Trauma-focused CBT

What is trauma-focused CBT?

Trauma-focused cognitive behavioural therapy (TF-CBT) is a structured, time-limited talking therapy that helps adults process a distressing or traumatic experience and reduce the symptoms it has left behind, such as intrusive memories, avoidance, hypervigilance and low mood. It’s recommended by NICE as a first-line treatment for post-traumatic stress disorder (PTSD).

It builds on standard CBT but is shaped specifically around how the mind processes frightening or overwhelming events. Sessions combine psychoeducation about common trauma reactions with structured work on the memory itself, often through a written or spoken account of what happened, alongside techniques for spotting and shifting unhelpful beliefs the event may have left behind, such as ‘it was my fault’ or ’the world is not safe’.

TF-CBT is usually delivered weekly over a course of sessions, with the pace agreed between you and your psychologist rather than fixed in advance. Early sessions focus on stabilising current symptoms and building a shared understanding of what is happening and why, before any detailed work on the memory itself begins.

When it helps

TF-CBT is generally offered to adults dealing with the aftermath of a specific frightening, dangerous or overwhelming event, or a series of related events. This might include a road traffic collision, an assault, a frightening medical procedure or diagnosis, a traumatic birth, witnessing harm to someone else, or a sudden bereavement. Common symptoms include intrusive memories or flashbacks, nightmares, feeling constantly on edge, avoiding people, places or reminders connected to the event, and persistent negative beliefs about yourself, other people or the world.

You do not need a formal diagnosis of post-traumatic stress disorder to ask about this therapy. Many people start after noticing that a difficult experience is still affecting their sleep, concentration, relationships or mood weeks or months later, even without a clinical label attached to it.

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What to expect

The first one or two sessions are usually an assessment. This is a chance to talk through what happened, in as much or as little detail as feels manageable, alongside your current symptoms, your history and what you would like therapy to help with. Nothing is fixed in this first conversation, and the plan is built together.

Once a shared plan is in place, sessions typically include structured work on the memory of the event, sometimes through retelling it in detail or writing it down, so that it can be processed rather than avoided. This sits alongside work on unhelpful beliefs the event has left behind and, where avoidance has crept into daily life, a gradual, planned return to situations or activities that feel difficult.

You are never required to disclose more than you are ready to in any single session, and the pace is adjusted if the work starts to feel overwhelming. Sessions take place online, by video call, so you can take part from a private space that works for you.

The evidence for trauma-focused CBT

The National Institute for Health and Care Excellence (NICE) recommends trauma-focused CBT as one of the first-line psychological treatments for post-traumatic stress disorder in adults, alongside EMDR (NICE guideline NG116). This recommendation is based on a substantial body of randomised controlled trials showing meaningful reductions in PTSD symptom severity following a course of treatment.

The evidence is strongest for single-incident trauma, though the approach can be adapted for people who have experienced repeated or prolonged difficult events. Where trauma is longstanding or particularly complex, your psychologist may recommend a longer course of treatment or a different approach, and will talk this through with you rather than assuming a single format fits everyone.

How we work online

Sessions are delivered entirely online, for adults in Greenwich and the surrounding area, including Blackheath, Charlton, Deptford, Lewisham, New Cross and Maze Hill. Many people booking from SE10 and the western edge of SE3 already rely on the Cutty Sark and Greenwich DLR stops, or Greenwich and Maze Hill stations, for the half-hour run into central London, and fitting therapy around that same commute, or around work, caring responsibilities or study, is often easier from home than from a waiting room.

We are clinical psychologists for Greenwich and south east London, working online with adults, and every session is delivered by video call rather than in person. That means no trip around Greenwich Market or the Old Royal Naval College at either end of your day, just the session itself.

Frequently asked questions

Do I need a PTSD diagnosis to start trauma-focused CBT?

No. Many people begin this therapy because a distressing event is still affecting their sleep, mood, concentration or relationships, without ever having had a formal assessment. A diagnosis can come out of the assessment process if it’s useful, but it isn’t a condition of starting.

What if I can’t remember the whole event clearly?

Partial or patchy memories are common after a frightening experience and don’t stop trauma-focused CBT from being useful. Your psychologist works with what you do remember, at whatever level of detail you can access, rather than expecting a complete or ordered account.

Will I have to describe what happened in detail?

Structured work on the memory is part of this therapy, but how much detail you go into, and when, is agreed with you rather than assumed. Sessions are paced so this work happens when you feel ready for it, not before.

Can trauma-focused CBT make things feel worse before they improve?

It’s common for symptoms to feel slightly more present as you begin working directly with the memory, rather than avoiding it. This is expected and monitored closely, and the pace is adjusted if it becomes too much.

How long does a course of trauma-focused CBT usually take?

Length varies with the nature of the trauma and how it affects you, and is agreed collaboratively rather than fixed from the outset. Straightforward, single-incident presentations often need fewer sessions than repeated or prolonged trauma.

Is online trauma-focused CBT as effective as sessions in person?

Research on remote delivery of trauma-focused psychological therapies, including video-based CBT, has generally found outcomes comparable to in-person sessions for many adults, provided the same structured approach is followed.