Attrition from pediatric trauma-focused cognitive behavioral therapy: A meta-analysis.

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the leading interventions for trauma-exposed children and adolescents and is associated with significant improvements in a variety of trauma-related symptoms. Nonetheless, attrition from TF-CBT is quite common, and children who do not receive the full intervention may continue to suffer from trauma-related symptoms. Rates of premature termination have varied across studies, and to date, no meta-analyses have been conducted regarding dropout from TF-CBT. The objective of the present study was to conduct a meta-analysis of the rates of attrition from TF-CBT, as well as review factors related to premature termination from this intervention. A total of 22 studies were available for inclusion in this meta-analysis. The prevalence of attrition was 33.9% (95% CI [26.2%, 42.5%]) from 2,059 children receiving TF-CBT. Clinician-rated attrition was 38.5%, and 17.5% did not receive an adequate dose of TF-CBT (e.g., 12+ sessions). Further, the study type was related to differing rates of dropout, with randomized controlled trials having a much lower attrition rate. Regarding risk factors for premature termination, the emerging literature suggests that a child's age, racial-ethnic minority status, and symptom levels may evince some ties to attrition. Caregiver, family, therapist, and treatment factors remain underexplored in relation to premature termination; however, preliminary work suggests that lack of caregiver attendance and difficulty in the child-therapist relationship may be related to attrition. A substantial number of children prematurely terminate from TF-CBT, underscoring the need to better prevent dropout.

Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions.

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

Maternal support and caregiver-child symptom concordance among sexually abused children.

Caregivers and children often diverge in their reports of children's trauma-related symptoms, and this discordance has been linked with children's behavioral difficulties and poorer treatment outcomes. Knowledge regarding what factors may be related to discordance is limited, and maternal support in relation to trauma-related symptom agreement has yet to be investigated. The aim of the present study was to examine the associations between discordance and both maternal emotional support and blame/doubt in caregivers' and children's reports of trauma-related symptoms in sexually abused children. Participants were treatment-seeking, sexually abused children (N = 122) aged 8-12 years (M = 9.45 years, SD = 1.09; 70.5% female, 57.4% White) and their nonoffending caregivers. Low intraclass correlation coefficients (ICCs) indicated the presence of significant discordance across symptom types, with caregivers reporting higher levels of trauma-related difficulties, ICCs = -.21-.22. Older children were more likely to disclose higher levels of anger and sexual concerns than younger children, ßs = .18-.33. Children's gender, race, and relationship to their caregiver were not related to symptom discordance. Further, maternal emotional support and blame/doubt were not associated with caregiver-child concordance for any examined difficulties. Assessment of both caregivers' and children's perceptions of trauma-related symptoms is vital given the likelihood of discordance in child and caregiver reports of symptom levels. Although maternal emotional support and blame/doubt may not be linked to concordance with regard to trauma-related difficulties, child age should further be considered as a potentially important factor in understanding caregiver-child symptom concordance.

The Role of Parents' Self-Perceptions in the Association Between Posttraumatic Stress Symptoms and Aspects of Parenting.

Parents' posttraumatic stress symptoms (PTSS) have been shown to be negatively associated with aspects of parenting, yet the mechanisms that link PTSS to parenting remain unclear. Because PTSS include negative alterations in cognitions, trauma-exposed parents may have skewed perceptions of themselves as parents. However, no studies have examined whether there is an indirect effect of PTSS on parenting through parents' self-perceptions. Path analysis was used to determine (a) whether DSM-5 posttraumatic stress disorder (PTSD) symptom clusters are related to parenting indices (i.e., support, satisfaction, involvement) and self-perceptions, (b) if parental self-perceptions are tied to aspects of parenting, and (c) if there is an indirect effect of PTSS on parenting through parental self-perceptions. Participants were 223 trauma-exposed parents (Mage = 36.92 years, SD = 7.9, 63.7% female) recruited from a midwestern U.S. university or via Amazon's Mechanical Turk. Negative alterations in cognitions and mood were inversely related to parental support, B = -0.41, p = .008, and alterations in arousal and reactivity were inversely associated with parental self-perceptions, B = -1.26, p = .001. Parental self-perceptions were positively related to all parenting indices, Bs = 0.27-0.44. Indirect effects were observed for alterations in arousal and reactivity and parental support, satisfaction, and involvement via parents' self-perceptions, Bs = -0.34 to -0.55. Parental self-perceptions appear to be a potential factor in understanding parenting difficulties for trauma-exposed parents experiencing alterations in arousal and reactivity. Targeting these perceptions may be a point of intervention aimed at improving parenting outcomes among trauma-exposed parents.

Racism, Posttraumatic Stress Symptoms, and Racial Disparity in the U.S. COVID-19 Syndemic.

The COVID-19 syndemic, with a disproportionately higher adverse impact on communities of color (i.e., COVID-19 infection and death), will likely exacerbate the existing health disparities in trauma-related symptoms between people of color (POC) and White Americans. However, no studies have examined the racial disparity in posttraumatic stress symptoms (PTSS) during COVID-19. Grounded in ecological theory and racial trauma framework, we investigated racial disparity in PTSS and three possible mechanisms, 1) COVID stress, 2) direct racism, and 3) indirect racism, for these disparities using a large U.S. national sample. Results indicated that POC reported higher levels of PTSS than White Americans. The PTSS racial disparity was accounted more by direct and indirect racism than by the COVID-19-specific stressors, after controlling for age, gender, education, income, parent status, adverse childhood experiences (ACEs), and intimate partner violence (IPV). Additional fine-grained analyses for Hispanic/Latinx Americans, Black/African Americans, and Asian American and Pacific Islanders by and large corroborated the above findings. Our findings highlighted the deleterious impact of the ongoing racism pandemic on the POC community as a public health crisis in addition to the COVID-19 pandemic.Supplemental data for this article is available online at at http://doi:10.1080/08964289.2021.2006131.

Relational Factors Associated With Posttraumatic Stress Among Emerging Adults of Color Exposed to Community Violence.

The relationship between trauma exposure and posttraumatic stress symptoms (PTSS) is well-documented, but less is known about factors that contribute to the expression of PTSS following community violence exposure, particularly among emerging adults of color. Utilizing the Person-Environment Interaction model (Slaug et al., 2018), this study examined the role of relational factors, specifically ethnic identity, community cohesion, and social support, associated with PTSS following exposure to community violence. Participants included 243 emerging adult university students of color (Mage = 20.27, SD = 1.95, 83.5% female). Linear regression analyses indicated that less frequent trauma exposure and greater perceived social support were related to lower PTSS. A significant interaction was also found between social support and exposure to community violence, such that at low levels of social support, individuals with more community violence exposure had the highest levels of PTSS. Regression and moderation analyses indicated that ethnic identity and community cohesion were not significantly associated with PTSS in this sample. Findings highlight the importance of incorporating social support strategies in treatments for PTSS following community violence exposure.

Maternal Support and Attrition from Child Trauma-Focused Therapy.

Many children prematurely terminate from trauma-focused therapy (TFT), and attrition is a critical barrier in addressing the impacts of childhood sexual abuse (CSA). The field's knowledge of risk factors for dropout is growing; however, one aspect of the child's environment that remains unexamined is maternal support following the CSA disclosure/discovery. Maternal support has been theorized to play a valuable role in influencing children's outcomes after CSA and may be relevant in understanding attrition. The objective of the current study was to investigate the associations between children's symptoms, relationship to the perpetrator, and maternal support in relation to premature termination from TFT among 186 sexually abused children (Mage = 9.24 years, SD = 3.72, 67.3% female). Two operational definitions of attrition were used: (a) clinician-rated dropout (i.e., clinician's ratings of whether the child completed treatment) and (b) whether the child received an adequate treatment dose treatment (i.e., ≥12 sessions). Maternal marital status was the only factor associated with clinician-rated treatment dropout, OR = 2.35, whereas maternal support and blame/doubt were unrelated. Living farther from the clinic was tied to an increased risk of receiving an inadequate treatment dose, OR = 0.96. Replication of these findings is needed, particularly using a clinician-administered measure of caregiver support; yet, maternal emotional support and blame/doubt may not evince strong ties to dropout from TFT among sexually abused children. Additional work is needed to discern if there are key subgroups for whom support is more strongly related to the risk of premature termination following CSA.

PostTraumatic Stress Symptoms And Beliefs Regarding Parenting And Children's Development Among Trauma-Exposed Parents.

Posttraumatic stress symptoms (PTSS) have been associated with increased risk for parenting difficulties; however, cognitive factors related to parenting, such as parenting perceptions and beliefs regarding children's development, remain unexplored. This is problematic as negative and unrealistic beliefs regarding parenthood and children may be a key mechanism by which PTSS increases vulnerability for adverse parenting outcomes. The aims of the study were to examine whether PTSS and the specific posttraumatic stress disorder (PTSD) symptom clusters were related to more negative parenting perceptions and to more unrealistic beliefs regarding children's development among 212 trauma-exposed parents (Mage  = 36.68 SD = 7.38; 60.9% female; 54.3% White). Higher levels of PTSS corresponded with more negative parenting perceptions and more unrealistic expectations of children. Intrusion, avoidance, and negative alterations in cognitions and mood were not associated with parenting perceptions. Trauma-related alterations in arousal and reactivity were related to more negative parenting-related beliefs regarding one's child and oneself. PTSS, particularly trauma-related changes in arousal and reactivity symptoms, may be relevant in understanding perceptions of parenthood and beliefs regarding children's development. These symptoms may be targeted via trauma-focused treatments to increase adaptive parenting outcomes for parents who have experienced trauma.

Child Sexual Abuse and Adult Sexual Assault among Emerging Adults: Exploring the Roles of Posttraumatic Stress Symptoms, Emotion Regulation, and Anger.

Child sexual abuse (CSA) has been previously linked with a risk for adult sexual assault (ASA) and posttraumatic stress symptoms (PTSS). Yet, the relations between CSA, ASA, and other psychological outcomes that may contribute to increased risk for ASA are less clear. This study aims to: 1) examine the links between CSA and ASA and potential risk factors (i.e., PTSS, emotion dysregulation, anger), 2) determine whether there are indirect effects between CSA and ASA through each factor, and 3) investigate whether there are indirect effects between CSA and ASA through the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters. The sample included 567 undergraduates (Mage = 20.84, SD = 4.10; 81.1% women; 56.6% white) from two universities. Both CSA and ASA were related to PTSS, emotion dysregulation, and anger. There were indirect effects of CSA on ASA through PTSS and anger (B = .04, B = .01, respectively). CSA was associated with each of the PTSD symptom clusters, but only marked alterations in arousal and reactivity were linked with ASA (B = .01). The clusters had no indirect effects on the relation between CSA and ASA. These findings revealed several factors that may be linked with increased risk for sexual victimization.

Sexual Behavior Problems and Premature Termination From Pediatric Trauma-Focused Treatment Among Sexually Abused Children.

Premature termination from child trauma-focused treatment is common; however, the role of children's level of symptoms as a risk factor for attrition remains uncertain. In particular, children's sexual behavior problems (SBPs) have received scant attention in the prior attrition literature, and no known studies to date have thoroughly examined SBPs in relation to premature treatment termination. The current study investigated whether higher levels of children's SBPs were associated with increased risk for attrition from trauma-focused treatment in a sample of 242 sexually abused children aged 2-12 years (M = 7.48 years, SD = 2.68; 64.5% female, 54.1% White). To assess the potential associations between SBPs and treatment dropout more thoroughly, two definitions of attrition were utilized: (a) clinician-rated dropout and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Whereas only 34.3% of the children completed treatment per their clinician, 69.4% received an adequate dose of treatment. In contrast to the study hypotheses, neither development-related nor sexual abuse-specific SBPs were associated with either clinician-rated dropout or adequate dose status, ORs = 0.99-1.00. Sexual acting-out behaviors in sexually abused children may not correspond with attrition from trauma-focused treatment at multiple points of treatment. Given the heterogeneity of SBPs, further assessment of whether attrition patterns differ across subgroups of children who exhibit SBPs is needed.

Predictors of Attrition Among Young Children Receiving Trauma-Focused Therapy.

Findings from studies of predominately school-aged children indicate that few children complete trauma-focused treatment; however, researchers have not specifically examined risk factors for dropout among young trauma-exposed children. The purpose of the present study was to investigate risk factors for attrition among young children receiving trauma-focused therapy. Study participants were 189 treatment-seeking children aged 3-5 years (M = 4.86 years, SD = 0.71; 54.1% female, 47.7% White) and their nonoffending legal guardian(s). Child and family characteristics, number of traumatic events, and pretreatment posttraumatic stress symptoms (PTSS) were examined in relation to two attrition definitions: (a) clinician-rated dropout and (b) whether the child received an adequate treatment dose (i.e., 12 or more sessions). Although 70.3% of children prematurely terminated therapy per their clinician, a nearly equivalent portion (67.4%) received an adequate treatment dose. Family characteristics were largely not associated with attrition, although residing farther from the clinic was related to clinician-rated treatment dropout, OR = 0.96. As expected, higher levels of externalizing symptoms were associated with clinician-rated dropout and inadequate dose status, ORs = .95 and .96, respectively, whereas lower levels of trauma-related anger were related to clinician-rated treatment completion, OR = 1.03, and lower levels of PTSS and sexual concerns corresponded with an increased likelihood the child received an inadequate treatment dose, ORs = 1.03 and 1.02, respectively. Thus, child and family factors appear to play a small role in predicting attrition; however, higher levels of externalizing problems and lower levels of PTSS may increase the risk for dropout.

Sexual Assault, Posttraumatic Stress Symptoms, and Indices of Aggression Among Women.

Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (Mage = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, ßs = .003-.08; however, PTSS was consistently linked with increased aggression, ßs = .22-.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, ß = .28, and hostility, ß = .38, and avoidance was related to verbal aggression, ß = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, ßs = .21-.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, ß = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.

Does Maternal Support Mediate or Moderate the Relationship between Sexual Abuse Severity and Children's PTSD Symptoms?

Maternal support and abuse severity are often considered to be vital factors in predicting children's functioning following childhood sexual abuse (CSA); however, much of the prior research has examined support and abuse severity as main effects, without consideration of how these factors may interrelate to predict children's post-CSA functioning. Further, even though mediators and moderators are conceptually distinct, maternal support has been theorized to be both a mediator and a moderator of symptoms, and it is unclear if support acts as either among sexually abused children. The aim of the present study was to investigate whether caregiver-reported maternal support mediates or moderates the relationships between sexual abuse severity and children's trauma-related symptoms. The study included 235 treatment-seeking children ages 3-16 (M = 8.85, SD = 3.77) and their non-offending mothers. Contrary to expectations, caregiver-rated maternal support did not mediate nor moderate the relationship between abuse severity and children's symptoms (range r2 =.002 -.03). Caregiver-rated maternal support may play a small role in mitigating sexually abused children's trauma symptoms. Irrespective of abuse severity, children with less supportive mothers may not be at heightened risk for experiencing higher levels of trauma-related difficulties.

Event Centrality: Factor Structure and Links to Posttraumatic Stress Disorder Symptom Clusters.

Event centrality is defined as the extent to which traumatic events are perceived to be integral to one's life. However, there are discrepancies regarding the factor structure of event centrality, as the factor structure may differ depending on the nature of the trauma. Event centrality has predicted posttraumatic stress disorder (PTSD); yet, few studies have taken into account other key cognitive predictors of PTSD, such as posttraumatic cognitions. The PTSD symptom clusters also remain largely unexamined, despite potential specificity in their ties to event centrality. The aims of the current study were to: (a) examine the factor structure of event centrality and whether the structure differs following interpersonal versus noninterpersonal trauma; (b) investigate whether event centrality predicts PTSD symptom clusters beyond posttraumatic cognitions; and (c) determine if the associations between event centrality, posttraumatic cognitions, and PTSD are equivalent between trauma types. The study aims were examined utilizing 263 college students (Mage = 24.54, SD = 6.29; 79.8% female; 58% White). Event centrality was best represented by one factor, which was consistent between groups. Structural equation models indicated that event centrality and posttraumatic cognitions regarding the self predicted each of the PTSD symptom clusters across groups, ßs = .27-.58. However, event centrality was more strongly related to avoidance symptoms among individuals who experienced a noninterpersonal trauma. For both the interpersonal and noninterpersonal groups, event centrality had equivalent ties to each cluster. Even after accounting for negative trauma-related beliefs, event centrality appears to be relevant in understanding posttrauma functioning.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La centralidad del evento: Estructura factorial y su relación con los grupos sintomáticos de TEPT CENTRALIDAD DEL EVENTO Y TEPT La centralidad del evento se define como la medida en que los eventos traumáticos se perciben como parte integral de la propia vida. Sin embargo, hay discrepancias con respecto a la estructura factorial de la centralidad del evento, ya que la estructura factorial puede diferir dependiendo de la naturaleza del trauma. La centralidad del evento ha predicho el trastorno de estrés postraumático (TEPT); sin embargo, pocos estudios han considerado otros predictores cognitivos claves de TEPT, tales como las cogniciones postraumáticas. Los grupos sintomáticos del TEPT también permanecen en gran parte sin examinar, a pesar de la especificidad potencial en sus vínculos con la centralidad del evento. Los objetivos de este estudio fueron: (a) examinar la estructura factorial de la centralidad del evento y si la estructura difiere tras un trama interpersonal versus uno no interpersonal; (b) investigar si la centralidad del evento predice los grupos sintomáticos de TEPT más allá de las cogniciones postraumáticas; y (c) determinar si las asociaciones entre la centralidad del evento, cogniciones postraumáticas y TEPT son equivalentes entre los tipos de trauma. Los objetivos del estudio fueron examinados utilizando 263 estudiantes universitarios (Medad = 24.54, DS = 6.29; 79.8% mujeres; 58% caucásicas). La centralidad del evento fue mejor representada por un factor, que fue consistente entre los grupos. Los modelos de ecuaciones estructurales indicaron que la centralidad del evento y las cogniciones postraumáticas respecto de sí mismo predijeron cada uno de los grupos sintomáticos del TEPT en todos los grupos, ßs = .27-.58. Sin embargo, la centralidad del evento estuvo más fuertemente relacionado a los síntomas evitativos entre los individuos que experimentaron un trauma no interpersonal. Para ambos grupos, interpersonal y no interpersonal, la centralidad del evento tuvo vínculos equivalentes con cada grupo. Incluso después de tomar en cuenta las creencias negativas relacionadas con el trauma, la centralidad del evento parece ser relevante para comprender el funcionamiento postrauma.

Posttraumatic Stress Disorder and Expectations of Parenthood and Children's Development.

Posttraumatic stress disorder (PTSD) may increase the risk of adverse parenting-related outcomes. Research has not determined if PTSD symptoms correspond with more negative expectations of parenthood and unrealistic beliefs regarding children's developmental milestones. Negative and unrealistic preparenthood and developmental expectations are tied to problematic parenting-related outcomes; thus, these beliefs are important to examine within the context of PTSD. The aim of the current study was to examine whether PTSD is related to negative parenthood expectations as well as more unrealistic perceptions of children's development. Included in the study were 368 trauma-exposed adults who had yet to become parents (Mage   = 25.92 years, SD  = 7.11; 68.2% female; 63.8% White). Structural equation modeling (SEM) revealed that probable PTSD was associated with more negative parenting expectations, ßs = -.08--.16. Alterations in cognitions and mood were associated with more negative perceptions of parenthood, ßs = .10--.31. However, higher levels of intrusion symptoms were related to more positive expectations of parenthood and more realistic development expectations, ßs = .17-.25. The data were a satisfactory fit for the model. Thus, PTSD may be relevant in understanding perceptions of parenthood, which may be important to address and ultimately improve parenting outcomes among parents with PTSD.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trastorno de estrés postraumático y percepciones de la paternidad y los hijos TEPT Y EXPECTATIVAS DE LOS PADRES El trastorno de estrés postraumático (TEPT) puede aumentar el riesgo de consecuencias adversas relacionadas con la crianza. La investigación no ha determinado si los síntomas de TEPT se corresponden con expectativas más negativas de la paternidad y creencias poco realistas con respecto a hitos del desarrollo de los niños. Una predisposición negativa y poco realista de la paternidad y expectativas del desarrollo están vinculadas a consecuencias problemáticas relacionadas con la crianza; por lo tanto, es importante examinar estas creencias dentro del contexto del trastorno de estrés postraumático. El objetivo del presente estudio fue examinar si el TEPT estaba relacionado con las expectativas de paternidad negativas, así como con percepciones poco realistas del desarrollo de los niños. En el estudio se incluyeron 368 adultos expuestos a traumas que aún tenían que convertirse en padres (M edad = 25.92 años, SD = 7.11, 68.2% mujeres, 63.8% blancos) fueron incluidos en el estudio. El modelo de ecuación estructural (SEM en sus siglas en inglés) reveló que el TEPT probable se asoció con expectativas de crianza más negativas, ßs = -08 - .16. Las alteraciones en las cogniciones y el estado de ánimo se asociaron con percepciones más negativas de la paternidad, ßs = .10 - .31. Sin embargo, los niveles más altos de síntomas de intrusión se relacionaron con expectativas más positivas de la paternidad y expectativas de desarrollo más realistas, ßs = .17-.25. El modelo tenía un ajuste adecuado. Por lo tanto, el TEPT puede ser relevante para comprender las percepciones de la paternidad, lo que puede ser importante para abordar y, en última instancia, mejorar los resultados de la paternidad entre los padres con TEPT.

Pretrauma Power and Control Beliefs and Posttraumatic Stress: A Longitudinal Study of Combat Soldiers.

Belief in one's ability to exert power and control over outcomes following trauma has long been understood as protective against the development of posttraumatic stress disorder (PTSD). The role of pretrauma beliefs about power and control, however, remains unclear. Though a strong pretrauma belief in power and control may similarly be protective, we predicted such a belief may actually be a diathesis for PTSD. When exposed to trauma, individuals with a strong pretrauma belief in power and control may believe they should have prevented the trauma and/or their acute reactions. Such expectations may lead to negative self-beliefs and a higher level of PTSD symptoms. Longitudinal structural equation modeling in a sample of combat soldiers (N = 305) supported our hypothesized model. Stronger predeployment power and control beliefs predicted more negative postdeployment self-beliefs, ß = .15, p = .035, 95% CI [.11, .18], and in turn, a higher level of PTSD symptoms, ß = .08, 95% CI [.01, .15]. Prior combat exposure moderated these effects in that soldiers with no prior combat experience evidenced the hypothesized associations, whereas those with moderate or high prior combat exposure did not. Resilience interventions for soldiers who are first entering combat may thus benefit from promoting acceptance of uncontrollable events in addition to agentic change skills.

Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth.

The inclusion of Persistent Complex Bereavement Disorder (PCBD) in the DSM-5 appendix signifies a call for research regarding the distinguishing features and clinical utility of proposed PCBD criteria. Rigorously constructed tools for assessing PCBD are lacking, especially for youth. This study evaluated the validity and clinical utility of the PCBD Checklist, a 39-item measure designed to assess PCBD criteria in youth aged 8 to18 years. Test construction procedures involved: (a) reviewing the literature regarding developmental manifestations of proposed criteria, (b) creating a developmentally informed item pool, (c) surveying an expert panel to evaluate the clarity and developmental appropriateness of candidate items, (d) conducting focus groups to evaluate the comprehensibility and acceptability of items, and (e) evaluating psychometric properties in 367 bereaved youth (Mage = 13.49, 55.0% female). The panel, clinicians, and youth provided favorable content validity and comprehensibility ratings for candidate items. As hypothesized, youth who met full PCBD criteria, Criterion B (e.g., preoccupation with the deceased and/or circumstances of the death), or Criterion C (e.g., reactive distress and/or social/identity disruption) reported higher posttraumatic stress and depressive symptoms than youth who did not meet these criteria, ηp2 = .07-.16. Youth who met Criterion C reported greater functional impairment than youth who did not, ηp2 = .08-.12. Youth who qualified for the "traumatic bereavement specifier" reported more frequent posttraumatic stress symptoms than youth who did not, ηp2 = .04. Findings support the convergent, discriminant, and discriminant-groups validity, developmental appropriateness, and clinical utility of the PCBD Checklist.

Early Treatment Response in Children and Adolescents Receiving CBT for Trauma.

OBJECTIVES: To investigate the incidence and correlates of early treatment response among youth receiving cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). METHODS: 56 youth who participated in a randomized controlled trial of CBT for PTSD and D-cycloserine were included. Youth with PTSD symptoms below clinical cutoff after Session 4 of a 12-session protocol were classified as early treatment responders (32% of parent reports, 44.6% of child reports). Pretreatment characteristics were examined in relation to responder status. RESULTS: Lower levels of pretreatment PTSD, depression, and anxiety symptoms and fewer trauma types were related to child- and parent-reported responder status (d = .57, d = .52, respectively). Early treatment response was maintained at follow-up. CONCLUSIONS: Pretreatment symptoms levels and number of traumas may play an important role in predicting early treatment response. Correlates of early treatment response may provide avenues for identifying youth who could benefit from abbreviated protocols.

Empirical support for the definition of a complex trauma event in children and adolescents.

Complex trauma events have been defined as chronic, interpersonal traumas that begin early in life (Cook, Blaustein, Spinazzola, & van der Kolk, 2003). The complex trauma definition has been examined in adults, as indicated by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) field trial; however, this research was lacking in child populations. The symptom presentations of complexly traumatized children were contrasted with those exposed to other, less severe trauma ecologies that met 1 or 2 features of the complex trauma definition. Included in this study were 346 treatment-seeking children and adolescents (ages 3­18 years) who had experienced atraumatic event. Results indicated that child survivors of complex trauma presented with higher levels of generalized behavior problems and trauma-related symptoms than those who experienced (a) acute noninterpersonal trauma, (b) chronic interpersonal trauma that begins later in life, and (c) acute interpersonal trauma. Greater levels of behavioral problems were observed in children exposed to complex trauma as compared to those who experienced a traumatic event that begins early in life. These results provide support for the complex trauma event definition and suggest the need for a complex trauma diagnostic construct for children and adolescents.

Revictimization Risk Factors Following Childhood Maltreatment: A Literature Review.

Revictimization research, to date, has primarily focused on sexual revictimization (i.e., child sexual abuse and adult sexual assault), which has resulted in a lack of understanding of trauma revictimization more generally. Specifically, it is unclear what factors are placing individuals with a history of child maltreatment (i.e., sexual abuse, physical abuse, and witnessing intimate partner violence [IPV]) at greater risk for subsequent adult victimization (i.e., sexual assault and IPV). Existing theoretical and empirical work on revictimization suggest that multiple risk factors are likely present within this framework (e.g., posttraumatic stress symptoms [PTSS], emotion dysregulation, and risk-taking behaviors). Prior research has suggested that PTSS are often linked with these other risk factors, and it is possible that the development of PTSS following child maltreatment may be related to the development or maintenance of additional factors that increase the likelihood of revictimization. The purpose of this review was to synthesize findings regarding risk factors that place maltreated individuals at greater risk for adult revictimization. Approximately 228 studies were identified following a thorough search of the peer-reviewed literature using multiple databases (PsycINFO, PILOTS, and Google Scholar). Each study was critically analyzed for relevance. The included studies were used in our review of prevalence, specific risk factors that have been identified, and unanswered questions in this literature. PTSS were noted to be particularly important in the revictimization framework, and thus, a novel model of revictimization was also proposed where PTSS are illustrated as being associated with the development and maintenance of other factors within the revictimization framework.