Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives.

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

"My Bad Experiences Are Not the Only Things Shaping Me Anymore": Thematic Analysis of Youth Trauma Narratives.

The purpose of this study was to better understand how youth with poly-trauma histories appraise and make meaning of their traumatic experiences within the trauma narrative and processing components of Trauma-focused Cognitive Behavioral Therapy (TF-CBT), and to explore the results of the meaning-making process. Thematic analysis was employed to explore the trauma narratives of youth (N = 16) ages 8 - 16 that were created during TF-CBT. Participants experienced a mean of 5.38 types of trauma that predominantly included various forms of child maltreatment. With regard to how youth appraise and interpret their traumatic experiences, four themes emerged, including I Am Not Safe, which denotes a lack of physical and psychological safety; It's My Fault, which symbolizes misattributions of responsibility; I Am Changed, which captures alterations in systems of meaning; and Why Did This Happen to Me?, which denotes the struggle to comprehend why the traumatic events occurred and their significance. With regard to the products of the meaning-making process, three themes emerged, including Now I Know, which denotes reappraisals; I Am Safe/r, which signifies increases in perceptions of safety, and I Can Do It, which includes the participant's perceptions of growth. Results from this study provide a deeper understanding of youth's experiences during these components of treatment, and illuminate the meaning-making process. Findings can help guide clinical-decision making, and highlight the importance of explicitly attending to specific components of the meaning-making process during trauma narration and processing.

Gender differences in the PTSD symptoms of polytraumatized youth during isolated phases of trauma-focused cognitive behavioral therapy.

OBJECTIVE: Gender differences in the development and severity of PTSD have long been observed, but much less is known about gender differences within the context of trauma-focused treatment. This study investigated gender differences in the PTSD symptoms of polytraumatized youth during Trauma-focused Cognitive Behavioral Therapy (TF-CBT). METHOD: The sample included child welfare-involved youth ages 7-18 (N = 138) who experienced a mean of 4.78 types of trauma and received TF-CBT at a trauma treatment clinic. Mixed ANOVA analyses assessed gender differences in PTSD symptoms from baseline to termination of treatment. PTSD symptoms were then mapped according to the phase of treatment, and factorial ANOVAs examined gender differences during isolated phases of TF-CBT. Potential interactions with sexual violence history were considered. RESULTS: Significant reductions in overall PTSD, intrusive, avoidance and arousal symptoms were found from baseline to termination of TF-CBT for the entire sample, although females reported higher symptom levels across all PTSD symptom domains. Significant gender differences were also revealed during some, but not all, phases of treatment, with variations among PTSD symptom domains noted. CONCLUSIONS: Findings suggest TF-CBT is effective in reducing PTSD in youth with poly-trauma exposure, irrespective of gender. Gender differences in symptom severity were revealed, however, and indicate the need to attend to gender within the context of treatment. Findings also suggest the use of measurement-based care, and specifically attending to symptom fluctuation in PTSD symptom domains during treatment, can help inform clinical decision making and individualize treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Just like Jail": Trauma Experiences of Older Homeless Men.

People experiencing homelessness often have a history of trauma, and losing one's home is a traumatic event. The trauma of living in emergency shelters and on the streets uniquely impacts older adults, whose experiences of homelessness increase the likelihood of multiple health conditions and premature aging. This paper includes data from 18 men, aged 50 and older, who had experienced multiple instances of homelessness, as part of a larger study to understand the return path to homelessness from permanent housing. When participants spoke with us about their failure to be in housing, their inability to free themselves from reoccurring homelessness could not be discussed without talking about their trauma. Participants spoke of trauma in early life, perhaps precipitating homelessness, as well as traumatic experiences while homeless. The men discussed feeling imprisoned by the systemic issues around homelessness, facing mistreatment by service providers, and being exposed to external threats in their lives on the streets, including violence. Findings from this study lend themselves to the explicit need for trauma-informed care and supportive services that are sensitive to the urgency of homelessness as it is experienced by men in late life.

Disseminating TF-CBT: A Mixed Methods Investigation of Clinician Perspectives and the Impact of Training Format and Formalized Problem-Solving Approaches on Implementation Outcomes.

BACKGROUND: Trauma Focused-Cognitive Behavioural Therapy (TF-CBT) has been established as an evidence-based treatment for youth with traumatic stress symptoms. The versatility of TF-CBT in conjunction with its established effectiveness has led to its widespread dissemination. However, dissemination efforts have not always translated into sustainability, which has prompted a more thorough investigation into those factors that impact implementation and encouraged the development of strategies that promote sustainability. Toward this end, the aims of this study were to: (1) determine which components of TF-CBT clinicians found the most difficult to implement; (2) explore clinicians' perceptions as to why these components were challenging; and (3) examine whether the use of formalized problem-solving approaches (FPSAs) or training format was associated with implementation outcomes. METHODS: A mixed methods design was utilized to analyse survey data from mental health professionals (N = 85) who received TF-CBT training. Thematic analysis explored responses to questions concerning those TF-CBT components respondents found most difficult to implement, while bivariate analyses helped determine whether training format or the use of FPSAs was associated with training engagement, confidence in delivering TF-CBT, fidelity or sustainability. RESULTS: Clinicians perceived the same three components of TF-CBT as most difficult regardless of the type of training they received, and provider, youth, caregiver, and organizational-related themes emerged from thematic analysis. Bivariate analyses indicated more extended training formats and the use of FPSAs were associated with greater implementation success. CONCLUSION: Findings suggest that perceived difficulty of TF-CBT components did not vary by training format, but more extended formats and the use of FPSAs were associated with more favourable implementation outcomes. Implementers should consider ways to utilize FPSAs within training programs, as well as focus on content identified by clinicians as difficult, as this may assist clinicians in developing skills and managing implementation barriers.