治疗过程中照顾者的行为可预测接受创伤聚焦认知行为疗法（TF-CBT）的青少年的症状变化。
In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT).
作者信息
Yasinski Carly, Hayes Adele M, Ready C Beth, Cummings Jorden A, Berman Ilana S, McCauley Thomas, Webb Charles, Deblinger Esther
机构信息
Department of Psychological and Brain Sciences, University of Delaware.
Durham Veteran's Affairs Medical Center.
出版信息
J Consult Clin Psychol. 2016 Dec;84(12):1066-1077. doi: 10.1037/ccp0000147. Epub 2016 Sep 12.
OBJECTIVE
Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms.
METHOD
Participants were a racially diverse sample of Medicaid-eligible youth (ages 7-17) and their nonoffending caregivers (N = 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV; UPID) at 3, 6, 9, and 12 months postintake.
RESULTS
Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers' cognitive-emotional processing of their own and their child's trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs.
CONCLUSIONS
The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. (PsycINFO Database Record
目的
研究表明，让照顾者参与针对青少年的创伤聚焦治疗会带来更好的治疗效果，但尚不清楚治疗过程中照顾者的哪些行为会增强或抑制这种效果。本研究考察了创伤聚焦认知行为疗法（TF-CBT）过程中照顾者行为与青少年认知过程及症状之间的关联。
方法
参与者是一个种族多样的样本，包括符合医疗补助条件的青少年（7至17岁）及其非犯罪照顾者（N = 71对），他们通过一项社区环境中的疗效研究接受了TF-CBT治疗。从录音治疗 session 中对照顾者和青少年的过程进行编码，并在入组后3、6、9和12个月使用儿童行为检查表（CBCL）和《精神障碍诊断与统计手册（第四版）》（DSM-IV；UPID）中的加州大学洛杉矶分校创伤后应激障碍反应指数来测量治疗结果。
结果
分段线性增长曲线模型显示，在TF-CBT的创伤叙事阶段，照顾者对自身及孩子创伤相关反应的认知情绪处理预示着治疗期间青少年内化和外化症状的减少。照顾者的支持预示着随访期间内化症状较低。相比之下，照顾者对孩子的回避和责备预示着随访期间青少年内化和外化症状的恶化。治疗早期照顾者的回避也预示着随访期间外化症状的恶化。在叙事阶段，照顾者的责备和回避与孩子对创伤信念的更多过度概括相关，责备还与孩子对平衡信念的较少接纳相关。
结论
TF-CBT治疗期间及之后照顾者行为与青少年症状学之间的关联凸显了评估和针对这些行为以改善临床结果的重要性。（PsycINFO数据库记录
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