Department of Psychology.
Clinic for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm.
Psychol Trauma. 2020 May;12(4):336-346. doi: 10.1037/tra0000482. Epub 2019 Jul 25.
Even though there is strong evidence for the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for trauma-exposed youth, there are still youth who continue to struggle with posttraumatic stress symptoms (PTSS) after treatment. Investigating treatment trajectories and predictors of symptom change can increase our understanding of factors associated with nonresponse so that trauma treatment can be optimized.
The sample consisted of 155 youths (M age = 13.9 years, SD = 2.8, 72.3% girls) who received TF-CBT. To examine whether different treatment trajectories could be identified, growth mixture models with linear effects of time were estimated based on Clinical-Administered PTSD-Scale (CAPS-CA) scores at pretreatment, posttreatment and follow-up. We further explored whether gender, age, trauma type, comorbid depression and anxiety, and posttraumatic cognitions were associated with treatment response.
The participants' trajectories could best be represented by 2 latent classes; nonresponders (21% of the sample) and responders (79% of the sample). The nonresponder group was characterized by a higher pretreatment PTSS level and slower improvement in PTSS compared with the responder group. Gender was the only significant predictor, where girls were more likely to be assigned to the nonresponder group.
The findings indicate that clinicians need to be aware that girls and youth with high levels of pretreatment PTSS may be at risk of nonresponse. The results support previous findings showing that TF-CBT is suitable across different age groups and can be an effective treatment for youth with a range of traumatic experiences and additional comorbid symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
尽管有大量证据表明创伤焦点认知行为疗法（TF-CBT）对创伤后青少年有效，但仍有一些青少年在治疗后继续遭受创伤后应激症状（PTSS）的困扰。研究治疗轨迹和症状变化的预测因素可以增加我们对与无反应相关的因素的理解，从而优化创伤治疗。
该样本包括 155 名青少年（M 年龄= 13.9 岁，SD = 2.8，72.3%为女孩），他们接受了 TF-CBT。为了检查是否可以确定不同的治疗轨迹，根据治疗前、治疗后和随访时的临床管理 PTSD 量表（CAPS-CA）评分，估计了具有线性时间效应的增长混合模型。我们进一步探讨了性别、年龄、创伤类型、共病抑郁和焦虑以及创伤后认知是否与治疗反应相关。
参与者的轨迹最好用 2 个潜在类别来表示；无反应者（样本的 21%）和反应者（样本的 79%）。无反应者组的 PTSD 水平较高，与反应者组相比，PTSD 改善较慢。性别是唯一显著的预测因素，女孩更有可能被分配到无反应者组。
研究结果表明，临床医生需要意识到，女孩和 PTSD 水平较高的青少年可能存在无反应的风险。结果支持先前的研究结果，表明 TF-CBT 适合不同年龄组，并且可以作为一种有效的治疗方法，适用于具有一系列创伤经历和其他共病症状的青少年。（PsycInfo 数据库记录（c）2020 APA，保留所有权利）。
