(PS11-C68) Are Baseline Depression and Posttraumatic Stress Disorder Symptoms Associated with the Length of Trauma-focused Cognitive-behavioral Therapy?

More than two thirds of children experience at least one traumatic event, and approximately 13.4% develop posttraumatic stress disorder (PTSD) symptoms as a result, with depressive disorders being the most common comorbid diagnosis (Copeland et al., 2007; Vibhakar et al., 2019). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017) has been shown to reduce youths’ PTSD and depression symptoms in over 20 randomized controlled trials (RCTs; e.g., Cohen et al., 2004; Jensen et al., 2014). Although some of these RCTs (e.g., Deblinger et al., 2011) examine treatment length as a criterion variable, it is contained and determined by random assignment rather than client need. Children with higher levels of PTSD and depression symptoms may require additional time spent effectively learning emotional regulation skills (e.g., Cohen et al., 2012), thus extending overall treatment length. In the current study, we examine a naturalized course of TF-CBT where all components of the model are addressed, and measurable improvements are made in client presentation and/or functioning before treatment is completed.

In contained TF-CBT delivery, one study found that some PTSD symptoms decreased more with 16 sessions than with 8 sessions when length was measured categorically (Deblinger et al., 2011). Yet, some youth with high depression symptoms at baseline still met PTSD criteria after 16 sessions (Mannarino et al., 2012). In naturalized TF-CBT delivery, longer treatment was associated with more severe PTSD symptoms at termination (Gusler et al., 2023), however, treatment length was not associated with meeting categorical PTSD criteria at baseline (Ross et al., 2021). These studies highlight the need to examine the relationship between treatment length, and baseline depression and PTSD symptoms as continuous and not categorical variables in naturalized TF-CBT delivery. We hypothesized that children with higher PTSD and depression symptoms at baseline would complete TF-CBT in more sessions.

Data were collected from an ongoing study of traumatized youth (ages 4-17) and their caregivers who completed TF-CBT at a community clinic (N = 154). Known covariates such as gender and age (e.g., Dorsey et al., 2020) were collected. Children’s Total PTSD Symptoms were assessed using the Child PTSD Symptom Scale for DSM-IV and DSM-5 (Foa et al., 2001; 2018). Children’s Depression Symptoms were assessed using the Behavioral Assessment for Children, Third Edition. Session Numbers were reported by clinicians as part of a treatment fidelity assessment.

We conducted a hierarchical linear regression with Gender and Age in Block 1, Depression Symptoms and Total PTSD Symptoms in Block 2, and Session Number as the criterion variable. The overall model was significant, predicting 13.9% of the variance in treatment length, (F(4, 114) = 5.75, p < 0.001). Depression Symptoms were significantly positively associated with Session Number. Total PTSD symptoms (β = 0.043, p > 0.05), Gender (β = -2.708, p > 0.05), and Age (β = 0.213, p > 0.05) were not significantly associated with Session Number. Future research should assess if the rate of change in depression symptoms is a better predictor of treatment length than baseline depression severity.