A MIXED METHODS ANALYSIS OF GENDER DIFFERENCES IN SYMPTOM PROGRESSION AND TRAUMA NARRATIVES DURING TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY

OF DISSERTATION A MIXED METHODS ANALYSIS OF GENDER DIFFERENCES IN SYMPTOM PROGRESSION AND TRAUMA NARRATIVES DURING TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phasebased interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through traumafocused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any genderrelated symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2X2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TFCBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.