TF-CBT Research

Numerous randomized controlled trials (RCTs) have established the benefits of Trauma-Focused Cognitive Behavioral Therapy for children as well for participating caregivers. These positive effects have been found in diverse populations and in children from preschool through adolescence. In research, TF-CBT consistently obtains outcomes that surpass the outcomes of nondirective supportive therapy and standard community care. 

Additionally there is evidence for TF-CBT effectiveness using a virtual delivery platform. 

Delivering an Evidence-Based Mental Health Treatment to Underserved Populations Using Telemedicine: The Case of a Trauma-Affected Adolescent in a Rural Setting

Shealy, K. M., Davidson, T. M., Jones, A. M., Lopez, C. M., & de Arellano, M. A. (2015). Delivering an evidence-based mental health treatment to underserved populations using telemedicine: The case of a trauma-affected adolescent in a rural setting. Cognitive and Behavioral Practice22(3), 331-344.

TF-CBT Outcomes at Discharge


Decrease in:

Increase in:

Child Outcomes

o   PTSD symptoms, shame, and abuse-related fears

o   sexualized behavior

o   anxiety and depression

o   behavior problems


o  ability to recognize and respond to potentially abusive situations

o  social adjustment


Caregiver Outcomes

o   abuse-related distress

o   PTSD symptoms

o   depression


o  parenting skills

o  support to child


The Lasting Clinical Benefits of TF-CBT

Follow-up outcomes have been evaluated in at least five randomized controlled trials conducted by the program developers. These studies consistently found maintenance of treatment gains up to 2 years after treatment, across a range of outcomes including internalizing behaviors, externalizing behaviors, problem sexual behaviors, and PTSD symptoms. Studies also suggest that clients and their caregivers may continue to improve after TF-CBT has ended. The findings of specific studies are summarized below. 

Study #1: At 12-month follow-up, preschoolers who received TF-CBT showed greater improvement in internalizing and externalizing behaviors and sexual behaviors, compared to children who received nondirective supportive therapy. Sexual behaviors and behavior problems continued to improve after treatment ended. (Cohen & Mannarino, 1997) 

Study #2: Three out of four initial treatment outcomes were maintained at 2-year follow-up, with TF-CBT showing outcomes superior to standard community care.  Specifically, parent involvement in TF-CBT was associated with decreased child depression and externalizing symptoms, while child involvement in TF-CBT was associated with a decrease in PTSD symptoms. Improvements in parenting practices did diminish slightly during the first year of follow-up, but continued to be improved overall. (Deblinger, Steer, & Lippman, 1999) 

Study #3: Compared to children who received nondirective supportive therapy, children randomly assigned to TF-CBT showed superior outcomes for anxiety, posttraumatic stress symptoms, and child sexual behaviors, six months after treatment ended. At 12-month follow-up, the TF-CBT group had fewer PTSD and dissociative symptoms and fewer child sexual behaviors. There was evidence suggesting that, for TF-CBT clients, PTSD symptoms may continue to improve after treatment ends. (Cohen, Mannarino, & Knudsen, 2005) 

Study #4: At 6 and 12 months post-treatment, children (ages 8 to 14) who had participated in TF-CBT showed fewer PTSD symptoms and less shame than children who had received a manualized form of client-centered therapy. In addition, their caregivers reported less abuse-related distress than caregivers in the comparison group. This follow-up was done as part of a multisite, randomized, controlled trial with a large sample (183 children).  (Deblinger, Mannarino, Cohen, & Steer, 2006)

Study #5: This was a follow-up of a study examining the impact of trauma narrative and treatment length on treatment outcome; a non-TF-CBT comparison group was not included. Follow-up found that improvements were sustained at both 6 and 12 months post-treatment. This included significant decreases in PTSD symptoms, internalizing and externalizing behaviors, child sexual behavior, anxiety, and abuse-related fear; improvement in ability to recognize and respond effectively to hypothetical abusive situations; and improvements in parents’ emotional distress related to the trauma, parenting practices, and depression. Parent distress and child anxiety continued to improve from discharge to 12-month follow-up, and the percent of children meeting criteria for PTSD had decreased from 71% (at start of treatment) to 11% at one-year follow-up. (Mannarino, Cohen, Deblinger, Runyon, & Steer, 2012)