hobbies or interests, use of drugs and alcohol. There can be many more strategies people may use, we recognise every individual has different coping strategies to try to minimise or eliminate their suffering.
Goals in Trauma-Focused CBT
Therefore together our goals in TF-CBT are to:
Reduce flashbacks and nightmares by opening up the memory and being able to discriminate with reminders of the trauma what is then (at the time of the trauma) and what is now (in the present moment). We may recall the memory spoken out loud or by use of writing in session using the present tense. Some people may revisit the site of trauma in this part of the work to aid adding context to the trauma memory.
Modify excessive negative beliefs of the trauma, changing perspectives to create new more helpful beliefs. For example ‘it was my fault X happened’ becomes ‘it was not my fault X happened’ we may develop a more compassionate response towards the self. In therapy we may do this through careful and gentle questioning to explore different perspectives. We then incorporate the more helpful belief into the trauma memory.
Remove unhelpful behavioural and cognitive strategies that maintain intrusions and the current sense of threat and danger. We may do this in therapy by exploring the advantages and disadvantages of each strategy both in the short and long term.
As we come towards the end of treatment we often hear people we support reporting a reduction or ceasing of intrusions, a decreased sense of danger in the present moment and an improvement in mood as the person begins regaining and rebuilding their life after after the traumatic event/s.
Please see the video below if you would like to learn more about the different stages of the therapeutic journey when we work with trauma using TF-CBT.
Emma McDonald, CBT & EMDR Therapist
•If you are looking for a Trauma Focused-CBT specialist we have a team of therapists who can offer this support face to face or online – further information can be found on our website www.thepsychotherapyclinic.co.uk