Date of Award


Document Type


Degree Name

MA in Clinical Psychology



First Advisor

Elissa J Brown, Ph.D.

Second Advisor

Melissa Peckins, Ph.D.


Caregivers play an integral role in their child’s trauma-focused cognitive-behavior therapy (TF-CBT; Cohen & Mannarino, 2006), an intervention that has established efficacy in treating children’s trauma-related symptoms (Cohen et al., 2017). Unfortunately, extant literature on TF-CBT lacks a comprehensive understanding and representation of demographic characteristics and baseline symptomatology for caregivers who participate in TF-CBT at community clinics. Furthermore, although researchers suggest that TF-CBT may improve caregivers’ own distress, posttraumatic stress disorder (PTSD), and depression from pre- to post-treatment (e.g., Cohen et al., 2004a; Cohen et al., 2004b; Deblinger et al., 2011; Tutus et al., 2017), there is no assessment of caregiver’s anxiety symptoms throughout treatment to date. Much of the existing literature regarding caregiver symptom improvement is methodologically flawed. Lastly, it is unclear which phase of TF-CBT results in the greatest symptom change for caregivers. The current study seeks to assess whether, and at which phase of treatment, caregivers who participate in TF-CBT at a community clinic report decreases in their depression and anxiety symptoms. The current study examined 235 caregivers of children receiving TF-CBT. Caregivers’ self-reported depression and anxiety symptoms were analyzed at pre-, mid-, and post-treatment time points. A one-sample Wilcoxon signed rank test was utilized to compare published norms of female adult nonpatient and female adult outpatient samples (Derogatis, 1991). A multivariate multilevel model utilizing between-cluster variability was implemented to assess for statistically significant improvement in depression and anxiety scores in both completer and intent-to-treat (ITT) samples. Finally, multilevel models (MLM; Raudenbush, 1989) with restricted maximum likelihood estimation (REML; Lindstrom & Bates, 1988; Snijders & Bosker, 2012) were conducted on both completer and ITT samples to assess degree of change during both Phase I (i.e., PRAC) and Phase II (i.e., TICE) of treatment. Caregivers in this sample more closely resembled nonpatient female adults in both depression and anxiety scores at baseline. Depression and anxiety scores decreased significantly for caregivers over the course of treatment, with greater changes seen in Phase I of treatment for both depression and anxiety. Clinical implications for caregiver engagement and assessment in the context of TF-CBT will be discussed.