Lesson 1Session 11: Interpersonal trust rebuilding: communication skills, boundaries, and rebuild social supportsThis session focuses on rebuilding interpersonal trust and social supports. Clients practice communication skills, assertive boundary setting, and safe relationship choices to counter isolation and trauma-related interpersonal difficulties.
Assessing current relationships and supportsPsychoeducation on trust after traumaAssertive communication skill practiceBoundary setting and saying no safelyPlanning to strengthen social networksLesson 2Session 10: Relapse prevention: coping plan, reducing avoidance, and consolidation of skillsThis session emphasizes relapse prevention and consolidation of skills. Clients refine coping plans, address avoidance patterns, and review key TF‑CBT tools to support long-term maintenance and early intervention if symptoms reemerge.
Reviewing core TF-CBT skills learnedIdentifying high-risk triggers and cuesDeveloping a written coping planStrategies to reduce future avoidanceEarly warning signs and action stepsLesson 3Session 4: Cognitive model introduction, identifying automatic thoughts and trauma-related beliefsThis session introduces the cognitive model, linking thoughts, feelings, and behaviors. Clients learn to identify automatic thoughts and trauma-related beliefs, preparing for later restructuring and meaning work around guilt, shame, and safety.
Explaining the CBT cognitive modelIdentifying automatic trauma thoughtsLinking thoughts, emotions, and behaviorsSpotting trauma-related core beliefsThought records for recent triggersLesson 4Session 3: Sleep and nightmare management, stabilizing skills, and behavioral activation overviewThis session targets sleep disruption and nightmares, introduces stabilizing skills, and provides a behavioral activation overview. Clients learn routines, stimulus control, and activity scheduling to reduce avoidance and support mood and trauma recovery.
Assessment of sleep patterns and routinesSleep hygiene and stimulus controlNightmare rescripting introductionDistress tolerance and self-soothingBehavioral activation and activity planningLesson 5Session 6: Gradual in vivo exposure planning (hierarchy) and behavioral experiments for safety beliefsThis session focuses on planning gradual in vivo exposure to trauma reminders. Clients build a fear hierarchy, test safety beliefs with behavioral experiments, and learn how to approach rather than avoid situations that maintain PTSD symptoms.
Identifying avoided situations and cuesConstructing a graded fear hierarchyDesigning in vivo exposure tasksBehavioral experiments for safety beliefsCoping plans for exposure homeworkLesson 6Session 9: Cognitive work focused on guilt, shame, and self-blame (processing meanings and responsibility)This session targets guilt, shame, and self-blame related to the trauma. Clients examine responsibility, hindsight bias, and moral injury, using cognitive techniques and compassionate perspectives to revise distorted meanings and self-judgments.
Mapping guilt, shame, and self-blame themesResponsibility pie and realistic appraisalChallenging hindsight and moral judgmentsDeveloping compassionate self-talkAddressing cultural and moral injuryLesson 7Session 5: Thought monitoring and cognitive restructuring practice; introduce work on meanings of traumaThis session strengthens thought monitoring and cognitive restructuring skills. Clients practice challenging unhelpful appraisals and begin exploring meanings of the trauma, including themes of safety, trust, control, esteem, and intimacy.
Daily thought monitoring exercisesEvidence for and against thoughtsGenerating balanced alternative thoughtsExploring trauma meanings and themesHomework planning and review processLesson 8Session 12: Review of progress, outcome measurement, maintenance plan, and follow-up schedulingThis final session reviews progress, outcome measures, and remaining goals. It finalizes a maintenance plan, schedules follow-up contacts, and reinforces self-efficacy, highlighting gains and preparing for future challenges without ongoing therapy.
Reviewing symptom change and measuresReflecting on goals and treatment gainsRefining long-term maintenance plansPlanning follow-up and booster optionsEnding therapy and celebrating progressLesson 9Session 2: Psychoeducation about PTSD and trauma memory, rationale for TF-CBT interventions, and introduction to grounding and breathingThis session deepens psychoeducation about PTSD and trauma memory, explains the rationale for TF‑CBT components, and introduces grounding and breathing skills to manage arousal, dissociation, and distress during and between sessions.
PTSD symptoms and maintaining cyclesTrauma memory, triggers, and remindersRationale for TF-CBT componentsTeaching diaphragmatic breathing skillsSensory grounding and orienting skillsLesson 10Session 8: Imaginal exposure / trauma narrative sessions with peak processing and cognitive restructuringThese sessions conduct imaginal exposure or trauma narrative work with peak processing. The focus is on detailed recounting, emotional engagement, and cognitive restructuring of stuck points, while maintaining safety and titrating distress.
Structuring the trauma narrative processFacilitating detailed imaginal recountingProcessing emotions during narrationIdentifying cognitive stuck pointsRestructuring key trauma appraisalsLesson 11Session 1: Assessment, formulation feedback, safety planning, and psychoeducation about trauma responsesThis session focuses on assessment, collaborative case formulation, and initial safety planning. It also introduces psychoeducation about common trauma responses, normalizing symptoms and preparing the client for the structure and goals of TF‑CBT treatment.
Screening tools and structured trauma assessmentCollaborative formulation and treatment goalsRisk, safety, and crisis response planningPsychoeducation on PTSD and trauma responsesExplaining TF-CBT structure and expectationsLesson 12Session 7: Imaginal exposure or narrative work preparation, managing distress, and dissociation precautionsThis session prepares for imaginal exposure or trauma narrative work. It emphasizes managing distress, using grounding, and setting dissociation precautions, including pacing, monitoring windows of tolerance, and establishing stop signals.
Clarifying goals of imaginal exposureReviewing coping and grounding skillsSetting distress and SUDS monitoringPlanning dissociation precautionsEstablishing stop and pause signals
