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Abstract

Dysfunctional trauma-related cognitions are associated with posttraumatic stress disorder (PTSD). The psychometric properties of the German version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER) were assessed in a sample of 223 children and adolescents (7-16 years) with a history of different traumatic events. Confirmatory factor analyses supported the original two-factor structure-permanent and disturbing change (CPTCI-PC) and fragile person in a scary world (CPTCI-SW). The total scale and both subscales showed good internal consistency. Participants with PTSD had significantly more dysfunctional trauma-related cognitions than those without PTSD. Dysfunctional posttraumatic cognitions correlated significantly with posttraumatic stress symptoms (PTSS; r = .62), depression (r = .71), and anxiety (r = .67). The CPTCI-GER has good psychometric properties and may facilitate evaluation of treatments and further research on the function of trauma-related cognitions in children and adolescents. (Partial) correlations provide empirical support for the combined DSM-5 symptom cluster negative alterations in cognitions and mood.
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... Since its development, in 2009, the CPTCI has been translated and adapted for use into different languages (e.g., German, Dutch, Taiwanese, Brazilian Portuguese). The psychometric properties of the different versions of CPTCI have been investigated in heterogenous samples, including community samples (participants were instructed to answer considering the most frightening event they experienced; e.g., [22]), clinical samples [23,24], or both [25]. ...
... Regarding the factorial structure of the CPTCI, the original two-factor correlated model was tested in all versions using confirmatory procedures (confirmatory factor analysis; CFA). However, the original two-factor model failed to demonstrate good adjustment indices in the Brazilian [22], German [23], Dutch [25] and the Taiwanese [26] versions. In the Brazilian and Taiwanese versions, the authors proposed new models based on statistical criteria. ...
... In the German version, the authors compared the original two-factor correlated model with the unidimensional model and with a bifactorial model (including a general factor and two subordinated factors similar to the ones of the original version). Despite the better adjustment indices of the bifactorial model compared to the two-factor correlated and unidimensional models, nine of the items in the bifactorial model presented small and nonsignificant loadings on their respective subscales, contradicting the adequacy of a subordinated two-factor structure [23]. Similarly, in the psychometric studies of the Dutch version of CPTCI, the unidimensional and the two-factor correlated models were compared, with the two-factor correlated model presenting better adjustment indices than the unidimensional model, both in the clinical and community samples [25]. ...
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This study aimed to examine the psychometric properties of the Child Post-Traumatic Cognitions Inventory (CPTCI) in a sample of Portuguese children and adolescents, following the exposition to a wildfire disaster. The sample included 533 children and adolescents living in regions exposed to the wildfire disaster (non-clinical sample: n = 483; clinical sample: n = 50). The short form of the instrument (CPTCI-SF) including two correlated factors (‘Sense of Disturbing and Permanent Change’ and ‘Sense of Being a Fragile Person in a Scary World’) showed good model fit and was invariant across gender and age-groups. Good internal consistency (> .70) was found, and higher CPTCI scores were associated with poorer adjustment indicators. The clinical sample presented significantly higher CPTCI scores than the non-clinical sample. These results contribute to the cross-cultural validation of the CPTCI and support the adequacy of its short form as a reliable and valid measure to be used with Portuguese children and adolescents.
... In 6-to 18-year-old children, two types of dysfunctional posttraumatic cognitions have been recognized based on empirical data − the sense of being permanently damaged after the traumatic event and of being a fragile person in a dangerous world (de Haan et al., 2016;Meiser-Stedman et al., 2009. ...
... The CPTCI has not been used with children younger than 6 years; in previous studies, no specific results were provided for children younger than 8 years. The German version of the questionnaire showed good internal consistency (subscales: Cronbach's α = 0.91 and α = 0.86, respectively) and good construct validity as indicated by positive correlations with children's symptoms of PTSD, depression, and anxiety following maltreatment (de Haan et al., 2016). ...
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Purpose: Research has shown that children and adolescents suffering from posttraumatic stress often have negative posttraumatic cognitions such as negative appraisals of the trauma sequel that increase mental health problems. However, little is known about posttraumatic cognitions in young children. The aim of this study was to investigate negative posttraumatic cognitions in 4- to 8-year-old children following maltreatment. We also examined their association with child age and well-being as well as caregiver psychopathology. Methods: The study includes N = 112 caregiver-child dyads with children’s mean age of M = 6.2 (SD = 1.1) years. Children had experienced physical abuse, emotional abuse, neglect, sexual victimization, and/or domestic violence prior to participation. Posttraumatic cognitions were assessed using a short child interview including four items adapted from the Child Posttraumatic Cognitions Inventory (CPTCI; Meiser‐Stedman et al in Journal of Child Psychology and Psychiatry, 50(4), 432–440, 2009). Results: Completion of the interview about posttraumatic cognitions was independent from child’s age. Higher levels of negative posttraumatic cognitions were significantly associated with a higher cumulative maltreatment score (r = .35) and higher scores of posttraumatic stress symptoms (r = .39). There was no significant correlation with parent variables. Conclusion: These findings indicate that posttraumatic cognitions might be an important diagnostic and treatment target for 4- to 8-year-old children.
... Frühere Ergebnisse zeigten, dass Kinder und Jugendliche häufiger eine PTBS nach interpersonellen, also von Menschen verursachten Erfahrungen, im Vergleich zu akzidentiellen potentiell traumatischen Erfahrungen entwickelten (Alisic et al., 2014;Barthel, Ravens-Sieberer, Schulte-Markwort, Klasen & Zindler, 2019;Trickey et al., 2012). Auch dysfunktionalen, posttraumatischen Kognitionen kommt in der Entstehung und Aufrechterhaltung posttraumatischer Symptome eine wichtige Rolle zu (unter anderem Bryant, Salmon, Sinclair & Davidson, 2007;de Haan, Petermann, Meiser-Stedman & Goldbeck, 2016;. Die vorliegende Studie untersucht, inwieweit posttraumatische Kognitionen die Unterschiede in der Entwicklung einer PTBS nach akzidentiellen oder interpersonellen potentiell traumatischen Erfahrungen bei Kindern und Jugendlichen erklären können. ...
... Der Zusammenhang zwischen posttraumatischen Kognitionen und Symptomen einer PTBS im Kindes-und Jugendalter konnte in mehreren empirischen Studien gezeigt werden (unter anderem Bryant et al., 2007;de Haan et al., 2016;Mitchell, Brennan, Curran, Hanna & Dyer, 2017). So stellten Bryant et al. (2007) ...
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Zusammenfassung. Theoretischer Hintergrund: Dysfunktionale posttraumatische Kognitionen über das Selbst und die Welt als Folge traumatischer Erfahrungen können die Entwicklung einer posttraumatischen Belastungsstörung begünstigen. Fragestellung: Diese Studie untersucht das Wirkgeflecht zwischen der Art des traumatischen Ereignisses (interpersonell/akzidentiell), posttraumatischen Kognitionen und posttraumatischen Belastungssymptomen in Kindheit und Jugend. Methode: Erhoben wurden Daten von N = 48 Jugendlichen (9 – 17 Jahren) mittels Selbstbericht. Ergebnisse: Die Mediationsanalyse zeigte, dass posttraumatische Kognitionen als signifikanter Mediator für interpersonelle im Vergleich zu akzidentiellen Erfahrungen wirkten. Diskussion: Die Ergebnisse zeigen, dass mit interpersonellen Traumata konfrontierte Kinder und Jugendliche in besonderem Maße Erschütterungen des Selbst- und Weltbildes ausgesetzt sind. Die Erkenntnisse betonen die Bedeutung kognitiver Elemente in der Traumatherapie mit Kindern und Jugendlichen.
... A further validation study among UK and Australian children and adolescents confirmed the test-retest reliability and internal consistency of the measure ( . Good psychometric properties have also been observed for the Korean (Lee et al., 2018) and German translations of the CPTCI (de Haan, Petermann, Meiser-Stedman, & Goldbeck, 2016). However, no validation studies exist for most translations used here in Studies II and IV. ...
... T1 = baseline; T2 = midintervention; T3 = postintervention; T4 = 6-month follow-up; CPTCI = Children's Post-Traumatic Cognitions Inventory; CRIES = Children's Revised Impact of Event Scale. and young people 6-18 years of age (de Haan,Petermann, Meiser-Stedman, & Goldbeck, 2016;Diehle, de Roos, Meiser- Stedman, Boer, & Lindauer, 2015). Students used a 4-point scale to indicate their agreement with 25 statements since the scary event (1 = don't agree at all, 2 = don't agree a bit, 3 = agree a bit, 4 = agree a lot). ...
Thesis
Background: For many who experience them, repeated traumatic events lead to chronic posttraumatic stress symptoms (PTSS). Forms of trauma-focused cognitive-behavioral therapy are able to treat PTSS among adults as well as children and adolescents. However, not all those suffering from PTSS benefit from such treatment. Availability and utilization of treatment are also significant problems both globally and in Finland. For further developing, better targeting, and effective implementation of treatments, it would be important to understand the underlying mechanisms of change by which they are able to reduce PTSS. Theories of posttraumatic stress disorder suggest two psychological mechanisms of change in particular to be key to treating PTSS: improvements in overly negative posttraumatic cognitions and the integration, contextualization, or normalization of traumatic memories. This dissertation examined the role of changes in negative posttraumatic cognitions and traumatic memories in two interventions aimed at children and adolescents traumatized by war or violence and evaluated the overall level of evidence available for different mechanisms of change in the treatment of PTSS. Additionally, with a randomized controlled trial, we studied the feasibility, acceptability, and effectiveness of narrative exposure therapy in the treatment of multiply traumatized children and adolescents within the Finnish healthcare system. Method: The empirical research in this dissertation is based on two sets of data. The first data set, collected from Gaza, Palestine, concerned 482 school-aged children randomized to take part in either a four-week group intervention, Teaching Recovery Techniques, or a waitlist. Using self-report measures, we collected information on the children’s experiences of war trauma, mental health, and posttraumatic cognitions before the intervention, during it, after it, and as follow-up six months later. The second data set concerned 50 children and adolescents 9–17 years of age living in Finland, who entered treatment at different healthcare units due to significant PTSS because of exposure to war or violence in the family. Half were randomized to receive narrative exposure therapy, while the rest received treatment as usual. Using mainly self-report measures, we collected information on their mental health, posttraumatic cognitions, and traumatic memories before and after treatment. In addition, the dissertation contains a systematic review collecting all available empirical evidence from randomized, controlled trials on the role of different mechanisms of change in psychological treatment of PTSS. Results: The Teaching Recovery Techniques group intervention was not able to change the posttraumatic cognitions of Gazan children significantly. Such changes did not act as its mechanism of change. This may also explain its limited effects on PTSS. High levels of PTSS and depressive symptoms predicted particularly severe, stable posttraumatic cognitions. Clinicians were able to implement narrative exposure therapy successfully in the treatment of multiply traumatized children and adolescents at different units within the Finnish healthcare system. Narrative exposure therapy was at least as effective in treating PTSS as treatment as usual. Some results suggested it was slightly more effective. Positive changes in posttraumatic cognitions and traumatic memories were both associated with amelioration of PTSS. However, we found no evidence of such changes acting as mechanisms of change specific to narrative exposure therapy. We found no evidence of overall significant changes in posttraumatic cognitions during treatment. Overall changes in traumatic memories were relatively small. The systematic review found evidence for the importance of changes in negative posttraumatic cognitions in several forms of treatment. Negative cognitions related to the self may be especially relevant. As of yet, there is next to no empirical evidence on changes in traumatic memories as a mechanism of change. Some preliminary findings suggest mindfulness-based interventions can reduce PTSS by increasing levels of dispositional mindfulness. The evidence for other specific mechanisms of change is still very limited and mixed. Conclusions: Exposure-based treatment is suitable for treatment of multiply traumatized children and adolescents within the Finnish healthcare system and does reduce PTSS. Changing the negative posttraumatic cognitions of children and adolescents traumatized by war and violence may be especially challenging. Still, it is a probable pathway to treating PTSS among them, as well. The effectiveness of group psychosocial interventions in reducing PTSS may be limited by their inability to affect posttraumatic cognitions. Changes in traumatic memories may be linked to recovery from PTSS, but evidence for such a link is still very limited.
... The Child Posttraumatic Cognitions Inventory (CPTCI; Meiser-Stedman et al., 2009; German version de Haan, Petermann, Meiser-Stedman, & Goldbeck, 2016; accidental sample Cronbach's α = .83; interpersonal sample Cronbach's α = .92) ...
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Background: Trauma adjustment varies in children and adolescents. Studies on objective risk factors of posttraumatic stress symptoms (PTSS) yielded inconsistent results. Dysfunctional posttraumatic cognitions (PTCs) might play a mediating role between risk factors and posttraumatic symptomatology. Objective: To investigate the interplay of the characteristics of the trauma (e.g. trauma type), the characteristics of the individual (e.g. age, sex), and the characteristics of the social environment (e.g. parental distress, marital status) on PTSS and depression, taking the child’s dysfunctional PTCs into account as a possible mediator. Method: Structural equation modelling was used to better understand trauma adjustment in two heterogeneous samples of children and adolescents: a sample of 114 participants aged 7–16 after accidental trauma and a sample of 113 participants aged 6–17 after interpersonal trauma. Results: In the accidental trauma sample, dysfunctional PTCs mediated the positive associations of younger age and lower parental educational level on child PTSS, but not on depression. In the interpersonal trauma sample, being female positively predicted child depression. Furthermore, parental dysfunctional PTCs positively predicted both child PTSS and depression. No mediation effect of child dysfunctional PTCs was found in the interpersonal trauma sample. Child dysfunctional PTCs moderately to strongly predicted child PTSS and depression in both trauma samples. Conclusions: The impact of the characteristics of the individual and the characteristics of the social environment on child PTSS and depression might depend on the type of trauma experienced. Dysfunctional PTCs mediated between the characteristics of the individual and the characteristics of the social environment and the severity of PTSS in the aftermath of accidental trauma, but not of interpersonal trauma.
... For details, see Ponnamperuma and Nicolson (2016). The eight statements are conceptually similar to "permanent and distressing change" (PC) and "fragile person in scary world" (SW) items on the Child Post-Traumatic Cognitions Inventory (CPTCI) (Meiser-Stedman et al., 2009), published after our data collection and validated in non-Western as well as Western samples (e.g., de Haan et al., 2016;Liu and Chen, 2015;Palosaari et al., 2016). ...
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Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to aspects of diurnal cortisol secretion in adolescents, but little is known about gender differences in these associations. A school-based sample of Sri Lankan adolescents aged13–16years took part in this study 4.5 years after the 2004 tsunami had impacted many of their lives to varying degrees. Saliva samples were obtained 4 times a day for 3 days in 84 participants, who also completed measures of lifetime trauma, current stressors, and posttraumatic stress symptoms (PTSS). We used multilevel regression to estimate effects of trauma exposure and symptoms on cortisol level, diurnal slope, and awakening response (CAR). Results indicated higher cortisol in girls and older adolescents. Although trauma, PTSS, and recent PTSD had non-significant main effects, these three variables interacted with gender, with higher cortisol in girls than in similarly traumatized or symptomatic boys. Co-occurrence of internalizing symptoms and PTSS was also associated with higher cortisol. The 28 adolescents with recent PTSD displayed flatter diurnal slopes, reflecting relatively low morning cortisol. Among the 56 trauma-exposed participants, negative trauma appraisals were associated with higher cortisol. Girls were more likely than boys to display elevated cortisol in relation to re-experiencing and hyperarousal symptoms. In contrast to significant findings for cortisol level and diurnal slope, the CAR showed no association with either trauma or PTSS, irrespective of gender. Findings, viewed in light of normative gender differences in HPA activity during adolescence, can contribute to understanding heightened female vulnerability to posttraumatic stress disorder.
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