Improvements in personal resiliency among youth who have completed trauma-focused cognitive behavioral therapy: A preliminary examination.

This preliminary investigation assessed whether different aspects of personal resiliency improved for youth (7-17 years old) impacted by child sexual abuse (CSA) after completing trauma-focused cognitive behavioral therapy (TF-CBT). The Resiliency Scales for Children and Adolescents (RSCA; Prince-Embury, 2007) were administered to 157 youth before and after participating in TF-CBT with their nonoffending caregivers. Hierarchal regression analyses were performed to ascertain whether pretest RSCA resiliency scores moderated decreases in the posttraumatic stress and self-reported depressive symptoms at posttreatment. The RSCA scales did not moderate any of the improvements on the PTSD and depression outcome measures. Paired t-tests between the mean pre- and posttest RSCA Sense of Mastery (MAS), Sense of Relatedness (REL), and Emotional Reactivity (REA) scores demonstrated significant (ps<0.001) improvements on these measures over time. Using residualized posttest scores for the three RSCA scales to assess improvement, significant correlations were found between changes in resiliency and various residualized outcome scores for posttraumatic stress disorder (PTSD) and depression measures. Decreases in the REA scores and increases in the MAS and REL scores were related to fewer symptoms of hypervigilance and less self-reported depression after completing TF-CBT. Only improvements in the REL scores were associated with fewer symptoms of re-experiencing after treatment. The results were discussed as indicating that significant improvements in personal resiliency had occurred over time with effect sizes less than those found for posttraumatic stress symptoms, but comparable to those found for self-reported depression reductions. Limitations and future research recommendations are discussed.

Cognitions and distress in caregivers after their child's sexual abuse disclosure.

The impact of child sexual abuse on children is well documented, but few studies have examined the impact of a child's sexual abuse disclosure on maternal caregivers. The studies that have been conducted suggest that parental response postdisclosure is variable. The present study examined the association between maternal attributions and abuse-specific cognitions with depression and trauma symptoms postdisclosure. Participants included 68 nonoffending maternal caregivers of children between the ages of 3 and 17 years who experienced child sexual abuse. Findings indicated that caregivers' abuse-specific cognitions were the best predictor of self-reported symptoms of depression after controlling for general negative attributions. These findings suggest that in order to reduce caregivers' distress and to enhance their support of their children, it is important to assess and treat caregivers' abuse-specific cognitions.

PTSD symptom cluster profiles of youth who have experienced sexual or physical abuse.

The research examined whether youth (6-17 years old) who were referred for treatment due to sexual, physical, or both types of abuse presented with distinct profiles of PTSD DSM-IV-TR symptom clusters. When examining data for the 749 youth participants, five PTSD symptom cluster profiles were identified with each profile representing approximately 20% of the youth. The five profiles were also differentiated with respect to being referred for physical or sexual abuse, age, parental ratings of internalizing symptoms, and self-reported depression. The youth referred for treatment in the aftermath of child sexual, physical, or both sexual and physical abuse presented with different profiles of PTSD symptom clusters thereby suggesting a need for individualized tailoring of evidenced-based treatments. Two cognitive behavioral approaches, designed for traumatized children and either their nonoffending or offending parents, were described for treating youth with the distinct PTSD profiles.

Depression and parenting by nonoffending mothers of children who experienced sexual abuse.

Parenting may be one mechanism by which depression in nonoffending mothers impacts child emotional and behavioral adjustment after sexual abuse. This study examined the relationship between self-reported maternal depression and parenting behaviors by nonoffending mothers of children who experienced sexual abuse. The participants were 204 nonoffending biological mother-child pairs recruited from a clinic providing services for children who experienced sexual abuse. The mothers completed pretreatment self-report measures of demographic information, depression, and parenting behaviors. Children (7 to 17 years) completed a measure of mothers' parenting behaviors. Mothers with clinically high levels of self-reported depression employed more inconsistent parenting behavior and provided poorer monitoring/supervision of their children than mothers without clinically high levels of self-reported depression. Implications for clinical practice and future research are discussed.

Trauma-focused cognitive-behavioral therapy for children: sustained impact of treatment 6 and 12 months later.

This study presents the findings from 6- and 12-month follow-up assessments of 158 children ages 4-11 years who had experienced sexual abuse and who had been treated with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with or without the inclusion of the trauma narrative (TN) treatment module and in 8 or 16 treatment sessions. Follow-up results indicated that the overall significant improvements across 14 outcome measures that had been reported at posttreatment were sustained 6 and 12 months after treatment and on two of these measures (child self-reported anxiety and parental emotional distress) there were additional improvements at the 12-month follow-up. Higher levels of child internalizing and depressive symptoms at pretreatment were predictive of the small minority of children who continued to meet full criteria for posttraumatic stress disorder at the 12-month follow-up. These results are discussed in the context of the extant TF-CBT treatment literature.

Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length.

BACKGROUND: Child sexual abuse (CSA) is associated with the development of a variety of mental health disorders, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an established treatment for children who have experienced CSA. However, there are questions about how many TF-CBT sessions should be delivered to achieve clinical efficacy and whether a trauma narrative (TN) component is essential. This study examined the differential effects of TF-CBT with or without the TN component in 8 versus 16 sessions. METHODS: Two hundred and ten children (aged 4-11 years) referred for CSA and posttraumatic stress disorder symptoms were randomly assigned to one of the four treatment conditions: 8 sessions with no TN, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. RESULTS: Mixed-model ANCOVAs demonstrated that significant posttreatment improvements had occurred with respect to 14 outcome measures across all conditions. Significant main and interactive effect differences were found across conditions with respect to specific outcomes. CONCLUSIONS: TF-CBT, regardless of the number of sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the children's personal safety skills. The eight session condition that included the TN component seemed to be the most effective and efficient means of ameliorating parents' abuse-specific distress as well as children's abuse-related fear and general anxiety. On the other hand, parents assigned to the 16 session, no narrative condition reported greater increases in effective parenting practices and fewer externalizing child behavioral problems at posttreatment.

Understanding and treating feelings of shame in children who have experienced maltreatment.

Feelings of shame have been found to be an important mediating factor in influencing a child's recovery from abuse. This article conceptualizes the development and maintenance of shame in the aftermath of experiencing child sexual and/or physical abuse. Research is reviewed that may shed light on the impact of shame and dysfunctional attributions with a view toward understanding how this type of painful emotional suffering can be prevented and/or treated. Trauma-focused interventions that have demonstrated efficacy in helping children overcome feelings of shame are described. Directions for future research that may further our understanding of the development, impact, and treatment of feelings of shame are suggested.

An overview of child physical abuse: developing an integrated parent-child cognitive-behavioral treatment approach.

This article reviews and summarizes the extant literature regarding child physical abuse (CPA). Literature is summarized that describes the wide range of short- and long-term effects of CPA on children as well as the documented characteristics of parents/caregivers who engage in physically abusive parenting practices. Although the reviewed research documents that interventions geared only toward the parent have been found to produce significant improvements with respect to parenting abilities, parent-child interactions, and children's behavior problems, there is a paucity of research examining the efficacy of interventions developed specifically to target the child's emotional and behavioral difficulties. Based on the few studies that have shown emotional and behavioral gains for children who have participated in treatment, an integrated parent-child cognitive-behavioral therapy (CBT) approach is proposed here to address the complex issues presented by both parent and child in CPA cases. The direct participation of the child in treatment also may improve our ability to target posttraumatic stress disorder (PTSD), depressive symptoms as well as anger control and dysfunctional abuse attributions in the children themselves. Implications for practice, public policy, and research are also addressed.

Relationship of attributional style, depression, and posttrauma distress among children who suffered physical or sexual abuse.

This study examined the relationship of attributional style, posttrauma, and depressive symptoms among children who have suffered either physical or sexual abuse. Ninety-eight children (67 physically abused, 31 sexually abused) were administered a depression inventory, the Post-Traumatic Stress Disorder-Reaction Index (PTSD-RI), and Children's Attributional Style Questionnaire (CASQ). With regard to group differences, the sexual abuse group scored significantly higher on the PTSD-RI, whereas the physical abuse group scored higher on the CASQ Composite for Negative Events. Results also indicated that attributional style predicted depression beyond the variance accounted for by abuse type (i.e., physical or sexual). However, the best predictor of PTSD-RI scores was an interaction effect between abuse type and negative attributional style. Clinical implications of these findings for children who suffer abuse are discussed.

Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression.

OBJECTIVE: The present study attempted to examine specific differences in the Post-Traumatic Stress Disorder (PTSD) symptomatology among abused children with and without concurrent depression. METHOD: PTSD and depressive symptoms were identified that discriminate between 98 children divided into three groups: (1) abused children with PTSD, (2) nonabused children who meet criteria for Major Depressive Disorder (MDD), and (3) abused children with both PTSD and MDD. RESULTS: Analyses revealed that nine items reflecting depressive symptomatology, primarily vegetative symptoms, differentiated the diagnostic groups (PTSD-only, MDD-only, and the combined group). A discriminant analysis revealed that the sum of responses to the nine significant items adequately predicted diagnostic classification for those with PTSD and depression, but did not correctly diagnose any in the combined group. Analyses also revealed that three post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated between the groups. The PTSD-only group reported more episodes of psychological amnesia while the PTSD and MDD group experienced more flashbacks. CONCLUSIONS: For the sample of abused children examined, these results illuminate differences with respect to PTSD symptom presentation for those children with PTSD who have a concurrent depressive disorder and their nondepressed counterparts. Children with PTSD who have a concurrent depression report greater levels of intrusive PTSD-related symptoms.