Narrative Focus Predicts Symptom Change Trajectories in Group Treatment for Traumatized and Bereaved Adolescents

Abstract

Growing evidence supports the effectiveness of Trauma and Grief Component Therapy for Adolescents (TGCT-A) in reducing posttraumatic stress disorder (PTSD) symptoms and maladaptive grief (MG) reactions. This pilot study explored whether the specific focus of students' narratives (i.e., focus on trauma vs. focus on loss) as shared by TGCT-A group members would predict initial pretreatment levels, as well as pre- to posttreatment change trajectories, of PTSD symptoms and MG reactions. Thirty-three adolescents from three middle schools completed a 17-week course of group-based TGCT-A. PTSD and MG symptoms were assessed at pretreatment, twice during treatment, and at posttreatment. The focus (trauma vs. loss) of each student's narrative was coded using transcripts of members' narratives as shared within the groups. The reliable change index showed that 61% of students reported reliable pre-post improvement in either PTSD symptoms or MG reactions. Students whose narratives focused on loss both reported higher starting levels and showed steeper rates of decline in MG reactions than students whose narratives focused on trauma. In contrast, students whose narratives focused on trauma reported higher starting levels of PTSD than students who narrated loss experiences. However, narrative focus was not significantly linked to the rate at which PTSD symptoms declined over the course of treatment. This study provides preliminary evidence that TGCT-A treatment components are associated with reduced PTSD symptoms and MG reactions. Loss-focused narratives, in particular, appear to be associated with greater decreases in MG reactions.

Internalizing and Externalizing Symptoms Moderate Treatment Response to School-Based Trauma and Grief Component Therapy for Adolescents

“…Results of this study, combined with those of a prior evaluation (Grassetti et al, 2015), underscore the need for additional research that replicates and extends these findings. Such studies would benefit from a larger sample size, the use of multiple informants (e.g., parents, teachers), and the use of school records that include attendance, disciplinary, and achievement data including successful developmental transitions (e.g., graduation at follow-up).…”

“…Participants included 44 seventh-and eighth-grade students from three middle schools who participated in an open trial of TGCTA (Grassetti et al, 2015). The University of Delaware Institutional Review Board approved the study procedures, and study participants were treated in accordance with ethical standards.…”

“…Previous studies have demonstrated the effectiveness of TGCTA in reducing PTS and MG reactions among adolescents (Layne et al, , 2008Saltzman, Pynoos, Layne, Steinberg, & Aisenberg, 2001). More recently, data from a prior study of the same school-based TGCTA implementation examined in the current study also demonstrated significant pre-to post-treatment reductions in both PTS and MG reactions, producing a 61% rate of reliable change as well as significant linear declines in symptoms over the course of treatment (Grassetti et al, 2015). TGCTA is designed to address the needs of a heterogeneous group of students by targeting both PTS and MG reactions-two related yet distinct conditions (Goenjian et al, 2009;Laor et al, 2002;McClatchey &Vonk, 2005;O'Connor, Lasgaard, Shevlin, & Guldin, 2010).…”

Understanding grief reactions, thwarted belongingness, and suicide ideation in bereaved adolescents: Toward a unifying theory

“…TGCTA uses a flexible modularized approach that can be tailored to youth’s individual needs and includes adaptive social support seeking to increase the availability of supportive relationships for bereaved youth. TGCTA outcomes include reductions in posttraumatic stress, depression, and maladaptive grief reactions, as well as enhanced school behavior and connectedness (Grassetti et al, ; Layne et al, ; Layne, Pynoos, Cardenas, Shafii & Shafii, ). Similarly, multidimensional grief therapy (MGT) is an assessment‐driven psychosocial intervention for bereaved children and adolescents that is based on multidimensional grief theory (Kaplow, Layne, & Pynoos, in press).…”

Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth

“…Such efforts show promise for informing theory‐building, case formulation, and intervention planning. In particular, such advances can assist in prescribing intervention components that are most effective in therapeutically reducing different dimensions of maladaptive grief reactions (given evidence that PTSS and maladaptive grief reactions differentially respond to different modularized treatment components; Grassetti et al., ) as well as facilitating adaptive grief reactions (Kaplow et al., in press). Efforts to embed this work within an integrative theoretical, psychometric, empirical, and clinical framework, including a developmental lifespan theory of grief, are under way (Kaplow & Layne, ; Layne et al., in press).…”