An examination of meaning-making processes in trauma-focused cognitive behavioral therapy for childhood trauma

Abstract

Clinical research has shown that cognitive components of overgeneralization are associated with Posttraumatic Stress Disorder (PTSD). Previous findings from treatment studies for adult PTSD suggest that cognitive shifts from overgeneralized to more balanced, accommodated beliefs are important change processes in PTSD treatment. Conversely, avoidance has been identified as an inhibitor of symptom improvement. It is not yet clear whether: 1) change in both overgeneralization and new beliefs (accommodation) are required for symptom change, 2) change in overgeneralization or accommodation alone is sufficient, or 3) whether chronic avoidance exacerbates the negative effects of overgeneralization. Previous research has not examined predictors of long-term change and has focused only on adult populations. This study examined the relationships between overgeneralization, accommodation, avoidance, and symptom reduction in a sample of 81 youth (age 7-17 years) receiving Trauma-Focused Cognitive Behavioral Therapy. Overgeneralization, accommodation, and avoidance expressed during the exposure phase of treatment were coded in audio-recorded therapy sessions. Overgeneralization, accommodation, avoidance, and their interactions were examined as predictors of symptoms at treatment and the follow-up period. Interaction findings revealed that overgeneralization was associated with higher posttreatment internalizing problems, but not when accommodation was high or when avoidance was low. Overgeneralization also predicted a worsening of externalizing symptoms over the follow-up period, but accommodation again reduced this effect and avoidance worsened this effect. These findings suggest that overgeneralization might inhibit therapeutic change in youth with PTSD, but the elicitation of accommodated beliefs and reduction of avoidance may buffer these negative effects.