About this item:

41 Views | 21 Downloads

Author Notes:

Elizabeth Alpert, Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA. Email: ealpert@udel.edu

Adele M. Hayes, Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA., Email: ahayes@udel.edu

EA developed the rationale and method for applying emotional processing theory to this investigation of change processes in TF-CBT and conducted the data analyses and interpretation under the supervision of AMH. EA and AMH drafted the manuscript. AMH designed and conducted the clinical trial on which this study was based and developed the CHANGE coding system used in the current study. CY trained coders and supervised coder meetings. CW and ED trained and supervised study therapists throughout the clinical trial. All authors provided critical revisions and approved the final version for submission.

We would like to thank our coding team for their help, Jean-Philippe Laurenceau and Emily Soriano for feedback on statistical analyses, and Edna Foa for her helpful comments on a previous draft of this manuscript.


Research Funding:

This research was supported by grants from the National Institute of Mental Health (NIMH: R01-MH086558) awarded to Adele M. Hayes and from the Substance Abuse and Mental Health Services Administration (SAMHSA: SM57145) awarded to the Delaware Division of Prevention and Behavioral Health Services.


  • Social Sciences
  • Science & Technology
  • Life Sciences & Biomedicine
  • Psychology, Clinical
  • Psychiatry
  • Psychology
  • childhood trauma
  • posttraumatic stress disorder
  • emotional processing
  • trauma-focused cognitive behavioral therapy
  • psychotherapy process

Processes of Change in Trauma-Focused Cognitive Behavioral Therapy for Youths: An Approach Informed by Emotional Processing Theory


Journal Title:



Volume 9, Number 2


, Pages 270-283

Type of Work:

Article | Post-print: After Peer Review


This study examines processes of change in trauma-focused cognitive behavioral therapy (TF-CBT) delivered to a community sample of 81 youth. Emotional processing theory (EPT) is used as an organizational framework. EPT highlights activating and changing pathological trauma-related responses and increasing adaptive responses across cognitive, emotional, behavioral, and physiological domains. We coded sessions during the trauma processing phase of TF-CBT to examine the extent to which pathological and adaptive trauma-related responses were activated across domains. Higher scores indicate that more domains (0-4) were activated at a threshold of moderate to high intensity. Curvilinear change (inverted U, increase then decrease) in multimodal negative response scores across sessions predicted improvement in internalizing and PTSD symptoms at posttreatment. Linear increases in multimodal positive responses predicted improvement in externalizing symptoms. Findings suggest value in activating and changing both pathological and adaptive trauma responses across multiple domains and examining nonlinear patterns of change.
Export to EndNote