Trauma-focused Cognitive Behavioral Therapy Research Articles

“There is a Mental Resistance”: Experiences of Involving Refugee Parents in a Youth Trauma Recovery Program from the Perspective of Participating Youth, Parents and Facilitators

Scalable light-touch programs that align with the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) approach is becoming an established intervention model for refugee youth with symptoms of post-traumatic stress. Teaching Recovery Techniques (TRT) is one example and, as TF-CBT guidelines state, parent sessions are included as the model relies on parents to provide support and instigate the techniques. In addition to traumatic stress, refugee families are often subjected to acculturative, isolation and resettlement stress. This study sought to understand how refugee parental involvement in TRT functions in practice and how it is perceived by participating youth, parents, and facilitators in Sweden. Thirty semi-structured interviews (11 youth, 8 parents, and 11 TRT facilitators) were conducted by phone or videoconference, transcribed, and analyzed using Thematic Network Analysis. A global theme ‘Parental engagement in trauma recovery requires dedicated attention’ emerged. Three organizing themes sat within this global theme: (i) Shifting roles when adapting differently to a new context; (ii) Tendency to keep parents at a distance; and (iii) Parent sessions don’t just happen. Whilst the potential for refugee parent involvement was recognized, a number of factors preventing their participation were identified. Cultural adaptations within TRT facilitators’ training are recommended, including: raising awareness about contextual factors and changes in family dynamics with regard to trauma and migration; adopting culturally responsive ways to present parental involvement to youth and parents; adding positive parenting skills; addressing parental mental health and readiness; and preparing facilitators to redirect parents to adequate services, when needed.

Evocation of positive memories as complement to trauma-focused cognitive–behavioural therapy for intimate partner violence against women

ABSTRACT Background: Focusing on positive memories as a complement to trauma-focused interventions for intimate partner violence against women (IPVAW) could contribute to enhancing the recovery from trauma with the development of a more integrated and emotionally modulated autobiographical narrative. Objective: To test the effectiveness of a trauma-focused cognitive behavioural therapy (CBT) tailored for IPVAW that incorporates the evocation of positive memories. Methods: Female survivors of IPVAW entered a randomized controlled trial comparing trauma-focused CBT for IPVAW (CBT; n = 35) to a version that incorporates the evocation of positive memories (CBT-M+; n = 44) and to a waitlist (WL; n = 12) control group. Pre and post measures were obtained for: posttraumatic stress, meaning of trauma, affect, emotional regulation, associated symptoms, self-concept and overall functioning. Results: A total of 43.04% of women who entered treatment dropped out, without significant treatment differences. Pre–post changes were not significant for the WL; both treatments resulted in significant improvements, with good effect sizes, for posttraumatic stress (g = 0.78 and g = 1.00 for CBT and CBT-M+, respectively), meaning of trauma, affect, associated symptoms, self-concept and overall functioning, but not in emotional regulation. There were no significant differences between CBT and CBT-M+ in the direct comparisons; however, the effect sizes showed better effects of CBT for centrality of the IPVAW, whereas they favoured CBT-M+ for PTSD, depression, self-esteem and impairment measures. No clinically significant change was reached for the WL, while both treatments significantly reduced the percentage of women with PTSD and self-esteem problems; additionally, the percentage of women with depression and impairment problems in the CBT-M+ group was significantly decreased. Conclusions: Although there were few differences between both treatments, CBT-M+ seemed to have a greater effect, pointing to the potential of the inclusion of the evocation of positive memories that should be further researched.

Resilience and Religious Coping in Libyan Survivors of Hurricane Daniele.

The aim of the study was to investigate the mediating roles of resilience, posttraumatic growth (PTG) and religiosity between the impact of hurricane trauma and psychological distress. Using a cross-sectional design, the study involved 101 Libyan participants with an average age of 30.43 years (SD = 9.59), of whom 72% were women. Participants completed validated tests, including the Impact of Event Scale (IES), Brief Resilience Scale, Muslim Religiosity Scale and Patient Health Questionnaire (PHQ). The results indicated that posttraumatic stress symptoms (PTSS) were not associated with PTG (r = 0.04, p > 0.05) or religiosity (r = 0.02, p > 0.05) but were negatively associated with resilience (r = -0.39, p < 0.001) and positively associated with psychological distress including anxiety (r = 0.72, p < 0.001) and depression (r = 0.69, p < 0.001). Structural equation modelling (SEM) revealed that only resilience positively mediated the association between PTSS and anxiety (indirect effect = 0.04, p = 0.031), while PTSS positively predicted psychological distress (β = 0.037, p < 0.001). Network analysis identified parent loss is strongly connected with intrusion (r = 0.121), as most central node, while partner loss was associated with hyperarousal (r = 0.063), irritability (r = 0.036) and both share the same connection with numbing, while interestingly partner and friends loss share connection with resilience (r = 0.177). The study concludes that urgent clinical interventions, such as trauma-focused cognitive behavioural therapy, are required for the affected individuals, with a focus on enhancing resilience as a protective factor against PTSS.

The sustainability of a community-based learning collaborative to improve the use of trauma-informed evidence-based practices

PurposeMost youth who experience trauma do not receive evidence-based trauma intervention. Efforts to increase use oftrauma-informed evidence-based practices (EBPs) have identified the learning collaborative (LC) as an effective training and implementation model, yet few studies have evaluated sustainability outcomes. This study examined the sustainability of a community-based LC (CBLC) by describing provider, agency, and community-level use of trauma-informed EBPs, an average of 5.3 years after the training. Methods106 participants from 20 agencies completed a follow-up survey after a CBLC training. Participants were trained in Trauma-Focused Cognitive-Behavior Therapy (TF-CBT; clinical track), in Evidence-Based Treatment Planning (EBTP; broker/case manager track), or in strategies to support TF-CBT and EBTP implementation (senior leader track). Clinical and broker track participants reported on their current employment and EBP use within the past three months. Senior leaders for all 20 agencies provided information about the use of trauma-informed EBPs at their agencies. ResultsAt the provider-level, only 36.5 % of the clinical track continued to use TF-CBT and 28.1 % of the broker track continued to use EBTP. Provider promotion to supervisory and leadership positions supported EBP sustainability. Agency-level outcomes indicated that 89 % of clinical agencies and 60% of broker agencies continued to use TF-CBT and EBTP. Although retention of providers within agencies was low, LC trained clinicians and brokers spread to twenty-four new agencies in the community providing psychotherapy and/or case management services to youth. ConclusionsFindings suggest the CBLC model resulted in some sustained community-level changes as agencies continued to use the trauma-informed EBPs and trained providers spread to other agencies within the local community. Provider promotions also increased representation of CBLC trainees in leadership positions. Results suggest that measuring sustainability as a multi-level implementation outcome can lead to a better understanding of implementation success.

Telehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability.

There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations.

The dissemination and implementation of trauma-focused cognitive behavioural therapy for children and adolescents in seven European countries

BackgroundThere is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as “trauma-focused cognitive behavioural therapy” (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.MethodsFor this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).ResultsCommon modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.ConclusionsThe results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

Group-Delivered Trauma-Focused CBT Integrating Racial Socialization: A Multiple Case Study

In addition to disparities in interpersonal trauma exposures, Black youth in the U.S. experience the compounding stress of racial trauma, both of which are associated with a disproportionate mental health burden. Black youth also face barriers to engaging with trauma-specific therapies to address trauma-related mental health problems, with research suggesting that they are less likely to complete trauma-specific treatment. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based therapy for trauma-related mental health problems in youth ages 3 to 18. Metzger and colleagues (2021) proposed a set of cultural considerations for Black families to address racial stressors and enhance engagement in TF-CBT. The aim of the current multiple case study was to demonstrate the utility of group-delivered TF-CBT integrating these considerations for a single telehealth group of Black adolescents and their caregivers. We describe the intervention, patient engagement and clinical outcomes, and feedback from families regarding their experience with the group model. We also outline clinical and implementation challenges and highlight directions for future research and clinical practice.

Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment.

Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.

A hospital and community-based violence intervention program for Black & Latino youth and their caregivers.

Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed.

Integration of a smartphone app with posttraumatic stress disorder treatment for frontline workers: a pilot study

ABSTRACT Objective Treatment of posttraumatic stress disorder (PTSD) is hindered by limited uptake, early drop-out and non-response. This pilot study aimed to explore the feasibility, acceptability, and usability of a mobile app as part of a blended approach to treating frontline workers experiencing PTSD. Method A single-group pre-post study was conducted with 10 adult frontline workers (firefighters, police, correctional workers) receiving trauma-focused cognitive-behavioural therapy for PTSD. Participants used an app (Support Base) designed to consolidate session content and encourage independent skills practice. At post-treatment, feasibility was assessed via app usage data and participant feedback, usability via the mHealth App Usability Questionnaire, and acceptability via items from the Mobile Application Rating Scale: user version. Results Usability ratings were above average and the app received an overall mean rating of 3.4/5. Despite generally positive attitudes towards using technology in therapy, participants had low levels of confidence/experience with wellbeing apps and almost half preferred using the standard treatment workbook. Clinicians highlighted a range of client barriers to app use, including difficulties in clinician/client collaboration. Overall, there was significant pre- to post-treatment improvement in clinical measures of PTSD and depression, but this change cannot be tied to app use. Conclusions Although Support Base was viewed by participants as usable and acceptable, there were feasibility issues which must be further considered in delivering this form of care. Due to the uncontrolled study design, any additive effects of the app beyond standard clinical treatment could not be assessed. The development of a more integrated blended care model is a potential avenue for future research.

Prazosin Treatment of Sleep Problems in Youth with PTSD

Post traumatic stress disorder (PTSD) is a condition characterized by reexperiencing symptoms, persistent avoidance, negative alterations in cognition and mood, and changes in arousal and reactivity in response to a traumatic event (American Psychiatric Association, 2013). The pathophysiology of PTSD is not fully understood but likely related to dysregulation of fear‐processing. Currently, the gold standard of treatment is trauma‐focused cognitive behavioral therapy (TF‐CBT). SSRIs are the only FDA‐approved pharmacologic treatments for PTSD in adults and there are no FDA approved medications to treat pediatric PTSD. Unlike studies in adults, double‐blinded randomized control trials (RCTs) did not show any efficacy for SSRIs in pediatric patients diagnosed with PTSD (Hudson et al., 2021). While estimates of pediatric PTSD prevalence varies, the prevalence of PTSD at age 18 is 7.8% (Rolling et al., 2023). Sleep disturbances such as insomnia, night‐time awakenings, and nightmares often persist despite treatment with TF‐CBT or SSRIs. Left untreated, sleep disturbances are predictive of PTSD persistence and comorbid psychiatric complications (Rolling et al., 2023). There is evidence supporting the use of the medication prazosin in alleviating pediatric PTSD sleep disturbances including nightmares and insomnia. Anywhere from 20–80% of children with PTSD report nightmares compared to a prevalence of 10–20% in the general pediatric population (Kovachy et al., 2013). There is a growing need for pharmacologic therapy given the paucity of providers trained in TF‐CBT and a need for symptomatic management. In this review, we will examine sleep disturbances in pediatric PTSD patients and discuss the feasibility of prazosin as an adjunct treatment option.

TF-CBT for Child Earthquake Survivors: Promoting Self-Compassion, PTG, and Reducing Behavioral Problems

The present study aimed to explore the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in facilitating post-traumatic growth, increasing self-compassion, and reducing behavior problems among the children experiencing the 2017 Sarpol-e Zahab (Iran) earthquake. Among earthquake-traumatized 9-12-year-old girls, 24 were selected through purposive sampling. The 24 participants were randomly assigned to the experimental and the control group, each with 12 subjects. The experimental group received 12 sessions of TF-CBT, although 3 subjects left the experimental group during the sessions. Consequently, the analysis included 21 participants: 9 in the experimental group and 12 in the control group. The post-traumatic growth inventory for children revised (PTGI-C-R), the self-compassion scale-short form (SCS-SF), and the Rutter children’s behavior questionnaire for parents were completed at baseline, after the intervention, and one-month follow-up. The results indicated that compared to the control group the participants in the experimental group obtained higher scores in post-traumatic growth and lower scores in behavior problems (i.e., aggression and hyperactivity, and anxiety and depression) (p <.01) which were consistent in the follow-up period. It was also find out that, the experimental group reported higher levels of self-compassion in the follow-up (p <.01). The study suggests that TF-CBT may be effective in improving post-traumatic growth, self-compassion, and behavior problems among children affected by earthquake trauma.

Trauma focused-cognitive behavioral therapy training effectiveness in promoting professional development of psychotherapists working with unaccompanied minors in Greece: a non-blinded randomized control trial.

The need to develop psychotherapists' skills to respond to current treatment challenges, such as addressing trauma due to the refugee crisis, is increasing. However, there is a dearth of evidencebased training for psychotherapists who work with refugees, especially in frontline countries. A randomly selected sample of 80 clinicians working with unaccompanied minors (UAMs) in Greek accommodation centers nationwide participated in an intensive trauma-focused cognitive behavioral therapy (TF-CBT) training (n=44) or a control-group (n=36) and completed the Professional Quality of Life Scale, the Work and Meaning Inventory and a questionnaire to assess knowledge and therapeutic skills, in pre-andpost measurements. Clinicians with 1-3 years of experience with refugees reported higher burnout (p=0.012, M=25.78 vs M=22.04) and secondary traumatic stress than those with less than a year (p=0.014, M=22.03 vs M=18.04). Positive meaning at work increased in both groups at post-test (TF-CBT group: p=0.019, M=15 vs M=13.6, and control group: p<0.001, M=15.17 vs M=13.42). The TF-CBT training group outperformed the control group in knowledge and skills (p=0.021, M=10.15 vs M=8.75) and identified a lower number of children with post-traumatic stress disorder symptoms (p=0.009, M=6.94 vs M=4.33) post-training. This study provides preliminary evidence on TF-CBT training effectiveness in equipping psychotherapists to work with UAMs, while their professional quality of life warrants further research.

Cognitive–behavioural therapy for complex post-traumatic stress disorder

SUMMARY Complex post-traumatic stress disorder (CPTSD) was adopted as a new diagnosis in ICD-11. Trauma-focused cognitive–behavioural therapy (CBT) is effective in treating PTSD but with CPTSD being a recently defined diagnosis, the evidence for its effectiveness in that disorder is not as clear, but it is still promising. This article reviews the diagnosis, psychopathology and some key differential diagnoses, and looks at the two CBT approaches that are currently used in clinical practice: the phase-oriented approach and the unimodal approach. The key aims of this article are to clarify the concept of CPTSD, its differentiation from borderline personality disorder and prominent comorbidities, how it develops and how CBT is used to treat it.

Exploring the Benefits of Dog-Assisted Therapy for the Treatment of Complex Trauma in Children: A Systematic Review.

The manifestation of complex trauma results from exposure to severe and repetitive stressors occurring within the caregiver system. Frequently associated with child maltreatment, complex trauma can lead to impairments in multiple domains, including attachment, affect and behavioural regulation, and cognition. Treatments, including Trauma-Focused Cognitive Behavioural Therapy, have been shown to be efficacious, but high attrition rates point to the need for complementary methods that boost client retention and treatment efficacy. This systematic review examines whether dog-assisted therapy has beneficial impacts on the treatment of complex trauma and whether it can decrease treatment attrition among children presenting with complex trauma exposure. We followed PRISMA guidelines to locate relevant research reports. Seven published research reports matched the inclusion criteria. Dog-assisted therapy may increase the efficacy of standard interventions for complex trauma, although only one study formally assessed treatment retention. Across most studies, there is an overall lack of detailed information on the nature of therapeutic activities involving the dog and how these activities may complement or enhance therapy as usual. Studies were of varying methodological quality, impacting the reliability of findings. Future studies should aim to better describe and justify dog-assisted therapy techniques and evaluate these in comparison with standard evidence-based approaches to the treatment of childhood complex trauma.

A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder.

Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD. Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale. Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone). Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

Unaccompanied migrant children in the United States: Implementation and effectiveness of trauma-focused cognitive behavioral therapy.

The number of unaccompanied children (UC) arriving in the United States (U.S.) from other countries has increased significantly over the past decade. UC report high trauma exposure and greater posttraumatic stress symptoms compared with youth who immigrate with caregivers. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has demonstrated preliminary effectiveness with UC. However, few studies have treated U.S.-based samples of UC, who emigrate primarily from Central America. One hundred thirty-eight UC were referred for treatment and 129 completed a pretreatment assessment including the Child and Adolescent Trauma Screen (CATS) and the Strengths and Difficulties Questionnaire (SDQ). Most UC were from Central America (n = 109; 79.0%) and resided in government facilities (n = 76; 55.1%). One hundred twenty-two youth began TF-CBT, had an average of 9.71 sessions (SD = 9.3, range: 1-48), and 41.8% (n = 51) completed treatment. One hundred four youth completed a brief, six-item progress monitoring measure of trauma symptoms, for which 84 had at least two observations during treatment. UC endorsed 3.80 traumatic events on average (SD = 2.38). High rates of violence, physical and sexual abuse, and serious injury were reported. There were significant improvements on most self-report rating scales (p < .05); within-subjects Cohen's d's ranged from .07 to 1.03 for pre- to posttreatment assessments and was d = .44 for the progress monitoring measure. Therapists reported on TF-CBT modifications for UC, including discussing mental health beliefs, navigating roles and relationships, tailoring treatment examples, exploring coping strategies, and addressing immigration factors. Preliminary findings support the utility of TF-CBT with UC. Implications for implementation and cultural modifications are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic stress disorder following childhood sexual and physical abuse: a study protocol for an 11-week randomised controlled trial comparing imaginal exposure and imagery rescripting

ABSTRACT Background: There is a vast amount of evidence supporting the effectiveness of trauma-focused cognitive-behavioral therapy in treating posttraumatic stress disorder (PTSD). However, it remains unclear which specific treatment is most effective for patients with PTSD following childhood sexual and physical abuse (CSPA). Although Imaginal Exposure (IE) has proven highly effective in treating PTSD and is widely acknowledged as a standard method, Imagery Rescripting (IR) may be more suitable for CSPA-related PTSD. IR not only addresses fear but also targets other emotions and cognitions associated with childhood maladaptive schemas. Preliminary findings suggest lower drop-out rates for IR compared to IE, but no Randomized Controlled Trial (RCT) currently assesses the effectiveness of IR for CSPA-related PTSD. Objective: This article presents a study protocol designed to investigate the optimal treatment (IE or IR) for individuals with CSPA-related PTSD and explore predictors of treatment success. Method: In our study protocol, we suggest the inclusion of 173 patients (N = 64 in IR, N = 64 in IE, and N = 45 in the waitlist condition). The therapy procedures for both IE and IR will consist of 16 sessions lasting 90 min each, with treatment durations of 11 weeks. Measurements take place at baseline, at start of treatment, 11 weeks after the start of treatment (after 16 sessions) and at follow-up at 26 weeks after the last session. A mixed regression will be used to compare the three active conditions before and after measurement. Results: This article serves as a study protocol. The results are not yet available but they will be presented in a subsequent article. Conclusion: This study protocol outlines a RCT which will be the first to provide information on the effectiveness of IR versus IE versus a control group in CSPA-related PTSD. Trial registration: Netherlands Trial Register NTR 4817. Registered 26 September 2014.

A community-based study of the impact of trauma exposure on school-aged children's self-concept and improvements following TF-CBT

BackgroundExperiencing trauma in childhood has been associated with more severe psychopathology and a greater risk of engaging in harmful behavior later in life. Traumatic exposure can also erode a child's self-concept. Negative self-concept has been associated with shame, self-doubt, and helplessness in the face of adverse experiences. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based model for children; however, research on its effectiveness in improving children's self-concept is limited. ObjectiveTo investigate the impact of trauma on school-aged children's self-concept and improvements following TF-CBT. Participants and settingA demographically diverse sample of trauma-exposed school-aged children referred to community-based agencies in Canada and a normative sample of school-aged children randomly selected from the general population in the United States. MethodA longitudinal design was used to assess trauma-exposed children's self-reported self-concept using the short-form Tennessee Self-Concept Scale – Second Edition (TSCS:2; Fitts & Warren, 1996) prior to and following TF-CBT. ResultsTrauma-exposed children had a significantly more negative mean self-concept compared to that of the normative sample. Improvements following TF-CBT – and not the passage of time alone – were found with gains maintained six months post-therapy. ConclusionsSchool-aged children awaiting treatment at community-based agencies are likely to hold clinically concerning negative views of themselves. TF-CBT was effective in significantly improving their self-concept with continued and lasting improvements observed after the therapy had been completed.