Karin L. Vanderzee

Posttraumatic Stress as a Mediator of the Relationship Between Trauma and Mental Health Problems Among Juvenile Delinquents

This study investigated the interrelationships among trauma exposure, PTSD, and mental health problems in a sample of 289 adolescents (199 male, 90 female) detained in a juvenile correctional facility. Mean differences were found in that females scored higher than males on measures of interpersonal trauma exposure and symptoms of both simple and complex PTSD. Females also endorsed more mental health problems in the areas of depression/anxiety, somatic complaints, and suicidal ideation. For all youth, trauma exposure, PTSD, and mental health problems were correlated. Results of structural equation modeling were consistent with the hypothesis that PTSD mediates the relationship between interpersonal trauma and mental health problems for all youth, although the results were stronger for females.

Deconstructing PTSD: Traumatic Experiences, Posttraumatic Symptom Clusters, and Mental Health Problems among Delinquent Youth

This study investigated interrelations among trauma exposure, posttraumatic stress disorder (PTSD) symptom clusters, and mental health problems among adjudicated adolescents. Girls scored higher than boys on measures of exposure to interpersonal trauma, PTSD symptom clusters, and mental health problems. Results of path analyses were consistent with the hypothesis that PTSD symptom clusters differentially mediate the relations between trauma exposure and mental health problems, with unique patterns of results for boys and girls. For all youth, avoidance mediated the association between trauma and internalizing symptoms whereas reexperiencing and arousal acted as mediators of externalizing. However, for boys only, noninterpersonal traumas also were related to PTSD symptoms, which in turn acted as mediators of internalizing. For girls only, reexperiencing and arousal acted as mediators of internalizing and associated symptoms of PTSD acted as a mediator of externalizing.

Implementing trauma-focused CBT with fidelity and flexibility: A family case study

Effective approaches for the treatment of childhood posttraumatic stress disorder and traumatic grief are needed given the prevalence of trauma and its impact on childrens lives. To effectively treat posttraumatic stress disorder in children, evidence-based practices should be implemented with flexibility and responsiveness to culture, developmental level, and the specific needs of the family. This case study illustrates flexibility with fidelity in the use of a manualized treatment, describing the implementation of Trauma Focused-Cognitive Behavior Therapy with three traumatized family members—a caregiver and two children. Particular attention is paid to the use of creative strategies to tailor interventions to the individual clients while maintaining fidelity to the principles and components of this evidence-based treatment.

Modes of Large-Scale Brain Network Organization during Threat Processing and Posttraumatic Stress Disorder Symptom Reduction during TF-CBT among Adolescent Girls.

Posttraumatic stress disorder (PTSD) is often chronic and disabling across the lifespan. The gold standard treatment for adolescent PTSD is Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), though treatment response is variable and mediating neural mechanisms are not well understood. Here, we test whether PTSD symptom reduction during TF-CBT is associated with individual differences in large-scale brain network organization during emotion processing. Twenty adolescent girls, aged 11–16, with PTSD related to assaultive violence completed a 12-session protocol of TF-CBT. Participants completed an emotion processing task, in which neutral and fearful facial expressions were presented either overtly or covertly during 3T fMRI, before and after treatment. Analyses focused on characterizing network properties of modularity, assortativity, and global efficiency within an 824 region-of-interest brain parcellation separately during each of the task blocks using weighted functional connectivity matrices. We similarly analyzed an existing dataset of healthy adolescent girls undergoing an identical emotion processing task to characterize normative network organization. Pre-treatment individual differences in modularity, assortativity, and global efficiency during covert fear vs neutral blocks predicted PTSD symptom reduction. Patients who responded better to treatment had greater network modularity and assortativity but lesser efficiency, a pattern that closely resembled the control participants. At a group level, greater symptom reduction was associated with greater pre-to-post-treatment increases in network assortativity and modularity, but this was more pronounced among participants with less symptom improvement. The results support the hypothesis that modularized and resilient brain organization during emotion processing operate as mechanisms enabling symptom reduction during TF-CBT.