Effectiveness of Trauma-Focused Cognitive Behavioral Therapy for Youth with Complex Trauma Exposure: A Systematic Review

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the most widely used treatments for children and adolescents presenting with posttraumatic stress. Despite strong rationale for its use with youth exposed to complex trauma (traumatic experiences that are chronic, repeated, prolonged, and interpersonal in nature), few studies have investigated its effectiveness in this population. The present review systematically synthesized and evaluated the existing empirical evidence for the effectiveness, feasibility, and acceptability of TF-CBT among youth with complex trauma. Twenty-three articles reporting on findings from 21 non-overlapping samples met the inclusion criteria for the current review (total N = 1,728). Articles were included if they were published after 1990, evaluated branded TF-CBT (four or more out of the five components), measured psychosocial and/or behavioral functioning pre-/post-TF-CBT, and included a sample of young people (mean age <20) exposed to complex trauma. This work supported TF-CBT as a “probably efficacious intervention” for reducing posttraumatic stress disorder (PTSD) symptoms among youth with complex trauma histories, according to the Division 12 Task Force on Psychological Interventions; at present, TF-CBT should be considered “Possibly Efficacious” for reducing International Classification of Diseases, 11th Revision (ICD-11) complex PTSD symptoms. TF-CBT was generally found to be feasible and acceptable, though qualitative and case studies illustrated challenges inherent to working with youth with complex traumatic experiences. Qualitative work also provided useful recommendations for enhancing feasibility and acceptability in this population. Overall, the literature provides a solid empirical foundation for TF-CBT’s use in youth exposed to complex trauma.