(PS4-B33) A Qualitative Content Analysis of Blame Attributions in Maltreated Youth Throughout Trauma-focused CBT

Trauma-focused cognitive behavior therapy (TF-CBT; Cohen et al., 2017), which emphasizes both behavioral principles and cognitive processing of trauma, is among the most well-supported interventions for youth exposed to interpersonal trauma (Lewey et al., 2018). Mechanisms of change studies in TF-CBT have shown that improvement in maladaptive post-trauma cognitions mediates reductions in posttraumatic stress disorder (PTSD) symptoms (Jensen et al., 2018). Restructuring maladaptive cognitions is a critical element in the reduction of PTSD, depression, and other trauma-related symptoms, regardless of child age (Sharma-Patel et al., 2014). Most studies assess post-trauma cognitions with quantitative measures, on which statements developed by measure developers are rated on the degree to which the trauma survivor believes them. This approach limits our understanding of survivors’ individual cognitive processing (Sofaer, 1999). Feiring and Cleland (2007) found that youths’ reports of post-trauma appraisals differed on quantitative and qualitative measures; specifically, children were less likely to report self-blame on open-ended measures. Thus, the aim of the proposed presentation is to identify youths’ perceptions of the causes of their trauma and how those attributions may change before and after completing TF-CBT.

Multicultural youth (ages 4-17; N = 126) from New York City who have experienced physical abuse, sexual abuse, peer sexual assault, and/or witnessing domestic violence were assessed pre- and post-TF-CBT. Qualitative responses regarding attributions of blame for the trauma were measured using the PERceptions of Children Exposed to Interpersonal ViolencE (PERCEIVE; Brown, 2006). The PERCEIVE includes open-ended questions followed by 64 quantitative items. Youth responded to the following two questions regarding their most upsetting traumatic event: “Why do you think this happened?” and “Whose fault do you think it is?”.

Following procedures from Fonteyn and colleagues (2008), an iterative approach was used to develop a codebook to guide content analysis. Three doctoral students separately coded a subset of pre- and post-treatment responses and collaborated to develop the codebook including definitions and examples. Themes regarding why the traumatic event occurred include perpetrator defect (33%), perpetrator emotion (8%), perpetrator force (3%), culture (3%), victim behavior (8%), and victim vulnerability (3%). Notably, many respondents stated they did not know why the events occurred (48%). Themes regarding blame attributions included self (15%), perpetrator (48%), no one (8%), and non-offenders involved in the event (8%). Findings suggest that examining qualitative data will provide a richer understanding of post-trauma cognitions in maltreated youth. The codebook will be used to guide content analysis of the remaining responses for poster presentation, which may include additional themes. For the poster, pre versus post cognitions will be discussed in the context of assessment and treatment (i.e., methods for restructuring maladaptive cognitions).