Parental Dysfunctional Posttraumatic Cognitions in Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents

Objective: Trauma-therapy in children and adolescents often involves the inclusion of their parents. A multi-informant approach was used to investigate whether trauma-focused cognitive-behavioral therapy (TF-CBT) changes dysfunctional posttraumatic cognitions (PTCs) in participating parents. This, in turn, may mediate their child's posttraumatic stress symptoms (PTSS) posttreatment. Method: Children and adolescents (6-17 years old) were assigned to either a TF-CBT (n = 57) or a waitlist (n = 56) condition, within a multisite randomized controlled trial conducted in Germany. They were assessed using the Clinician Administered PTSD Scale for Children and Adolescents, version for DSM-IV and they completed the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for Children and Adolescents (UCLA). Their parents completed the UCLA, caregiver report, and the Posttraumatic Cognitions Inventory to rate their dysfunctional PTCs related to their child's trauma. The mediation hypothesis was tested using a multiple mediation model. Results: The change in parental PTCs was stronger in the TF-CBT condition (b = 13.19, 95% confidence interval [CI] [2.89, 23.49]). It mediated the relationship between the group (TF-CBT vs. waitlist) and the caregiver report on the child's PTSS (b = −.08, 95% CI [−.15, −.01]), but not the child's PTSS, assessed using the interview (b = .01, 95% CI [−.14, .17]) and the self-report questionnaire (b = .01, 95% CI [−.08, .10]), posttreatment. Conclusions: TF-CBT helped participating parents to challenge their dysfunctional PTCs related to their child's trauma. The change in parental PTCs only mediated their perception of their child's PTSS but not their child's self-perception or the clinical evaluation of their child's PTSS. Clinical Impact Statement This study suggests that including parents in the trauma-focused cognitive-behavioral therapy, delivered to their child, might help them change their own dysfunctional thoughts and beliefs about their child's traumatic experience. Although parents who reported the change in their dysfunctional thoughts, in the course of the therapy, tended to report the reduction in their child's posttraumatic stress symptoms, the self-report questionnaire and the clinical interview do not suggest any evidence that the change in parental dysfunctional thoughts mediates their child's treatment outcome.