(PS6-34) Changes in Blame Attributions During Trauma-focused Cognitive-behavioral Therapy

Interpersonal trauma exposure during youth is associated with various forms of psychopathology, such as PTSD, depression, and conduct problems (Wamser-Nanney & Vandenberg, 2013). After interpersonal trauma exposure, many youth experience maladaptive posttraumatic cognitions (MPCs), including dysfunctional blame attributions (e.g., self-blame; Reich et al., 2023). There is robust evidence demonstrating that reductions in MPCs mediate PTSD improvement (Alpert et al., 2023). MPCs have been identified as critical treatment targets to ameliorate trauma-related sequelae regardless of youths’ age (Sharma-Patel et al., 2014). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017) effectively addresses MPCs (Pfeiffer et al., 2017). During phase one of TF-CBT, therapists provide psychoeducation and teach parenting, relaxation, affect modulation, and cognitive coping skills (Cohen et al., 2017). During phase two, therapists conduct trauma narration, trauma-specific cognitive processing, and personal safety skills training (Cohen et al., 2017). Despite MPCs’ established role as a critical treatment target, it remains unknown when these attributions change during TF-CBT and which treatment components are associated with such change. For treatment non-responders, clinicians may need to emphasize treatment components associated with reductions in MPCs. We aim to examine how blame attributions change during TF-CBT. We hypothesize that self-blame will demonstrate the greatest reductions during phase two, perpetrator blame will demonstrate the greatest increases during phase two, and accident blame will not change over the course of treatment.

            A multicultural sample of 81 youth aged 5-17 who completed TF-CBT at a community clinic were assessed before treatment (“pre”), immediately after phase one of treatment (“mid”), and after treatment (“post”). The following blame attributions were assessed using the self-report measure PERceptions of Children Exposed to Interpersonal ViolencE (PERCEIVE; Brown, 2000) at pre, mid, and post: self-blame (e.g., “it was my fault”), perpetrator blame (e.g., “perpetrator is a bad person”), and accident blame (e.g., “sometimes accidents happen”).

            A repeated-measures within-subjects MANOVA including three time points (pre, mid, and post-treatment) was conducted to evaluate changes in blame attributions during TF-CBT. The overall model was significant, F = 3.60, p = .003. A post-hoc Bonferroni test was conducted to ascertain when changes in attributions occurred. Results showed that self-blame decreased overall, from pre (M = 2.20, SD = 2.86) to post-treatment (M = 0.85, SD = 1.96), p < .001, with more change occurring during phase two, from mid (M = 1.62, SD = 2.76) to post-treatment (M = 0.85, SD = 1.96), p = .013.  Accident blame decreased overall, from pre (M = 2.73, SD = 2.22) to post-treatment (M = 2.15, SD = 1.96), p = .044, with no phase differences. Perpetrator blame did not change over the course of treatment. These results suggest that self-blame, perpetrator blame, and accident blame show different patterns of change over the course of TF-CBT. If accepted, clinical implications and future research directions will be discussed.