Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome?

Abstract

Background: Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11^th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame.

Objective: The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT).

Participants and setting: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC.

Methods: Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes.

Results: There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline.

Conclusions: This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.

Keywords: Trauma-Focused Cognitive-Behavioral Therapy; childhood trauma; chronic trauma; complex trauma.