The overall aim of this dissertation was to gain a better understanding of parents’ emotional reactions to their child’s trauma and what role their reactions play in children’s treatment outcomes.
The data were derived from an effectiveness study investigating the effect of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) compared with the therapy usually given (TAU) in ordinary community child mental health clinics, which was also the focus of one of the papers of the current dissertation. The next goal of this dissertation was to evaluate an assessment scale that measures parents’ emotional reactions to their child’s traumatic event, the Parent Emotional Reaction Questionnaire (PERQ), and to examine whether the degree of parents’ different emotional reactions covaried with the type of trauma that the child had experienced. Moreover, the aim was to examine the extent to which parents benefitted from the therapy provided to their child and to investigate whether changes in parental reactions and depression had a mediating role in the treatment difference between TF-CBT and TAU on children’s posttraumatic stress (PTS) symptoms and depression.
Methods: The total sample in the source study comprised 156 children and adolescents and 135 of their caregivers, all of whom were participating in a randomized controlled study comparing TF-CBT and TAU. All participants were recruited from their general practitioner or Child Protective Services, and they were given therapy in the community mental health clinics to which they belonged. Parents’ emotional reactions and depressive symptoms were assessed by self-report questionnaires, whereas children’s symptoms were assessed by using both a clinical diagnostic interview and self-report questionnaires. The analytical methods that were applied in this dissertation were exploratory factor analysis, correlation analyses, paired sample t-tests, multivariate analysis of variance (MANOVA), mixed-effects analyses, and mediation analyses.
Results: The results from the exploratory factor analysis showed that parents’ emotional reactions, as measured by the PERQ, could be divided into three subcategories: parental distress, parental shame, and parental guilt (Paper 1). Parents of children who were exposed to all types of traumatic events reported relatively high degrees of distress, whereas parents’ feelings of shame and guilt were highest among parents of children who were exposed to or witnesses of domestic violence (Paper 2). When investigating the effect of TF-CBT compared with TAU, we found significant differences between the two therapy conditions in terms of PTS symptoms and their influence on daily functioning, depressive symptoms, and child mental health problems (Paper 3). Although parents’ emotional reactions and depression also decreased from the pretreatment to posttreatment period, no significant effect of therapy group was found in this regard. Furthermore, the change in parental variables did significantly mediate the therapy effect of TF-CBT above that of TAU on child depressive symptoms but not on child PTS symptoms (Paper 4).
Conclusions: Parents reported experiencing different types of emotional reactions to their child’s traumatic events, and these reactions seemed to depend on the type of trauma experienced by the child. Furthermore, parental emotional reactions and depressive symptoms were reduced during the therapy process in both treatment groups, and this reduction was found to mediate the effect of the treatment on child depressive symptoms. Lastly, TF-CBT was effective in treating child trauma related problems in Norwegian community mental health clinics.