Trajectories and Possible Predictors of Treatment Outcome for Youth Receiving Trauma-Focused Cognitive Behavioral Therapy

Objective: 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. Method: 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. Results: 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. Conclusions: 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.