Trauma-focused CBT

Trauma-focused Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT) is a family of talking therapies. They use the ideas of CBT together with working directly on the memory of what happened (Phoenix Australia, 2020–21). If something happened and you can’t shake it, trauma-focused CBT goes to the memory itself.

What the three main versions involve

There are three main versions: cognitive processing therapy, prolonged Exposure (facing things in steps) Facing what you've been avoiding, a bit at a time, and staying long enough for the alarm to settle. For fear and anxiety, it's often the part of therapy that does most of the work. More in the jargon decoder , and cognitive therapy for post-traumatic stress disorder (PTSD). For PTSD, Australia’s guidelines give all three their strongest recommendation. They give the same strong recommendation to a different therapy, eye movement desensitisation and reprocessing (EMDR (eye movement desensitisation and reprocessing) A structured therapy for memories that still feel raw. You bring a painful memory to mind for short stretches while your attention is split, usually by following your therapist's hand as it moves from side to side. The aim is for the memory to become less upsetting. More in the jargon decoder ), and don’t rank any of these therapies above the others (Phoenix Australia, 2020–21).

Cognitive processing therapy. Works through themes that often shift after trauma: safety, trust, power and control, how you see yourself, and closeness with other people. You learn to look at the upsetting thoughts you’ve had about the trauma since it happened, and to question and change them (National Center for PTSD). Early on, your therapist may suggest writing a detailed account of what happened. Whether you write one is up to you, and you decide it together. Between sessions there’s writing and worksheets to do. It usually runs about 12 weekly sessions of about an hour, so around three months, and it can also be done in a group.

Prolonged exposure. You gradually Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder memories, feelings and situations you’ve been avoiding since the trauma (National Center for PTSD). After the first couple of sessions, you talk through the memory in detail in each session. That part is recorded so you can listen back at home between sessions. You and your therapist make a list of situations you’ve been avoiding, and you work through the list step by step, starting with the easier ones. It usually runs 8 to 15 weekly sessions of 60 to 90 minutes, about three months, one to one. The idea is that facing the memory, rather than avoiding it, lets the fear settle.

Cognitive therapy for PTSD. You and your therapist build a picture of why the memory still feels like a present threat for you in particular, and work from that. You go back over the worst moments of the memory and add what you know now, such as the fact that it’s over. That way the memory holds how things ended, as well as the fear. You also work on harsh conclusions you may have drawn from what happened, such as blaming yourself, or feeling that nowhere is safe anymore. You also work out which sights, sounds and places set off the memory, and practise telling them apart from the thing that happened (Lundin and colleagues, 2024). It usually runs up to about 12 weekly sessions of 60 to 90 minutes (Psychological Health Center of Excellence, 2025).

All three work on the memory directly. The biggest differences are how much you talk about what happened, and how much you do between sessions. EMDR vs talking about trauma compares them with EMDR.

What a session is like

Cognitive processing therapy and prolonged exposure follow a set plan. Cognitive therapy for PTSD is built around your own picture of what’s keeping the memory going.

Early sessions include learning about common reactions to trauma, so you can make sense of what you’re going through. Later sessions work on the memory, and on the thoughts that go with the memory.

There’s usually work to do between sessions, such as worksheets, writing, or listening back to a recording of the session. The pace is agreed with your therapist as you go.

The hard parts

Trauma-focused CBT asks you to go towards a painful memory instead of away from it, and that’s hard.

Some people feel worse for a while during Trauma-focused therapy Therapies that work directly on the memory of what happened, rather than only on how you're coping now. Trauma-focused CBT is the family name for several of them. More in the jargon decoder . In a study of 192 women having cognitive processing therapy or prolonged exposure, a minority had a worsening of symptoms at some point during treatment. Feeling worse for a while wasn’t linked to stopping early, and people whose symptoms worsened still improved meaningfully by the end (Larsen and colleagues, 2016).

A much larger study looked at about 25,000 veterans in the United States having cognitive processing therapy or prolonged exposure in everyday care (Holder and colleagues, 2025). About one in five had a clear worsening of symptoms at some point during treatment or in the three months after. Most didn’t. The researchers couldn’t tell whether the therapy caused the worsening, or how long the worsening lasted. Symptoms go up and down anyway, and worsening like this happens in other treatments too. Worsening of symptoms was about as common with prolonged exposure as with cognitive processing therapy, even though prolonged exposure is often expected to be harder.

In research trials of therapy for PTSD, about one in six people stopped before the end. People stopped a little more often in trauma-focused therapies, at a bit under one in five (Lewis and colleagues, 2020).

If therapy starts to feel like too much, tell your therapist. The pace can change. Telling your therapist something isn’t working has ways to bring this up. If you’re still somewhere you’re not safe, safety comes first, and it’s reasonable to put trauma work on hold until you are.

Who it tends to suit

Trauma-focused CBT can suit you if you want to make sense of what happened by talking it through. It can also suit you if you like a clear structure and a sense of progress, and you can make time for work between sessions. It’s also worth a look if you’ve had general counselling and you’re still troubled by what happened.

What the evidence says

A large 2020 review compared 20 treatments across 90 trials. EMDR and trauma-focused CBT did best, with no clear difference between the two. Counselling that wasn’t trauma-focused helped too, but less than either of them (Mavranezouli and colleagues).

For adults living with both PTSD and problems with alcohol or other drugs, Australia’s guidelines suggest trauma-focused CBT over usual care (Phoenix Australia, 2020–21).

When the trauma went on for a long time, there’s less research to go on. A review of 51 trials looked at people likely to have some features of complex PTSD. In those trials, trauma-focused CBT, exposure-based therapy and EMDR all helped PTSD symptoms more than usual care (Karatzias and colleagues, 2019). The people in those trials weren’t diagnosed with complex PTSD as such, though. Australia’s guidelines don’t yet recommend any treatment specifically for complex PTSD, and clinicians disagree about whether to spend time getting steadier before working on the memory.

So for PTSD after one event or a few, trauma-focused CBT has some of the strongest evidence of any therapy. The choice between trauma-focused CBT and EMDR usually comes down to what suits you.

Young people

For children and teenagers, Australia’s guidelines strongly recommend a version of trauma-focused CBT designed for young people, with a parent or carer involved. Where possible, the parent or carer takes part the whole way through. They help with practice between sessions, and learn how best to support the young person (Phoenix Australia, 2020–21).

If you’re under 18, a GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder or headspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder can help you find someone to see. What’s different about therapy when you’re under 18 covers the rest.

Getting it in Australia

Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder offer trauma-focused CBT, and some other mental health professionals are trained in it too. Training varies, so it’s fair to ask a therapist what trauma training they’ve done, and how much of their work is with trauma.

Trauma-focused CBT comes under cognitive behavioural therapy, which is on Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder ’s list of approaches for a Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder . With a plan, Medicare gives a Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder on up to ten individual sessions a calendar year with a psychologist, Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder or Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder . Some sessions run longer than standard ones, so check what you’d pay.

Where individual face-to-face trauma-focused therapy isn’t available or isn’t right for someone, Australia’s guidelines suggest trauma-focused CBT in a group, or guided trauma-focused CBT by video call. These are suggestions, with less evidence behind them than the three versions and EMDR above (Phoenix Australia, 2020–21).

One trial of 126 women with PTSD in the United States compared cognitive processing therapy by video with the same therapy in person. It worked about as well by video, and the improvement had lasted when people were checked again six months later. How well people felt they got on with their therapist was a little lower by video at the start, and the difference had gone by the middle of treatment. People in the video group joined from a clinic room with good equipment rather than from home, so the trial doesn’t show how well video works from your own home. People with a current risk to their safety were left out (Morland and colleagues, 2015).

There are several ways to pay:

Paying the full fee. No Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder or plan needed, and no session limit. It’s the only way to see a Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder or Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , whom Medicare doesn’t cover.
Workplace programs. Many employers pay for a few sessions for their staff.
Community services. Community mental health services and many community organisations are usually free.
headspace. headspace offers free or low-cost support for people aged 12 to 25.
Groups. Group sessions usually cost less per session, and a plan gives a rebate on up to ten group sessions a year, on top of the ten individual ones.
A Mental Health Treatment Plan. Your GP assesses whether a plan suits you. Ten sessions a calendar year is a funding limit, not a judgement about how much therapy anyone needs.

Free and low-cost options has the full list.

If you’ve served in the Australian Defence Force, or you’re family of someone who has, Open Arms offers free counselling on 1800 011 046, 24 hours a day.

Whichever version you choose, how well you and your therapist work together matters a great deal. Australia’s guidelines treat a strong working relationship with the therapist as the basis for trauma treatment. Why who you see matters more than what they do explains why.

If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.

If you’re experiencing family, domestic or sexual violence, 1800RESPECT is on 1800 737 732.

Where next

If you’re not sure therapy is what you want, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try. PTSD covers what helps in the first weeks after a trauma, and the options if trauma-focused therapy isn’t right for you yet.