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Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results:In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion:The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

Although trauma-focused interventions are effective in treating patients with PTSD, they are not frequently used in clinical practice. To address this gap, the present study aimed to develop and evaluate a web-based training for trauma-focused therapy. Our main objective was to increase the knowledge and competencies of current and future licensed psychotherapists in the core procedures that have been identified as efficacious treatment components. The web-based training consists of modules on diagnostics and psychoeducation, disease models, evidence-based interventions, coping with difficulties in therapy, and exercises to promote self-care and mental hygiene. In a waitlist controlled evaluation study, therapists (N ϭ 499) were randomized into either an intervention or a waitlist control group. Knowledge, competencies, self-efficacy expectations, and willingness to conduct trauma-focused therapy were assessed via self-report in both groups before and after training completion. Results indicate a relatively low dropout rate and a high level of satisfaction with the content and structure of the training. In comparison to the waitlist control group, participants who successfully completed the training showed a significantly greater improvement in subjective ratings of knowledge and perceived treatment competence, perceived emotional competence, self-efficacy, and willingness to conduct trauma-focused therapy. They also improved significantly in their results on the knowledge test. In sum, results of this feasibility study suggest that the web-based training is an acceptable program to increase knowledge and competencies in terms of trauma-focused interventions. Further research should focus on evaluating whether the training increases therapists' competence in terms of objectively rated clinical skills. Public Significance StatementThe results of the present study show that a web-based training in evidence-based trauma therapy is an accepted and feasible way to train clinicians in evidence-based trauma therapy. Web-based This article was published Online First August 22, 2019.LISA M. SANSEN received her diploma degree in Psychology and her PhD in Clinical Psychology from Bielefeld University in Germany. She is currently employed as senior psychotherapist at the outpatient clinic of Bielefeld University. Her areas of professional interest include implementation and research of cognitive-behavioural therapy, especially of posttraumatic stress disorder, and dissemination of trauma-focused interventions.LAURA B. SAUPE received her diploma in Psychology from the University of Marburg in Germany. She is currently employed as a PhD student at the workgroup for clinical psychology and psychotherapy at Bielefeld University in Germany. Her areas of professional interest include transgenerational effects of war and displacement; family violence, including its effects on adolescents' future expectations; and the dissemination of trauma-focused treatments via e-learning.ANNIKA STEIDL received her MS in Clinical Psychology from ...

Although trauma-focused interventions are the first-line therapies for patients with posttraumatic stress disorder (PTSD), they are not frequently used in clinical practice. Factors preventing therapists from applying trauma-focused methods include a lack of training and negative attitudes towards trauma-focused therapy. The aim of the present study was to investigate which factors predict willingness to carry out trauma-focused therapy and to examine whether a web-based training is able to reduce negative attitudes and reservations about these interventions. In a wait-list controlled evaluation study, therapists (N = 499) were randomized into an intervention or a wait-list control group. Results show that trauma-treatment specific competencies and overcoming pre-existing concerns towards trauma-focused therapy significantly predict therapists’ willingness to utilize trauma-focused interventions. Thus, the content alignment of the web-based course is appropriate for improving therapists’ willingness to conduct trauma-focused therapy. A retrospective examination of therapists after the training and a comparison of fears and reservations before and after the training demonstrate a significant reduction of fears and reservations. In terms of perceived contraindications, no effects of the web-based training were found. The present study provides compelling evidence that web-based training in evidence-based PTSD therapy is able to reduce reservations that may prevent therapists from applying evidence-based trauma-focused interventions.

The formulation of life perspectives is one of the developmental tasks of adolescence. Expectations regarding one’s own future are shaped by cultural and contextual factors. However, there is little cross-cultural research that includes countries affected by war and turmoil. A Ugandan version of the Future Expectations Scale for Adolescents (FESA) was developed and evaluated with a sample of 279 Ugandan adolescents with low socioeconomic status living in rural communities affected by the Ugandan civil war (1986–2006). The Ugandan FESA was constructed on the basis of a combined item pool of the original Chilean and an adapted Brazilian FESA. Confirmatory factor analysis revealed that the factor structure of the original FESA did not fit the Ugandan data. Principal component analysis revealed a 3-factor solution, including the domains of children and family, work and education, and general future optimism. The final version consists of 19 items, which were deemed culturally appropriate by local focus groups. Overall, the item pool of the FESA was found useful for further studies in post-conflict societies.