![A study room where an old map is being redrawn on a desk by the window](https://viacara.com/img/content/approaches-trauma-focused-cbt-feature-light.webp) # Trauma-Focused CBT Learn how trauma-focused CBT works, what happens in sessions, how it differs from EMDR and what NICE says about it and its main forms. ## What is trauma-focused CBT? Trauma-focused cognitive behavioural therapy adapts [CBT](https://viacara.com/approaches/cbt/) for post-traumatic stress disorder (PTSD). NICE says to offer it to an adult who comes forward more than a month after a traumatic event. The NHS names trauma therapy such as trauma-focused CBT among the treatments you may have. The name covers a family of closely related therapies rather than one script. NICE names four: [cognitive processing therapy](https://viacara.com/approaches/trauma-focused-cbt/#cognitive-processing-therapy), cognitive therapy for PTSD, narrative exposure therapy and [prolonged exposure therapy](https://viacara.com/approaches/trauma-focused-cbt/#prolonged-exposure). They share one idea. The memory of the trauma is stored in a way that keeps it feeling current. That memory can be worked on directly. Sources: [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1), [NHS: PTSD](https://viacara.com/approaches/trauma-focused-cbt/#ref-2) ## How it *works* After a traumatic event, the memory often stays fragmented and vivid. It comes back as if the danger were still here. Meanings such as blame, shame or a sense that nowhere is safe keep the alarm running. Avoiding reminders feels protective, but it stops the memory from settling. Trauma-focused CBT works on all three at once. You revisit the memory in a steady, planned way so it can be filed as past rather than present. You look at what the event has come to mean, and test whether those meanings still hold. Areas of *trauma-focused work* - **Prepare together** You learn about trauma responses and ways to manage distress. - **Memories and meanings** Your therapist helps you explore memories and the meanings attached to them. - **Daily life** You work on avoidance and activities that have become difficult. These are connected areas of work. Trauma-focused CBT includes several approaches, so the exact method can differ. Sources: [Ehlers & Clark 2000](https://viacara.com/approaches/trauma-focused-cbt/#ref-3), [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) ## What *sessions* look like NICE describes a standard course as eight to twelve sessions. It says more may be needed, for example after several traumas. Your therapist will explain the plan before you begin any of it. A typical course covers: - **Understanding PTSD.** Learning why the memory behaves the way it does - **Building safety and skills.** Grounding techniques and a plan for difficult moments - **Working with the memory.** Talking or writing through what happened, at your pace - **Changing the meaning.** Examining beliefs about blame, danger and yourself - **Reducing avoidance.** Returning to places and activities the trauma took away - **Planning ahead.** Knowing your triggers and what to do when they arrive You will not be rushed into the memory work. Most therapists spend the first sessions on preparation, and you decide together when you are ready. Source: [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) ![The desk seen from the chair, with the redrawn map finished and the window open](https://viacara.com/img/content/approaches-trauma-focused-cbt-mid-light.webp) Trauma-focused CBT revisits the memory so its meaning can change ## Cognitive processing *therapy* Cognitive processing therapy (CPT) works on what the trauma made you believe. Patricia Resick built it for survivors of rape and sexual assault. It joins education, exposure and work on thinking. A course runs to twelve sessions of about fifty minutes. You look at ways of thinking that keep you stuck. The sessions work through five themes a trauma often disturbs: safety, trust, power and control, esteem and intimacy. A 2019 review gathered 11 trials of CPT. It found CPT ahead of waiting lists and placebo therapies. CPT was also ahead of other active treatments at the end of therapy, though not at follow-up. Sources: [Resick & Schnicke 1992](https://viacara.com/approaches/trauma-focused-cbt/#ref-5), [CPT: about](https://viacara.com/approaches/trauma-focused-cbt/#ref-6), [Asmundson et al. 2019](https://viacara.com/approaches/trauma-focused-cbt/#ref-7) ## Prolonged *exposure* Prolonged exposure asks you to go towards what you have been avoiding. Edna Foa and her colleagues wrote the manual behind it. It has two halves: going back over the memory in the room, and returning to safe situations between sessions. In a 2023 trial, a course ran from eight to fifteen sessions. Each lasted ninety minutes, with forty of them given to the memory. A 2010 review pooled 13 trials of prolonged exposure. It found a large effect against waiting lists and placebo therapies. Against other active therapies, including CPT and EMDR, it found no significant difference. Sources: [Powers et al. 2010](https://viacara.com/approaches/trauma-focused-cbt/#ref-8), [Sloan et al. 2023](https://viacara.com/approaches/trauma-focused-cbt/#ref-10) ## Written exposure *therapy* Written exposure therapy is the short one. You write about the trauma in the session itself, for thirty minutes at a time. A course is five sessions, and there is nothing to do in between. Two trials have compared it with the longer therapies. In 2018 it did no worse than cognitive processing therapy, and far fewer people dropped out. In 2023 it did no worse than prolonged exposure, again with fewer leaving. Both trials were run in United States veterans' hospitals. NICE's PTSD guideline came out in 2018 and does not name this therapy. Ask a therapist whether they work this way. 8–12 sessions in a standard course NICE guideline [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) more after several traumas 12 sessions of CPT about 50 minutes each [CPT: about](https://viacara.com/approaches/trauma-focused-cbt/#ref-6) 8–15 sessions of prolonged exposure 90 minutes each [Sloan et al. 2023](https://viacara.com/approaches/trauma-focused-cbt/#ref-10) 5 sessions of written exposure nothing to do in between [Sloan et al. 2018](https://viacara.com/approaches/trauma-focused-cbt/#ref-9) Sources: [Sloan et al. 2023](https://viacara.com/approaches/trauma-focused-cbt/#ref-10), [Sloan et al. 2018](https://viacara.com/approaches/trauma-focused-cbt/#ref-9), [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) ## Who is it best *suited* to? Trauma-focused CBT is designed for people with PTSD after one event or many. It can be a good fit if you: - Have flashbacks, nightmares or intrusive memories of something that happened - Avoid people, places or conversations that bring it back - Carry strong guilt, shame or self-blame about the event - Want a structured approach with a clear plan and a known length - Prefer to talk through what happened rather than process it another way NICE says to offer it to children and young people aged seven and over as well. It asks for the therapy to suit their age, and for parents or carers to be involved as needed. Source: [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) ## How it differs from *EMDR* NICE also says to offer [EMDR](https://viacara.com/approaches/emdr/) after a non-combat trauma. That applies once three months have passed. Both work on the memory. The difference is the route. Trauma-focused CBT puts the memory into words, with work between sessions. EMDR holds the memory in mind during a side-to-side movement and asks for far less description. Many people choose between them on that basis, and some professionals are trained in both. Some people have intrusive thoughts with rituals to keep themselves safe. For that pattern, [exposure and response prevention](https://viacara.com/approaches/erp/) is the CBT built for it. A trauma specialist will help you tell the two apart. Source: [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) ## The *evidence* A 2020 review pooled 114 randomised trials of therapies for PTSD. It found robust evidence that trauma-focused CBT has a clinically important effect. The forms with the strongest evidence were cognitive processing therapy, cognitive therapy and prolonged exposure. 114 randomised trials of PTSD therapies, with robust evidence for trauma-focused CBT 2020 review [Lewis et al. 2020](https://viacara.com/approaches/trauma-focused-cbt/#ref-4) It is not a promise. Where symptoms remain afterwards, NICE says to consider CBT aimed at those symptoms, such as sleep problems or anger. The right person to start with is one who will tell you that honestly. Not sure whether this is the approach for you? Our [trauma and PTSD page](https://viacara.com/support/trauma/) starts from what you are living with, not from the name of a therapy. Sources: [Lewis et al. 2020](https://viacara.com/approaches/trauma-focused-cbt/#ref-4), [NICE NG116](https://viacara.com/approaches/trauma-focused-cbt/#ref-1) On this page [What is trauma-focused CBT?](https://viacara.com/approaches/trauma-focused-cbt/#what-is-trauma-focused-cbt) [How it works](https://viacara.com/approaches/trauma-focused-cbt/#how-it-works) [What sessions look like](https://viacara.com/approaches/trauma-focused-cbt/#what-sessions-look-like) [Cognitive processing therapy](https://viacara.com/approaches/trauma-focused-cbt/#cognitive-processing-therapy) [Prolonged exposure](https://viacara.com/approaches/trauma-focused-cbt/#prolonged-exposure) [Written exposure therapy](https://viacara.com/approaches/trauma-focused-cbt/#written-exposure-therapy) [Who is it best suited to?](https://viacara.com/approaches/trauma-focused-cbt/#who-is-it-best-suited-to) [How it differs from EMDR](https://viacara.com/approaches/trauma-focused-cbt/#how-it-differs-from-emdr) [The evidence](https://viacara.com/approaches/trauma-focused-cbt/#the-evidence) Related [Trauma and PTSD](https://viacara.com/support/trauma/) [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) [EMDR Therapy (Eye Movement Desensitisation and Reprocessing)](https://viacara.com/approaches/emdr/) [Exposure and Response Prevention (ERP)](https://viacara.com/approaches/erp/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) Thanks for your interest. We're not taking on new clients at the moment. ## Looking for trauma-focused CBT? We ask what matters to you, then find professionals who fit. Leave your email and we'll let you know as soon as we're ready for you. This conversation helps us find you the right support. What you share helps us understand what you're looking for and find someone who fits. Your email keeps you updated on what's happening next and isn't shared with anyone we introduce you to. [Privacy policy](https://viacara.com/privacy/) [Terms of service](https://viacara.com/terms/) ## References 1. National Institute for Health and Care Excellence (2018). *Post-traumatic stress disorder (NG116)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng116) 2. National Health Service (2026). *PTSD (post-traumatic stress disorder)*. [nhs.uk](https://www.nhs.uk/mental-health/conditions/ptsd-post-traumatic-stress-disorder/) 3. Ehlers, A. & Clark, D. M. (2000). *A cognitive model of posttraumatic stress disorder*. Behaviour Research and Therapy. [doi:10.1016/S0005-7967(99)00123-0](https://doi.org/10.1016/S0005-7967(99)00123-0) 4. Lewis, C., Roberts, N. P., Andrew, M., Starling, E. & Bisson, J. I. (2020). *Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis*. European Journal of Psychotraumatology. [doi:10.1080/20008198.2020.1729633](https://doi.org/10.1080/20008198.2020.1729633) 5. Resick, P. A. & Schnicke, M. K. (1992). *Cognitive processing therapy for sexual assault victims*. Journal of Consulting and Clinical Psychology. [doi:10.1037/0022-006X.60.5.748](https://doi.org/10.1037/0022-006X.60.5.748) 6. Cognitive Processing Therapy (n.d.). *About CPT*. [cptforptsd.com](https://cptforptsd.com/about-cpt/) 7. Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J. & Powers, M. B. (2019). *A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder*. Cognitive Behaviour Therapy. [doi:10.1080/16506073.2018.1522371](https://doi.org/10.1080/16506073.2018.1522371) 8. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J. & Foa, E. B. (2010). *A meta-analytic review of prolonged exposure for posttraumatic stress disorder*. Clinical Psychology Review. [doi:10.1016/j.cpr.2010.04.007](https://doi.org/10.1016/j.cpr.2010.04.007) 9. Sloan, D. M., Marx, B. P., Lee, D. J. & Resick, P. A. (2018). *A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial*. JAMA Psychiatry. [doi:10.1001/jamapsychiatry.2017.4249](https://doi.org/10.1001/jamapsychiatry.2017.4249) 10. Sloan, D. M., Marx, B. P., Acierno, R., Messina, M., Muzzy, W., Gallagher, M. W., Litwack, S. & Sloan, C. (2023). *Written exposure therapy vs prolonged exposure therapy in the treatment of posttraumatic stress disorder: A randomized clinical trial*. JAMA Psychiatry. [doi:10.1001/jamapsychiatry.2023.2810](https://doi.org/10.1001/jamapsychiatry.2023.2810) ## Related ### [Trauma and PTSD](https://viacara.com/support/trauma/) Trauma can keep a frightening event alive long after it ended. PTSD is common and treatable. Find a professional who works with trauma. ### [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help. ### [EMDR Therapy (Eye Movement Desensitisation and Reprocessing)](https://viacara.com/approaches/emdr/) Learn how EMDR works, what happens in sessions and why it is recommended for trauma and PTSD. ### [Exposure and Response Prevention (ERP)](https://viacara.com/approaches/erp/) Learn how ERP works, what sessions involve and where it sits in the NICE guideline for OCD. ### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods.