Do Externalizing Problems Impact Change in Post-Traumatic Stress Symptoms for Youth in a School-Based Group Intervention?

Trauma exposure places youth at an increased risk for post-traumatic stress symptoms (PTSS) and externalizing problems. Trauma-focused therapies help treat these symptoms, but many youth with these symptoms are still unable to receive treatment. Offering trauma-focused therapies in a group format is one way to extend therapeutic services to more youth who need them. Providing group interventions to youth in the school setting can further minimize barriers for youth who need therapeutic services. Despite the relationship between trauma exposure and externalizing behavior problems, and the disruptive nature of externalizing problems, the impact of externalizing problems on outcomes in group treatment for PTSS has yet to be examined. This study uses multilevel modeling to examine whether PTSS symptom change during group therapy for youth with PTSS differs as a function of youth’s self-reported externalizing problems or as a function of youth’s exposure to other youth’s externalizing problems within their therapy group. Results show that youth’s own level of externalizing problems at baseline did not yield a significant effect on PTSS symptom change from pre- to post-treatment; however, youth who were part of groups with higher levels of externalizing problems experienced less change in PTSS from baseline to post-intervention. While youth with higher levels of externalizing problems themselves still report experiencing reductions in PTSS from group therapy, the presence of these youth in group sessions may impede therapeutic progress of other groups members. The clinical implications of these findings for treatment of PTSS in youth with externalizing behavior problems will be discussed.