In-Session Caregiver Behavior Predicts Symptom Change in Youth Receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• Published in: Journal of consulting and clinical psychology 2016-12, Vol.84 (12), p.1066-1077
• Main Authors: Yasinski, Carly, Hayes, Adele M., Ready, C. Beth, Cummings, Jorden A., Berman, Ilana S., McCauley, Thomas, Webb, Charles, Deblinger, Esther
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Avoidance behavior; Behavior change; Blame; Caregivers; Caregivers - psychology; Child; Child Behaviour Checklist; Children & youth; Clinical outcomes; Cognition; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Therapy - methods; Correlation analysis; Diagnostic and Statistical Manual; Emotion recognition; Female; Human; Humans; Internalization; Male; Medicaid; Mental disorders; Mental health care; Outcome and Process Assessment (Health Care); Parents; Parents - psychology; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychological Trauma - therapy; Social Support; Stress Disorders, Post-Traumatic - psychology; Trauma; Trauma-Focused Cognitive Behavior Therapy; Youth
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000147

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. Method: 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. What is the public health significance of this article? This study highlights the importance of assessing and targeting caregiver behavior during Trauma-Focused Cognitive Behavioral Therapy, a well-established treatment for youth trauma, as these behaviors are associated with long-term youth outcomes.