ORCID

https://orcid.org/0000-0003-3674-9999

Date of Award

2024

Document Type

Dissertation

Degree Name

Philosophy (Ph.D)

Department

Psychology

First Advisor

Elissa Brown

Second Advisor

Andrea Bergman

Third Advisor

Lauren Moskowitz

Abstract

Trauma-Focused Cognitive-Behavioral therapy (TF-CBT) is one of the most empirically supported interventions for treating children’s posttraumatic stress disorder, depression, and other behavior problems. Caregivers are involved in treatment and improve in their own symptoms during TF-CBT. Research suggests that caregivers’ and children’s outcomes may be interrelated in trauma-focused interventions, and that children’s posttraumatic stress is mediated by decreases in caregivers internalizing symptomatology. There are numerous limitations to existing literature, including the limited direction of the mediations and the consideration of only internalizing symptoms in mediations. This study aimed to prospectively examine how changes in caregivers’ negative affectivity mediate changes in their children’s internalizing and externalizing symptoms. It also aimed to examine how changes in children’s internalizing trauma symptoms mediate changes in their caregivers’ negative affectivity. The current study consisted of racially and ethnically diverse caregivers (N = 243) and their children (N = 243) participating in an ongoing effectiveness study of TF-CBT in a community clinic in Queens. They were evaluated right before starting TF-CBT, in the middle of treatment, and at the culmination of treatment. At each evaluation, caregivers reported on their own psychopathology and their children’s externalizing symptoms, and children reported on their own internalizing symptomatology. First, an exploratory factor analysis (EFA) was conducted to determine the homogenous items in the caregiver psychopathology measure that encompass a negative affectivity construct. Measurement models were conducted through confirmatory factor analysis (CFA) to verify this factor structure at each time point. Finally, mediation analyses using a structural equation modeling framework were conducted to understand if a reciprocal relationship exists for caregiver and child symptom improvements during TF-CBT for caregiver negative affectivity and child internalizing symptoms (Model 1), and caregiver negative affectivity and child externalizing symptoms (Model 2). The EFA produced a negative affectivity construct with 12 items. The CFAs at each time point did not have adequate fit indices, so caregivers’ negative affectivity scores were presented as observed variables and calculated using a sum score. Unfortunately, neither Model 1 nor Model 2 yielded adequate fit. Clinical implications and future research directions will be discussed.

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