Changing maladaptive trauma-related cognitions and emotional activation during trauma-focused cognitive behavior therapy: Thematic content and relationships with posttraumatic stress symptoms

Behav Res Ther. 2025 Nov 5;195:104910. doi: 10.1016/j.brat.2025.104910. Online ahead of print.

ABSTRACT

BACKGROUND: Changing maladaptive trauma-related cognitions may be crucial in trauma-focused cognitive behaviour therapy (TF-CBT). We identified common maladaptive cognitions during TF-CBT’s trauma narration and processing phase and examined their relationship with trauma type and post-traumatic stress symptoms (PTSS). We also assessed whether maladaptive trauma-related cognitions (overgeneralization, assimilation), more balanced and functional cognitions (accommodation), and negative emotions during this phase of TF-CBT were associated with PTSS.

METHODS: Adolescents exposed to multiple types of traumas (N = 87, mean age = 15.8 years, 78.3 % girls) received TF-CBT. The Change and Growth Experiences (CHANGE) coding system measured maladaptive trauma-related cognitions, accommodated beliefs, and negative emotions during the trauma narration and processing phase. We then categorized the maladaptive cognitions from the CHANGE coding according to predefined topics. Mixed-effects analyses were used to assess relationships between maladaptive cognitions, accommodation, in-session negative emotion, and PTSS.

RESULTS: Maladaptive trauma-related cognitions primarily concerned trust, esteem, and guilt. Sexual violence was associated with trust, esteem, intimacy, and guilt cognitions. Trust and esteem-related cognitions significantly predicted higher levels of PTSS at posttreatment. Higher levels of maladaptive cognitions and negative in-session emotion also predicted higher posttreatment PTSS. Low in-session negative emotion appeared to amplify the negative impact of maladaptive cognitions on PTSS at posttreatment. Accommodation showed no association with PTSS.

CONCLUSIONS: Maladaptive trauma-related cognitions, particularly related to trust and esteem, were common and associated with higher levels of PTSS at posttreatment. Low emotional engagement during trauma processing may potentiate the negative effects of maladaptive cognitions on PTSS. Results suggest both emotional processing and cognitive change are important treatment pathways for youth with PTSS.

PMID:41270522 | DOI:10.1016/j.brat.2025.104910