Lisa Jobe-Shields

Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence

OBJECTIVE Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. METHODS Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. RESULTS The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. CONCLUSIONS TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.

Emotion Regulation as a Mediator of the Relation Between Emotion Socialization and Deliberate Self‐Harm

This study examined (a) whether retrospective reports of specific parent responses to sadness (i.e., reward, punishment, neglect, override, magnification) were related to deliberate self-harm (DSH) and (b) whether difficulties regulating emotions (i.e., difficulties monitoring, evaluating, and modifying emotions) mediated those relations. One hundred eighteen college students completed measures of parental emotion socialization, emotion regulation difficulties, and DSH. Parental reward and override of sadness were directly related to lower DSH scores. Parental punishment and neglect of sadness were related to higher DSH scores, and these associations were mediated by difficulties evaluating emotions. In other words, parental punishment and neglect of sadness may place individuals at risk for DSH by fostering negative evaluations of emotional experiences and the belief that nothing can be done to effectively manage emotions.

Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t = -2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t = -2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR(2) = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.

Perceptions of Parental Awareness of Emotional Responses to Stressful Life Events.

There is a need to better understand family processes related to recovery from past stressful life events. The present study aimed to investigate links between perceptions of parental awareness regarding stressful life events, continued event-related rumination, and current symptoms of depression. Students at a diverse, urban university completed a Life Events Checklist and a semistructured interview regarding family processing of stressful life events, as well as self-report measures of event-related rumination and depression. Results indicated that perceptions of mothers’ and fathers’ awareness of sadness regarding stressful life events as well as mothers’ and fathers’ verbal event processing predicted symptoms of event-related rumination and depression. Results support the inclusion of perceptions of parental awareness in the understanding of how emerging adults continue to cope with past stressful life events.

Targeting Family Risk Factors in the Context of Treating Youth Depression: A Survey of Psychologists

This study investigated the practices and perceptions of psychologists related to targeting family risk factors when treating youth depression. Participants were practicing psychologists recruited through the National Register of Health Service Providers in Psychology (N = 279). Psychologists completed a brief anonymous survey about addressing parental psychopathology, interparental discord, and parent–child relationship problems when treating youth depression. Psychologists tended to use clinical interviews with parents and youth to assess family risk factors for a large percentage of their cases, whereas they tended to use questionnaires completed by parents and youth for a relatively small percentage of cases. When psychologists made treatment recommendations related to family risk factors, they perceived that a relatively small percentage of families adhered to the recommendations. Although they tended to report knowing when to make treatment recommendations that target family risk factors, they felt less confident in how to get families to follow the recommendations. Results highlight important directions for future research related to directly targeting family risk factors in the context of treating youth depression.

Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices

ABSTRACT Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.

Does caregiver abuse history relate to caregiver focus, support, and attendance at follow-up sessions in a child advocacy setting?

ABSTRACT Utilizing quantitative and qualitative clinical service data collected at a Child Advocacy Center, the present study investigated whether caregiver history (history of childhood abuse or adult victimization, mental health treatment history) was associated with caregiver focus and attendance at a scheduled follow-up appointment. Results of mixed method analyses indicated that caregiver history of abuse was positively associated with caregivers being supportive/protective. Other than a history of prior service-related problems, our study did not identify any predictors of attendance at follow-up sessions. This and other findings are discussed in the context of engaging caregivers in child welfare services.

Emotional security theory: An application to sibling bereavement

Abstract There is a need for guiding theory to understand the experiences and outcomes of bereaved siblings, particularly from a family systems framework. The present study investigated the relevance of emotional security theory in a sample of 72 young adults who experienced sibling bereavement. We investigated (1) whether perceptions of prolonged parental grief predicted key aspects of emotional security (disengagement, preoccupation, and security), and (2) whether emotional security mediated a relation between perceptions of prolonged parental grief and young adult emotional functioning. Results supported the potential utility of emotional security theory as a theoretical framework for understanding sibling bereavement.

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers’ Views of the Role of Technology and Web-Based Resources

This mixed-methods study assessed providers’ views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.