Abstract
Refinement, targeting, and better dissemination of trauma-focused therapies requires understanding their underlying mechanisms of change. Research on such mechanisms among multiply traumatized children and adolescents is scarce. We examined the role of improvements in problematic qualities of traumatic memories and maladaptive posttraumatic cognitions in PTSD symptom reduction, in a randomized, pragmatic trial of narrative exposure therapy vs. treatment as usual with 40 participants 9–17 years old (48% female, 75% refugee background) repeatedly exposed to war or family violence related trauma. Posttraumatic cognitions, quality of traumatic memories and PTSD symptoms were assessed by self-report before and after treatment. Improvements in both quality of traumatic memories (rMI = .36) and posttraumatic cognitions (rMI = .46) correlated with symptom reduction. However, improvement during treatment was only significant for quality of traumatic memories (FMI(11,333.56) = 4.77), not for posttraumatic cognitions. We detected no difference in effects of narrative exposure therapy and treatment as usual on cognitions or memories. We tentatively suggest problematic, overly sensory and incoherent quality of traumatic memories may be a useful target in the treatment of PTSD symptoms among multiply traumatized children and adolescents. Changing maladaptive posttraumatic cognitions, though important, may be challenging among those with severe, repeated trauma.
Highlights
Meta-analyses have found several trauma-focused treatments effective in treating posttraumatic stress symptoms (PTSS) among children and adolescents (Brown et al 2017; Gillies et al 2016)
Results indicated no significant effect of Time (FMI(13,726.70) = 1.45, p = 0.229), Intervention (FMI(157,323.45) = 0.75, p = .386) or Time × Intervention interaction (FMI(1, 4498.45) = 0.95, p = 0.330)
Changes in PTSS from pretest to posttest correlated significantly with changes in posttraumatic cognitions from pretest to posttest
Summary
Meta-analyses have found several trauma-focused treatments effective in treating posttraumatic stress symptoms (PTSS) among children and adolescents (Brown et al 2017; Gillies et al 2016). Information processing accounts of PTSD suggest maladaptive PTCs have a key role in preventing recovery from PTSS by keeping up a sense of on-going threat and promoting the use of dysfunctional strategies to reduce distress (Ehlers and Clark 2000; Dalgleish 2004). They would be important targets for treatment, which developers of evidence-based PTSD treatments have acknowledged (Schnyder et al 2015)
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