(PS11-C66) The Relation Between Baseline Anger and Treatment Outcomes in Trauma-Focused Cognitive-Behavioral Therapy

Annually, more than 25% of youth in the United States experience interpersonal violence (IPV; Finkelhor et al., 2009), and approximately 25% develop symptoms of posttraumatic stress disorder (PTSD; Alisic et al., 2014). Previous studies have found that exposure to IPV during childhood and adolescence may disrupt the adaptive development of emotion regulation processes (e.g., Gruhn & Compas, 2020). Furthermore, high levels of anger are a common feature of the clinical presentation that emerges in the aftermath of IPV (Olatunji et al., 2010). Although some degree of anger may be an appropriate and adaptive response to IPV, higher levels may impede treatment outcomes (Forbes et al., 2008; Kaczkurkin et al., 2016). For example, in a study of female adolescent survivors of sexual assault and abuse who received prolonged exposure for adolescents, Kaczurkin et al. (2016) found that high levels of baseline anger were associated with lower rates of PTSD symptom change. However, because this study did not include children and the sample size is small (N = 61), the generalizability of these findings is limited. In the proposed poster, we aim to examine whether baseline anger moderates the rate of PTSD symptom change throughout TF-CBT in both children and adolescents. We hypothesize that higher anger levels at baseline will be associated with a lower rate of PTSD symptom change.

A multicultural sample of 340 youth aged 3-19 (M = 12.08; SD = 3.72) who received at least one session of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017) at a community clinic were assessed pre, mid, and post-treatment. Anger was assessed using the Anger Control subscale of the Behavior Assessment System for Children, third edition, Self Report of Personality (BASC-3-SRP; Kamphaus & Reynolds, 2015). PTSD symptoms were assessed using the Child PTSD Symptom Scale (CPSS; Foa et al., 2001; Foa et al., 2018).

A mixed effects regression was conducted to evaluate the relationship between baseline Anger Control scores and the rate of CPSS change from pre- to post-treatment. Anger Control and weeks since the pre-treatment assessment were entered as predictors, the interaction between Anger Control and weeks since pre-treatment was entered as a moderator, and the rate of CPSS change was entered as a criterion variable. To control for baseline CPSS scores, pre-treatment CPSS scores were entered as a covariate. We found a significant main effect of Anger Control on CPSS scores at pre-treatment,  = .045, p < .001, suggesting that youth with higher baseline Anger Control scores also have higher baseline CPSS scores. Additionally, we found that Anger Control scores significantly moderate the relationship between weeks since pre-treatment and CPSS scores, t = -3.693, df = 332, p < .001. However, the effect was minimal,  = -.001. These results suggest that youth with baseline Anger Control scores above the mean showed a slightly higher rate of CPSS change from pre- to post-treatment than youth with baseline Anger Control scores equal to or below the mean. If accepted, we plan on running additional analyses to examine whether anger’s role as a moderator differs by developmental level and by treatment phase. Clinical implications and future research directions will be discussed.