title: Narrative Focus Predicts Symptom Change Trajectories in Group Treatment for Traumatized and Bereaved Adolescents.
abstract: Growing evidence supports the effectiveness of Trauma and Grief Component Therapy for Adolescents (TGCT-A) in reducing posttraumatic stress disorder (PTSD) symptoms and maladaptive grief (MG) reactions. This pilot study explored whether the specific focus of students' narratives (i.e., focus on trauma vs. focus on loss) as shared by TGCT-A group members would predict initial pretreatment levels, as well as pre- to posttreatment change trajectories, of PTSD symptoms and MG reactions. Thirty-three adolescents from three middle schools completed a 17-week course of group-based TGCT-A. PTSD and MG symptoms were assessed at pretreatment, twice during treatment, and at posttreatment. The focus (trauma vs. loss) of each student's narrative was coded using transcripts of members' narratives as shared within the groups. The reliable change index showed that 61% of students reported reliable pre-post improvement in either PTSD symptoms or MG reactions. Students whose narratives focused on loss both reported higher starting levels and showed steeper rates of decline in MG reactions than students whose narratives focused on trauma. In contrast, students whose narratives focused on trauma reported higher starting levels of PTSD than students who narrated loss experiences. However, narrative focus was not significantly linked to the rate at which PTSD symptoms declined over the course of treatment. This study provides preliminary evidence that TGCT-A treatment components are associated with reduced PTSD symptoms and MG reactions. Loss-focused narratives, in particular, appear to be associated with greater decreases in MG reactions.
authors.affiliation: a Department of Psychological and Brain Sciences , University of Delaware.
authors.forename: Stevie N
authors.initials: SN
authors.lastname: Grassetti
authors.affiliation: b Couple and Family Therapy Department , Drexel University.
authors.forename: Joanna
authors.initials: J
authors.lastname: Herres
authors.affiliation: a Department of Psychological and Brain Sciences , University of Delaware.
authors.forename: Ariel A
authors.initials: AA
authors.lastname: Williamson
authors.affiliation: a Department of Psychological and Brain Sciences , University of Delaware.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Yarger
authors.affiliation: c UCLA/Duke University National Center for Child Traumatic Stress and Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Layne
authors.affiliation: a Department of Psychological and Brain Sciences , University of Delaware.
authors.forename: Roger
authors.initials: R
authors.lastname: Kobak
mesh_terms: D000293:Adolescent; D001601:Bereavement; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D062525:Narrative Therapy / Q000379:methods*; D010865:Pilot Projects; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome