Posttraumatic stress disorder symptom change in youth after trauma‐focused cognitive behavioral therapy: Insights from cross‐sectional and cross‐lagged panel network analysis

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment widely used for youth experiencing symptoms related to posttraumatic stress disorder (PTSD). This study used both cross-sectional and cross-lagged panel network (CLPN) analyses to examine changes in PTSD symptom networks following TF-CBT and explore their clinical relevance. Using data from a statewide implementation of TF-CBT, we constructed PTSD symptom networks for 652 youth (M_age = 12.47 years, 57.5% girls, 21.9% youth of color) who completed TF-CBT and provided both pre- and posttreatment data. At pretreatment, central symptoms included detachment, psychological and physiological reactions, and negative cognitions. Although the overall connectivity between symptoms significantly increased after treatment, p = .003, the symptom structure remained stable. CLPN analyses identified symptoms with high predictive influence (out-expected influence [out-EI]: physiological reactions, negative emotional state, and diminished interests) and susceptibility to influence (in-EI: internal and external avoidance, nightmare, detachment). Pretreatment centrality, B = 0.07, p < .001, and in-EI, B = 0.72, p = .003, but not out-EI, B = -0.04, p = .633, were associated with larger overall pre-post symptom reductions, controlling for baseline symptom severity. Improvements in symptoms with high pretreatment centrality, B = 1.17, p = .011), and in-EI centrality, B = 0.34, p = .568, but not out-EI centrality, B = 0.34, p = .568, were related to posttreatment psychosocial functioning over and above peripheral symptoms. These results offer preliminary evidence on how symptoms change during treatment, providing insight for understanding change mechanisms of TF-CBT and further refining youth trauma treatment.