Date of Award

2024

Document Type

Dissertation

Degree Name

Philosophy (Ph.D)

Department

Psychology

First Advisor

Andrea Bergman

Second Advisor

Elissa J. Brown

Third Advisor

Melissa Peckins

Abstract

Youth exposed to interpersonal violence often develop maladaptive posttraumatic cognitions about the event(s), the world, and themselves. These maladaptive cognitions have robust associations with onset and maintenance of posttraumatic stress disorder (PTSD) and internalizing symptoms (Mitchell et al., 2017). Growing literature suggests changes in cognitions, particularly appraisals about control, vulnerability, and personal change following trauma exposure, serve as a mechanism of change in trauma-specific psychotherapy interventions for youth (Meiser-Stedman et al., 2017; Smith et al., 2007). Little research has examined change in blame attributions as a mediator of treatment outcome, despite their importance in understanding how youth process their trauma and are their robust associations with trauma-related symptoms (McGee et al., 2001). The current study sought to assess whether changes in self-blame and perpetrator blame mediate changes in PTSD, anxiety, and depression mid- and post-Trauma-Focused Cognitive Behavior Therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006), a phase-based evidence-based intervention that addresses maladaptive cognitions through a variety of treatment components. Path models were analyzed to examine indirect effects of changes in self-blame (N = 164) and perpetrator blame (N = 420) on symptom change in a diverse sample of youth ages 4 to 17. Results indicated that reductions in self-blame mediated decreases in anxiety and depressive symptoms during Phase I of TF-CBT, which focuses on stabilization, psychoeducation, and coping skills. Path models demonstrated that perpetrator blame mediated decreases in PTSD and anxiety following imaginal exposure and cognitive processing of the traumatic events in Phases II and III of TF-CBT. Findings highlight the importance of assessing and addressing attributions of blame toward the self and the perpetrator(s) of interpersonal violence throughout treatment.

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