What happens during TF-CBT:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has core principles, outlined by the acronym PRACTICE — psychoeducation, emotional regulation, cognitive processing, and exposure. Here's what we do with each component of PRACTICE:

🔹 P – Psychoeducation 

• Provide education about PTSD, trauma reactions, and how trauma affects the brain, emotions, and behaviors.

• Focus on self-compassion, normalization of symptoms, and the impact of trauma on functioning (e.g., relationships, work, physical health).

🔹 R – Relaxation Skills

• Teach and practice mindfulness, deep breathing, progressive muscle relaxation, or grounding techniques to manage physiological arousal.

• Tailor to the client's preferences and context.

🔹 A – Affective Expression and Regulation

• Help clients recognize and label emotions that may have been suppressed due to trauma.

• Explore avoidant emotional patterns, anger, shame, or guilt more prevalent in trauma survivors.

• Introduce tools like emotion wheels, journaling, or experiential techniques.

🔹 C – Cognitive Coping

• Work with cognitive distortions around self-worth, safety, trust, control, and intimacy.

• Change any deeply ingrained core beliefs (e.g., "I'm broken," "I can't trust anyone") that require cognitive restructuring. 

🔹 T – Trauma Narrative and Processing

• Support the client in constructing a trauma narrative either verbally or in written form.

• Integrate meaning-making, not just factual recounting—what the trauma meant to the client and how they carry it today.

🔹 I – In Vivo Mastery of Trauma Reminders

• Identify real-life avoidance patterns (e.g., avoiding medical care, intimacy, driving).

• Collaboratively design gradual exposure tasks to help desensitize and rebuild confidence.

• Encourage experimentation with feared but safe situations.

🔹 C – Conjoint Sessions (if applicable)

• include a partner, family member, or close friend in sessions if relationship repair or communication around the trauma is needed or beneficial.

• Optional based on the client's goals and trauma type.

• If not used, focus instead on building healthy relational skills and boundaries.

🔹 E – Enhancing Safety and Future Development

• Broaden the focus to include life goals, career, relationships, self-care, and long-term recovery.

• Develop a relapse prevention plan, including how to manage future triggers or stressors.

• May include identifying risk factors for retraumatization or engaging in unsafe behaviors (e.g., substance use, unsafe relationships).