Trauma-Focused CBT in Practice

This is a Practitioner course in the trauma-focused CBT pathway. It assumes that you already hold the Foundation knowledge of this approach, whether from the Foundation course or from your training and practice, which is what Understanding Trauma and PTSD teaches. What it adds is formulation and treatment decisions with real caseloads: the disorder-specific or situation-specific methods, sequencing, and what to do when the standard approach does not work; it revisits the foundations only as far as it needs to before building on them, so it does not repeat the course below.

If you have not met this approach before, Understanding Trauma and PTSD is the place to start; if you already hold its foundations from your training or practice, this is the right level to begin at.

The trauma-focused CBT pathway. The NICE-recommended treatment for post-traumatic stress disorder, taught as a protocol: understanding trauma and PTSD, trauma-focused CBT in practice, then complex PTSD and specialist populations.

• Developing the trauma narrative Why a coherent narrative helps
• Identifying and updating hotspots Locating hotspots in the narrative
• The Narrative Review and Integration Phase The narrative review is the primary mechanism for emotional processing, requiring the client to engage with the memory at an emotional level.
• Facilitating the Narrative Construction: Socratic Dialogue and Emotional Processing While the preceding modules have delineated the structural components of the trauma narrative and have introduced the identification of maladaptive cognitions, …
• Re-scripting the Narrative: From Fragmented Memory to Resilient Story Re-scripting integrates cognitive restructuring into a cohesive narrative of resilience.

• Working with Dissociation During Narrative Construction: Stabilisation, Grounding and Re-consolidation Trauma does not only leave a memory; it leaves a worldview, and once the memory work has broken the spell of nowness, the beliefs must be met on their own groun…
• Integrating the Trauma Narrative into Self‑Concept and Identity Integration of the trauma narrative into self‑concept is essential for lasting recovery.
• Memory Reconsolidation and Updating in Trauma‑Focused CBT Memory reconsolidation is a time‑limited window after memory re‑activation during which the memory can be updated with new information.
• Challenging unhelpful beliefs Common trauma-related beliefs
• Graded exposure to reminders Building the exposure hierarchy

• Integrating Cognitive Restructuring with Graded Exposure: Targeting Safety Behaviours and Belief Testing Integrating explicit belief testing into each exposure task transforms avoidance into a cognitive experiment.
• Managing Acute Distress and Safety Planning During Graded Exposure in Trauma‑Focused CBT Safety planning is co‑constructed with the client and outlines concrete steps for managing escalation of distress.
• Constructing Belief‑Focused Exposure Hierarchies in Trauma‑Focused CBT Belief‑focused hierarchies link each exposure cue directly to a specific trauma‑related cognition, enhancing the potency of belief disconfirmation.
• Assessing and Tracking Trauma‑Related Beliefs Across Exposure Sessions Systematic belief assessment, using both the PTCI for global cognition and the BRS for session‑by‑session tracking, provides objective data to guide TF‑CBT.
• Generalising and Consolidating Belief Change After Graded Exposure Immediate post‑exposure reflection consolidates the new belief by verbalising the prediction‑outcome discrepancy.