ZoomIn: Individual dynamics in trauma treatment

Experiencing traumatic events can have significant consequences, both for the individual affected, their close ones, and for society. Youth who have experienced trauma face more mental and physical challenges and have poorer connections to education and the future job market compared to their peers. More than one in four Norwegian youths have experienced one or more traumatic events. 

Common reactions to trauma include re-experiencing, avoidance of reminders of the event, negative thoughts, or feelings, and/or hyperarousal. For many, these symptoms resolve on their own, but for some, the symptoms endure, leading to post-traumatic stress disorder (PTSD). It is therefore important to offer effective treatment for PTSD.

Treatment effectiveness varies

There are several evidence-based treatments for PTSD, but even for the recommended first-line treatment for children and adolescents, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), treatment effectiveness varies considerably. Preliminary figures from 2018-20 suggest that 30-40 % of children receiving TF-CBT do not experience clinically significant improvement and/or drop out. This means that TF-CBT is not equally effective for everyone. 

A better understanding of individual trajectories of change or lack of change would be a useful step towards more personalized treatment. To pinpoint what should be done for youth who do not experience improvement, it would be useful to look at trajectories of change in individual symptoms from before to after treatment and identify common residual symptoms. There is also need for a better understanding of how recovery from PTSD occurs from day to day and how positive improvement in one symptom can be followed by improvement in other symptoms, creating a positive chain reaction.

In collaboration with user panels (youth who have had PTSD as well as therapists), The Norwegian Council for Mental Health (NCMH), and national and international researchers, NKVTS will conduct the first study examining changes in daily symptoms during evidence-based treatment for PTSD, among youth. It is also the first study to investigate individual recovery processes after PTSD. ZoomIn has the potential to contribute to a better understanding of individual change processes, which is necessary to make trauma treatment more personalized and effective for more people.

By combining studies of group-level associations with in-depth studies of individual youths’ symptom levels from day to day, we will have the opportunity to better understand similarities and differences in recovery. This will provide us with more information and new ideas on how TF-CBT can be made more personalized and thereby help even more youth.

Sample data

The project will utilize data from two clinical samples of children and youth aged 8 to 18 years. Both samples have undergone TF-CBT in child and adolescent psychiatric outpatient clinics (BUP). 

• Sample 1 consists of 567 children who have answered questions about their PTSD symptoms three times – before, during, and after treatment. 
• Sample 2 consists of 60 youths who have answered daily questions about PTSD symptoms throughout the treatment. Their therapists have also recorded therapy sessions and their content.