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Child / Adolescent - Trauma / Maltreatment

The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy

(PS6-61) The Role of Family Accommodation in Child Posttraumatic Stress Symptoms and Functional Impairment in the Context of Cognitive Behavioral Therapy

Friday, November 15, 2024
4:00 PM – 5:00 PM EST
Location: Franklin Hall, Level 4, Marriott Downtown
Abstract Text: Family accommodation (FA), refers to actions by family members to excessively modify their own behaviors or family routines in service of facilitating anxiety-related youth avoidance. Although well-intentioned and associated with alleviation of distress in the short term, FA ultimately prolongs symptoms by depriving youth of the opportunity to employ adaptive coping strategies. While FA has been extensively applied within the framework of youth anxiety and obsessive-compulsive disorders, relatively less work has been done applying this construct to posttraumatic stress symptoms (PTSS). Using data from a previously completed clinical trial comparing stepped care CBT for Children After Trauma to standard Trauma-Focused Cognitive Behavior Therapy (TF-CBT), the present study sought to: 1) examine relationships among FA, PTSS, and related functional impairment at baseline; and 2) explore the association between change in FA during treatment and PTSS domains and functional impairment, respectively, at post-treatment and 12-month follow-up. Participants included 183 children and their caregivers (M child age = 7.89; 55.19% female; 73.22% non-Hispanic; 51.37% White). Correlational and cross-sectional mediation analyses revealed that baseline FA was 1) significantly, positively associated with PTSS domains and functional impairment, and 2) partially mediated the relationship between PTSS and functional impairment. Additionally, results of hierarchical regression models indicated that pre-to post-treatment change in FA was generally associated with post-treatment functional impairment, and post-treatment and 12-month follow up PTSS across domains, with the exception of PTSS-avoidance, where no association was found. These findings suggest that FA may limit opportunities for trauma processing and corrective learning – important features of trauma-focused CBT interventions, thereby perpetuating symptomology and exacerbating functional impairment. Relatedly, reductions in FA may function as a salient mechanism for reducing PTSS and functional impairment in trauma-focused-CBT-based interventions. Indeed, refining interventions targeting sustained FA-reduction may present an innovative way to address PTSS and functional impairment in youth, with potential for profound impact in advancing behavioral health in our communities. Moreover, when targeting PTSS with trauma-focused interventions, it is important to consider the role of the caregiver and the child’s capacity to emotionally regulate and cope with their traumatic event. Exploring the intersectionality of FA with household structure, socioeconomic factors, and trauma experiences could also provide important insights into the sustainability of interventions and support systems, ultimately fostering more inclusive and effective models for addressing youth mental health. Further research is also necessary to address FA in a more culturally sensitive way, including whether FA differs depending on the type of trauma exposure, and this relationship in youth who have not undergone trauma treatment, in order to better serve the needs of youth with trauma-related concerns in diverse populations given the sensitive nature of this mechanism.