Abstract
Parents experience differentiated emotions after learning of their child’s abuse; however, little is known about the effect of trauma therapy on these differentiated reactions and the factors associated with these reactions. This study examined the impact of child trauma therapy on parents’ distress, guilt, and shame over the course of treatment and following treatment, the correlates of these emotional reactions before treatment, and the correlates of changes in these reactions. The sample at pre-therapy included 92 trauma-exposed children (68.90% female, Mage = 9.58 years, 38.10% Caucasian) and their parents receiving Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). Parents rated their distress, guilt, and shame, their functioning (stress-levels, parent support), and their child’s functioning (emotion regulation and internalizing/externalizing symptoms) at pre-therapy, post-therapy, and 6-month follow-up. Significant modest-to-large improvements in parent distress, guilt, and shame were found immediately following TF-CBT and from pre-therapy to 6-month follow up. Parent and child functioning, as well as characteristics of the child’s abuse, accounted for a significant proportion of the variance in parents’ distress, guilt, and shame prior to treatment, with child internalizing symptoms being a consistent correlate. Changes in parent support and child internalizing symptoms were associated with changes in parent distress and shame over the course of TF-CBT, and changes in child externalizing symptoms were associated with changes in parents’ shame from pre-therapy to follow-up. Improvements in parents’ discrete emotional reactions were observed throughout TF-CBT and months after therapy has ended. The implications of results, as related to the key factors associated with these reactions, are discussed.
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Notes
Polyvictimization was computed with a total of 24 types of trauma, with 14 being the greatest number of traumas reported in the current study: sexual abuse, physical abuse, witnessing DV, verbal abuse at home, physical abuse at home, neglect, death/illness of a loved one, injury of a caregiver as a result of DV, sexual assault, sexual interference, invitation to sexual touching, sexual exploitation, sexual assault with a weapon, assault, witness/victim of a serious accident, witness/victim of community violence, fire/natural disaster, medical trauma, exposure to war/ethnic conflict, witness/victim of terrorist attack, divorce/separation, bullying/assault by a peer, and unspecified trauma.
References
Abidin, R. R. (2012). Parenting stress index, fourth edition (PSI-4). Psychological Assessment Resources.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families.
Adams, J., Mrug, S., & Knight, D. C. (2018). Characteristics of child physical and sexual abuse as predictors of psychopathology. Child Abuse & Neglect, 86, 167–177. https://doi.org/10.1016/j.chiabu.2018.09.019
Bambrah, V., Mastorakos, T., Cordeiro, K. M., Thornback, K., & Muller, R. T. (2018). Child-parent discordance and child trauma symptomatology throughout therapy: Correlates and treatment response. Journal of Family Violence, 33(4), 281–295. https://doi.org/10.1007/s10896-017-9948-x
Bolen, R. M., & Gergely, K. B. (2015). A meta-analytic review of the relationship between non-offending caregiver support and post-disclosure functioning in sexually abuse children. Trauma, Violence, and Abuse, 16(3), 258–279. https://doi.org/10.1177/1524838014526307
Burgess, A. W., Hartman, C. R., Kelley, S. J., Grant, C. A., & Gray, E. B. (1990). Parental response to child sexual abuse trials involving day care settings. Journal of Traumatic Stress, 3(3), 395–405. https://doi.org/10.1002/jts.2490030308
Cicchetti, D. (2016). Socioemotional, personality, and biological development: Illustrations from a multilevel developmental psychopathology perspective on child maltreatment. Annual Review of Psychology, 67, 187–211. https://doi.org/10.1146/annurev-psych-122414-033259
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multi-site randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402. https://doi.org/10.1097/00004583-200404000-00005
Cohen, J. A., & Mannarino, A. P. (1996). Factors that mediate treatment outcome of sexually abused preschool children: Initial findings. Journal of the American Academy of Child & Adolescent Psychiatry, 35(10), 1402–1410. https://doi.org/10.1097/00004583-199610000-00028
Cohen, J. A., & Mannarino, A. P. (1998). Interventions for sexually abused children: Initial treatment findings. Child Maltreatment, 3(1), 17–26. https://doi.org/10.1177/1077559598003001002
Cohen, J. A., & Mannarino, A. P. (1998b). Factors that mediate treatment outcome of sexually abused preschool children: Six- and 12-Month Follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 37(1), 44–51. https://doi.org/10.1097/00004583-199801000-00016
Cohen, J. A., & Mannarino, A. P. (2000). Predictors of treatment outcome in sexually abused children. Child Abuse and Neglect, 24(7), 983–994. https://doi.org/10.1016/S0145-2134(00)00153-8
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). The Guilford Press.
Cole, P. M., Dennis, T. A., Smith-Simon, K. E., & Cohen, L. H. (2009). Preschoolers’ emotion regulation strategy understanding: Relations with emotion socialization and child self-regulation. Social Development, 18(2), 324–352. https://doi.org/10.1111/j.1467-9507.2008.00503.x
Cyr, M., McDuff, P., & Hébert, M. (2013). Support and profiles of nonoffending mothers of sexually abused children. Journal of Child Sexual Abuse, 22, 209–230. https://doi.org/10.1080/10538712.2013.737444
Eisenberg, N., Cumberland, A., & Spinrad, T. L. (1998). Parental socialization of emotion. Psychological Inquiry, 9(4), 241–273. https://doi.org/10.1207/s15327965pli0904_1
Elliott, A. N., & Carnes, C. N. (2001). Reactions of nonoffending parents to the sexual abuse of their child: A review of the literature. Child Maltreatment, 6(4), 314–331. https://doi.org/10.1177/1077559501006004005
Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In B. O. Rothbaum (Ed.), Pathological anxiety: Emotional processing in etiology and treatment (pp. 3–24). Guilford Press.
Frankel, L. A., Hughes, S. O., O’Connor, T. M., Power, T. G., Fisher, J. O., & Hazen, N. L. (2012). Parental influences on children’s self-regulation of energy intake: Insights from developmental literature on emotion regulation. Journal of Obesity. https://doi.org/10.1155/2012/327259
Hakulinen, C., Jokela, M., Hintsanen, M., Pulkki-Råback, L., Hintsa, T., Merjonen, P., et al. (2013). Childhood family factors predict developmental trajectories of hostility and anger: A prospective study from childhood into middle adulthood. Psychological Medicine, 43(11), 2417–2426. https://doi.org/10.1017/s0033291713000056
Hawley, K. M., & Weisz, J. R. (2003). Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: The therapist’s dilemma and its implications. Journal of Consulting and Clinical Psychology, 71(1), 62–70. https://doi.org/10.1037/0022-006X.71.1.62
Holt, T., Cohen, J. A., & Mannarino, A. (2015). Factor structure of the Parent Emotional Reaction Questionnaire: Analysis and validation. European Journal of Psychotraumatology. https://doi.org/10.3402/ejpt.v6.28733
Holt, T., Cohen, J., Mannarino, A., & Jensen, T. K. (2014). Parental emotional response to children’s traumas. Journal of Aggression, Maltreatment & Trauma, 23(10), 1057–1071. https://doi.org/10.1080/10926771.2014.953717
Holt, T., Jensen, T. K., & Wentzel-Larsen, T. (2014). The change and the mediating role of parental emotional reactions and depression in the treatment of traumatized youth: Results from a randomized controlled study. Child and Adolescent Psychiatry and Mental Health, 8(1), 11. https://doi.org/10.1186/1753-2000-8-11
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Jones, S., Eisenberg, N., Fabes, R. A., & Mackinnon, D. P. (2002). Parents’ reactions to elementary school children’s negative emotions: Relations to social and emotional functioning at school. Merrill-Palmer Quarterly, 48(2), 133–159. https://doi.org/10.1353/mpq.2002.0007
Konanur, S., Muller, R. T., Cinamon, J. S., Thornback, K., & Zorzella, K. P. (2015). Effectiveness of trauma-focused cognitive behavioural therapy in a community-based program. Child Abuse & Neglect, 50, 159–170. https://doi.org/10.1016/j.chiabu.2015.07.013
Lowe, R., & Ziemke, T. (2011). The feeling of action tendencies: On the emotional regulation of goal-directed Behavior. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2011.00346
Mannarino, A., & Cohen, J. A. (1996). Family-related variables and psychological symptom formation in sexually abuse girls. Journal of Child Sexual Abuse, 5(1), 105–120. https://doi.org/10.1300/J070v05n01_06
Pine, D. S., & Cohen, J. A. (2002). Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biological Psychiatry, 51(7), 519–531. https://doi.org/10.1016/s0006-3223(01)01352-x
Plummer, C. A., & Eastin, J. A. (2007). System intervention problems in child sexual abuse investigations: The mothers’ perspectives. Journal of Interpersonal Violence, 22(6), 775–787. https://doi.org/10.1177/0886260507300753
Scheeringa, M. S., & Zeanah, C. H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 14(4), 799–815.
Schuetze, P., & Eiden, R. D. (2005). The relationship between sexual abuse during childhood and parenting outcomes: Modeling direct and indirect pathways. Child Abuse & Neglect, 29(6), 645–659. https://doi.org/10.1016/j.chiabu.2004.11.004
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33(6), 906–916. https://doi.org/10.1037//0012-1649.33.6.906
Ullman, S. E. (2007). Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. Journal of Child Sexual Abuse, 16(1), 19–36. https://doi.org/10.1300/J070v16n01_02
Wamser-Nanney, R., & Steinzor, C. E. (2017). Factors related to attrition from trauma-focused cognitive behavioural therapy. Child Abuse & Neglect, 66, 73–83. https://doi.org/10.1016/j.chiabu.2016.11.031
Williamson, V., Creswell, C., Butler, I., Christie, H., & Halligan, S. L. (2016). Parental responses to child experiences of trauma following presentation at emergency departments: A qualitative study. BMJ Open, 6(11), e012944.
Yancey, C. T., & Hansen, D. J. (2010). Relationship of personal, familial, and abuse-specific factors with outcome following childhood sexual abuse. Aggression and Violent Behavior, 15(6), 410–421. https://doi.org/10.1016/j.avb.2010.07.003
Yasinski, C., Hayes, A. M., Ready, C. B., Cummings, J. A., Berman, I. S., Mccauley, T., et al. (2016). In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT). Journal of Consulting and Clinical Psychology, 84(12), 1066–1077. https://doi.org/10.1037/ccp0000147
Acknowledgements
This research was funded by grants to Robert T. Muller, Ph.D., from the Provincial Center of Excellence for Child and Youth Mental Health at the Children’s Hospital of Eastern Ontario, and the Hedge Funds Care Canada Foundation.
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Mastorakos, T., Bambrah, V. & Muller, R.T. What About the Parents? Changes in and Correlates of Parents’ Discrete Emotional Reactions to their Child’s Trauma in Trauma Therapy. J Fam Viol 36, 1095–1106 (2021). https://doi.org/10.1007/s10896-021-00306-0
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DOI: https://doi.org/10.1007/s10896-021-00306-0