(PS4-C72) Trauma-focused Cognitive Behavioral Therapy and Externalizing Behavior Problems in Adolescents

Approximately 62% of adolescents in a national sample reported experiencing at least one potentially traumatic experience. Youth can experience a range of psychopathology following a traumatic exposure, including externalizing behavior problems. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an empirically supported treatment for PTSD and externalizing problems among youth. However, the specific mechanism(s) responsible for the reduction in youth externalizing or PTSD symptoms have not been examined. While parenting, emotion regulation, and executive functioning have all been implicated as important factors related to the treatment of externalizing behaviors and trauma among youth, little to no empirical work has considered executive functioning, trauma, and externalizing problems together in a sample of children. Thus, the purpose of the current study was to examine the pattern of executive functioning, externalizing problems, and PTSD symptoms change during the first phase of TF-CBT. The current study also examined executive functioning as a possible mechanism of change in externalizing and PTSD symptoms. The current study utilized a single-case time-series design with 4 male youth between the ages of 12 and 16 years who presented for treatment at an outpatient clinic in Lubbock, Texas. This study utilized simulation modeling analysis (SMA; Borckardt et al., 2008) and reliable change index (RCI; Jacobson & Truax, 1991) to examine session by session changes in executive functioning, externalizing problems, and PTSD symptoms. SMA is designed for relatively short, autocorrelated, case-based time-series data that are common in clinical research (Borckardt & Nash, 2014; Borckardt et al., 2008). Results suggest significant decreases in caregiver-reported externalizing problems for Participants One, Three, and Four over the course of therapy. Additionally, self-reported PTSD symptoms significantly decreased during the baseline (pre-treatment) phase and leveled out during the treatment phase for Participants Two and Four. Only Participant Four demonstrated significant improvements in executive functioning utilizing caregiver-report. Results suggest youth executive functioning did not function as a mechanism of change in externalizing problems and PTSD symptom reduction. Notably, the specific components of psychoeducation, parenting, and relaxation were identified as important factors regarding symptom reduction. The results of this study suggest it may not be necessary for children who present with clinically elevated externalizing problems to receive treatment for those problems before engaging in TF-CBT as recommended by the TF-CBT manual. The current study provides support that TF-CBT could sufficiently treat co-occurring externalizing and trauma symptoms. Overall, the current study provides information regarding the pattern and timing of change in symptoms throughout Phase One of TF-CBT. This study also provides feasibility data for the use of single-case time-series designs for trauma exposed youth as well as in community mental health settings.