Clinical and Developmental Considerations for Implementing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) With Adolescents Who Have Experienced Multiple Traumas: a Case Study

J Child Adolesc Trauma. 2026 Mar 25;19(2):897-915. doi: 10.1007/s40653-026-00831-4. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line treatment for youth exposed to trauma; however, limited guidance exists on its application with adolescents facing cumulative and developmentally salient trauma experiences.

METHOD: This case study describes the TF-CBT treatment of a 15-year-old immigrant adolescent with a history of multiple interpersonal and migration-related traumas, including domestic violence, physical abuse, COVID-19-related stressors, and discrimination tied to her Indigenous identity and immigration status. Treatment was delivered across 25 sessions following the PRACTICE components and guided by a developmentally informed framework integrating relational, contextual, and cultural considerations.

FINDINGS: The adolescent showed reductions in trauma-related avoidance, increased affect regulation skills, improved cognitive flexibility, and decreased distress during trauma narration and processing. Caregiver involvement facilitated better communication and strengthened safety practices in the home. These clinical gains were consistent with TF-CBT’s theorized mechanisms of change for adolescents with cumulative trauma.

CONCLUSIONS: This case demonstrates actionable, developmentally informed, and culturally responsive strategies for implementing TF-CBT with adolescents navigating complex trauma histories. Grounding intervention decisions in adolescent developmental processes may enhance engagement, relational safety, and overall treatment outcomes for youth with multiple traumas.

PMID:42179392 | PMC:PMC13190884 | DOI:10.1007/s40653-026-00831-4