Psych · Psychotherapy
Trauma-focused CBT and EMDR
Also known as Trauma-focused CBT · TF-CBT · Prolonged exposure · Cognitive processing therapy · CT-PTSD · EMDR · Eye movement desensitization and reprocessing · Trauma-focused psychotherapy
Exam-exhaustive fellowship reference on trauma-focused psychological therapies — PE, CPT, CT-PTSD/TF-CBT, child TF-CBT, and EMDR — with Ehlers–Clark and exposure mechanisms, readiness, session architecture, meta-analytic and guideline evidence, complex presentations, pharmacotherapy interface, and CASC/MEQ pearls. FRANZCP-primary, globally tagged.
Checked against its sources on 23 Oct 2026
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FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- Significant risk of harm to self or others at assessment: establish a risk management and safety plan as part of initial treatment planning
- Psychologically-focused debriefing should not be offered for the prevention or treatment of PTSD
- Endless 'stabilisation only' framed as care when trauma-focused therapy is indicated, acceptable, and feasible
- Labelling unstructured supportive talk or isolated bilateral stimulation as PE, CPT, or EMDR
- Benzodiazepines should be considered relatively contraindicated for patients with PTSD or recent trauma
- People with PTSD should not be excluded from treatment based solely on comorbid drug or alcohol misuse
Meet the patient
A 34-year-old paramedic comes to clinic eight months after a child died in her arms at a road crash. She has not driven past the intersection since. She replays the monitor flat-lining when she tries to sleep, drinks three glasses of wine to fall asleep, and told her last clinician she is "not ready" to talk about it. Her PCL-5 is 51.[1][10]
The registrar heard "not ready" and booked six sessions of supportive counselling plus a benzodiazepine. The examiner wants the move you make next: which trauma-focused protocol, on what evidence, and what does readiness actually mean?[10][16]
References26ShowHide
- [1]Ehlers A, Clark DM A cognitive model of posttraumatic stress disorder Behav Res Ther, 2000.PMID 10761279
- [2]Ehlers A, Clark DM, Hackmann A, et al. Cognitive therapy for post-traumatic stress disorder: development and evaluation Behav Res Ther, 2005.PMID 15701354
- [3]Foa EB, Hembree EA, Cahill SP, Rauch SA, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics J Consult Clin Psychol, 2005.PMID 16287395
- [4]Powers MB, Halpern JM, Ferenschak MP, Gillihan SJ, Foa EB A meta-analytic review of prolonged exposure for posttraumatic stress disorder Clin Psychol Rev, 2010.PMID 20546985
- [5]Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial JAMA, 2007.PMID 17327524
- [6]Resick PA, Galovski TE, Uhlmansiek MO, Scher CD, et al. A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence J Consult Clin Psychol, 2008.PMID 18377121
- [7]Monson CM, Schnurr PP, Resick PA, Friedman MJ, et al. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder J Consult Clin Psychol, 2006.PMID 17032094
- [8]Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults Cochrane Database Syst Rev, 2013.PMID 24338345
- [9]Cusack K, Jonas DE, Forneris CA, Wines C, et al. Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis Clin Psychol Rev, 2016.PMID 26574151
- [10]Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis Eur J Psychotraumatol, 2020.PMID 32284821
- [11]Shapiro F The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences Perm J, 2014.PMID 24626074
- [12]Lee CW, Cuijpers P A meta-analysis of the contribution of eye movements in processing emotional memories J Behav Ther Exp Psychiatry, 2013.PMID 23266601
- [13]Cuijpers P, Veen SCV, Sijbrandij M, Yoder W, Cristea IA Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis Cogn Behav Ther, 2020.PMID 32043428
- [14]Cohen JA, Deblinger E, Mannarino AP, Steer RA A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms J Am Acad Child Adolesc Psychiatry, 2004.PMID 15187799
- [15]Cloitre M, Koenen KC, Cohen LR, Han H Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse J Consult Clin Psychol, 2002.PMID 12362957
- [16]De Jongh A, Resick PA, Zoellner LA, van Minnen A, et al. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS Depress Anxiety, 2016.PMID 26840244
- [17]Bisson JI, Berliner L, Cloitre M, Forbes D, et al. The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process J Trauma Stress, 2019.PMID 31283056
- [18]Brady K, Pearlstein T, Asnis GM, Baker D, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145
- [19]National Institute for Health and Care Excellence Post-traumatic stress disorder (NG116) NICE guideline NG116, 2018.Source
- [20]Menon SB, Jayan C Eye movement desensitization and reprocessing: a conceptual framework. Indian journal of psychological medicine, 2010.PMID 21716864
- [21]Guina J, Rossetter SR, DeRHODES BJ, et al. Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis. Journal of psychiatric practice, 2015.PMID 26164054
- [22]Blevins CA, Weathers FW, Davis MT, et al. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. Journal of traumatic stress, 2015.PMID 26606250
- [23]Asukai N [Prolonged Exposure Therapy for Post-traumatic Stress Disorder]. Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 2015.PMID 26524872
- [24]Held P, Szoke DR, Pridgen SA, et al. Tracking individualized stuck points in cognitive processing therapy: The amount of change matters. Journal of traumatic stress, 2025.PMID 40339138
- [25]Wachen JS The use of practice assignments in cognitive processing therapy to promote cognitive and emotional change: A case study. Journal of clinical psychology, 2024.PMID 38149907
- [26]Cohen JA, Mannarino AP Trauma-Focused Cognitive Behavioural Therapy for Children and Parents. Child and adolescent mental health, 2008.PMID 32847188