Relaxation

Quick reference

Relaxation addresses the physical part of the stress response. Help the child notice early cues and discover strategies they can actually use. The aim is increased choice and participation, not perfect calm. In TF-CBT, skills support gradual engagement with trauma-related material; they should not become a rule that all discomfort must disappear before treatment can proceed.

• Explain bodily alarm cues in language the child understands.
• Offer a small choice of strategies and practice together.
• Check comfort, accessibility, and what changed after practice.
• Revisit the skill across sessions and settings with an appropriate caregiver.

Child and caregiver work

Start with a neutral situation and ask where stress shows up: tight shoulders, a fast heartbeat, an unsettled stomach, or restless movement. Avoid assuming every physical symptom is anxiety; new or concerning symptoms may require medical assessment. Explain the difference between responding to a real threat and an alarm activated by a safe reminder.

Introduce comfortable, unforced breathing, gentle muscle release, pleasant imagery, or another acceptable calming activity. Demonstrate briefly and invite feedback. Do not prescribe rapid or exaggerated breaths. If breath attention causes dizziness or distress, stop that exercise and select another option. Eyes can remain open, and the child can choose a position that feels comfortable.

Practice noticing a cue, choosing a skill, and returning attention to the task. Ask about changes in tension, focus, or ability to remain present rather than treating a distress score as a pass/fail test. Integrate brief practice with increasingly relevant material under a trained therapist’s guidance. Skills remain available during exposure, but using them solely to escape every reminder can preserve avoidance.

Coach the caregiver to model the skill during an ordinary routine and offer a brief invitation instead of repeated commands to calm down. Explore their own stress response and rehearse how to support the child without taking over. A child’s preferred strategy may differ from the caregiver’s; that is useful information.

Example language

Original examples for adaptation; not published protocol scripts.

Choice: “Would you like to try relaxing your hands or taking a few easy breaths? You can tell me if either feels uncomfortable.”

Reflection: “Did anything change in your body or your attention? Even a small change helps us learn which tools fit you.”

Caregiver coaching: “Try offering, ‘I’m going to loosen my shoulders. You can join me if you want,’ and notice whether that feels more helpful than ‘calm down.’”

Developmental considerations

Young children may engage through playful demonstrations, such as softening hands after a gentle squeeze. Keep practice short and concrete. Older children can compare strategies and select cues for practice. Adolescents may prefer discreet options they can use in class. Adapt for sensory preferences, pain, respiratory conditions, mobility, and communication needs; imagery is optional rather than a requirement.

Common challenges

If quiet attention increases distress, try orienting to the room, gentle movement, or a concrete external task. If the child says a skill “doesn’t work,” clarify the expected benefit and review context rather than insisting it should remove the feeling. If a caregiver uses relaxation as punishment or demands compliance, reframe it as a practiced support skill.

Between sessions

Choose a comfortable time for brief rehearsal before stress is intense. Specify an accessible setting and a caregiver response the child accepts. Record which strategy was tried and whether it helped participation. Review barriers next session, and adapt. Families should not initiate trauma exposure on their own to test the skill.