Cognitive Behavioral and Integrative Treatment of Abused Children: Examining Cognitive and Emotional Processes and Developmental Considerations

Degree awarded: Ph.D. Psychology. The Catholic University of AmericaMaltreated and abused children often experience a wide range of psychological and physical problems, including emotional avoidance and negative post-traumatic cognitions, and present to treatment with a broad range of developmental abilities. The present study explored trauma-related beliefs, emotion regulation, and verbal engagement, and their relation to symptoms in 42 children with complex trauma histories who presented for a treatment outcome study of trauma-focused integrated play therapy (TF-IPT) and trauma-focused cognitive behavioral therapy (TF-CBT). As predicted, emotion regulation deficits and negative trauma-related beliefs at baseline corresponded with greater psychological symptoms, with distinct patterns emerging. Across treatment conditions, negative trauma-related beliefs decreased significantly from pre- to post-treatment and verbal engagement increased significantly across sessions; both changes corresponded significantly with reductions in symptomatology. Contrary to prediction, no significant improvements in emotion regulation capacities were found (although for children in the TF-IPT condition means were in the expected direction), and improvement in emotion regulation was not related to change on any measure of psychological symptoms. Treatments also did not differ significantly in their ability to decrease trauma-related beliefs, improve emotion regulation, or facilitate verbal engagement, although only children in TF-CBT showed significant improvement in trauma cognitions. Additionally, simple meditational analyzes using a non-parametric bootstrapping approach indicated no indirect effect of treatment group by any mediators tested for symptom improvement. Even though the study's statistical power was limited by the presence of only 22 treatment completers and replication is needed, results suggest that remediating children's trauma-related cognitions is important in trauma treatment, while emotion regulation capacities may be more difficult to impact therapeutically (or to measure meaningfully). Additionally, future interventions that enhance children's verbal engagement in treatment may increase treatment effectiveness. Integrative treatments such as TF-IPT may hold promise, especially for young children with immature cognitive and language capacities. Further research, including a larger randomized controlled clinical trial of both TF-CBT and TF-IPT, would be beneficial in developing better understandings of these mechanisms of change for abused children and the differential effects of treatments on underlying process variables.Made available in DSpace on 2013-02-08T16:06:02Z (GMT). No. of bitstreams: 1 Krueger_cua_0043A_10390display.pdf: 1159704 bytes, checksum: 517d91881ea6388c1af26411f32a95c0 (MD5