(PS3-90) The Relation Between Caregiver-Reported Family Cohesion and Youth PTSD Symptom Change During Trauma-Focused Cognitive-Behavioral Therapy

Over two-thirds of youth experience trauma before the age of 18 (Finkelhor et al., 2015; McLaughlin et al., 2013), 16% of whom develop posttraumatic stress disorder (PTSD; Alisic et al., 2014). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017) is the most well-researched treatment for trauma-related symptoms in youth (e.g., Thielemann et al., 2022). Caregivers play an essential role in treatment and receive many of the same treatment components as their participating children (Brown et al., 2020). Caregiver factors, such as support for their children and engagement in therapy, have been found to be predictors of treatment outcome (Cohen & Mannarino, 2000; Cohen et al., 2018). The influence of relational factors between youth and caregivers on treatment outcomes are less understood.
Youth perceptions of the caregiver-child relationship have been shown to significantly improve across TF-CBT (Paul et al., 2024). In the proposed poster, we will explore whether family cohesion at pre-treatment moderates youth PTSD symptom change in TF-CBT. We hypothesize that families with high cohesion (versus low cohesion) at pre-treatment will experience greater reductions in PTSD symptoms.
Data are drawn from an ongoing study of TF-CBT at an urban community clinic for traumatized youth. TF-CBT includes psychoeducation on trauma, relaxation skills, affect regulation, and cognitive processing (PRAC), followed by trauma narration (i.e., imaginal exposure), in vivo exposure, conjoint work, and enhancing safety (TICE). Measures are completed at pre-treatment, mid-treatment (between PRAC and TICE), and post-treatment assessments. Family cohesion is assessed using caregiver-reported Family Environment Scale, Cohesion subscale (FES-Cohesion; Moos & Moos, 1994). Youth PTSD symptoms are assessed using the Child PTSD Symptom Scale for DSM-5 (CPSS-5; Foa et al., 2018).
We conducted a preliminary analysis with 20 families. A repeated measures ANOVA including three-time points (pre, mid, and post) was conducted to examine family cohesion as a moderator of PTSD symptom change. Given the low sample size, the interaction term did not meet significance, F (2, 36) = .80, p =.46, ω² = 0. However, R² change for the interaction term was 8%, suggesting that the interaction accounted for meaningful variance. Children with higher caregiver-reported cohesion at pre-treatment experience greater reductions in PTSD symptoms during TF-CBT. For the presentation, we will rerun analyses with approximately 60 families.