In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT).
OBJECTIVE
Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms.


METHODS
Participants were a racially diverse sample of Medicaid-eligible youth (ages 7-17) and their nonoffending caregivers (N = 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV; UPID) at 3, 6, 9, and 12 months postintake.


RESULTS
Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers' cognitive-emotional processing of their own and their child's trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs.


CONCLUSIONS
The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. (PsycINFO Database Record
Department of Psychological and Brain Sciences, University of Delaware.
Carly
C
Yasinski
Department of Psychological and Brain Sciences, University of Delaware.
Adele M
AM
Hayes
Durham Veteran's Affairs Medical Center.
C Beth
CB
Ready
Department of Psychology, University of Saskatchewan.
Jorden A
JA
Cummings
Department of Psychological Science, University of Arkansas.
Ilana S
IS
Berman
Department of Psychological and Brain Sciences, University of Delaware.
Thomas
T
McCauley
State of Delaware Division of Prevention and Behavioral Health Services.
Charles
C
Webb
Esther Deblinger, CARES Institute, School of Osteopathic Medicine, Rowan University.
Esther
E
Deblinger
D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010290:Parents / Q000523:psychology*; D000067073:Psychological Trauma / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology