TF-CBT: what helps, and the gap for the youngest

When a child has been subjected to abuse, everyone around the child asks the same question: what helps? For one treatment the answer is unusually clear. For the youngest children the answer is that nobody really knows, and that is worth saying out loud.

The treatment with the strongest support

Trauma-focused cognitive behavioural therapy, TF-CBT, is the most studied treatment for children with post-traumatic stress symptoms. The latest network meta-analysis, Hoppen and colleagues, weighs 70 randomised trials with 5,528 children and young people. Against no treatment the effect is large, 1.06 standard deviations at the end of therapy.

The treatment is bounded, not endless. The UK's NICE recommends individual TF-CBT for children aged 7 to 17, typically 6 to 12 sessions. The Swedish National Board of Health and Welfare describes the same method for Swedish care, usually twelve sessions of 50 to 90 minutes.

The honest comparison

Against another active treatment, rather than against nothing, the effect is roughly half: 0.55. And a meta-analysis by Thielemann and colleagues shows why figures without a comparison group must not be read as treatment effects. The before-and-after change looks like 1.14, but it contains time passing and children who would have improved anyway. The fair figure against controls is 0.52.

The gap for the youngest

For children aged seven or under who have been subjected to sexual violence, Sweden's health technology agency SBU reviewed the entire evidence base. Seven studies existed. Two held moderate quality. Both are American and over twenty years old. SBU's conclusion is that it cannot be determined which treatment helps the youngest, and Sweden has no national care programme for them.

That is a research gap with real consequences. The youngest children are the ones who find it hardest to tell, and the ones whose treatment rests on the thinnest ground.

What this means in practice

• A child with post-traumatic symptoms after abuse should be offered trauma-focused treatment. It is established, bounded in time, and described by the Swedish health authorities.
• A guardian can ask the clinician: is this TF-CBT or EMDR, and how many sessions are planned?
• For children below school age no method has firm support. That is a reason to demand research, not a reason to withhold care.

Marianco's rehabilitation programme is built on this evidence base, including its gaps. We say what is established and what is not, because that is the difference between selling hope and earning trust. Sources: Hoppen et al., network meta-analysis, 2025. Thielemann et al., systematic review. NICE, guideline NG116. SBU, report 380 and SBU commentary 2023. The National Board of Health and Welfare's method guide.