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Objective: Research examining the factor structure of the Adolescent Dissociative Experiences Scale (A-DES) has yielded mixed findings. This study sought to further clarify the factor structure of the A-DES among youth with histories of exposure to multiple traumas and adversities., Method: We conducted a factor analysis of the A-DES using data from 1,157 treatment-seeking adolescents with histories of trauma exposure in order to expand understanding of dissociation's construct validity and provide the first attempt at post hoc analysis of trauma-impacted adolescents., Results: A bifactor CFA model fit the data best and identified a strong general factor, supporting a unidimensional latent structure. Only the general dissociation factor was associated with cumulative trauma exposure, operationalized as the number of different types of exposure endorsed on the Trauma History Profile (THP), but this association was small., Conclusions: The study findings point toward a unidimensional conceptualization of dissociation. A developmental psychopathology framework is recommended for future research, allowing a nuanced and integrated approach to understanding dissociation and increasing generalizability across adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: A confirmatory factor analysis (CFA) of the Adolescent Dissociative Experiences Scale (A-DES) that found a best-fitting three-factor model for a trauma-exposed sample was recently replicated; however, a post hoc bifactor CFA model fit the data better and identified a strong general factor. Only the general factor was associated with cumulative trauma exposure, but this association was small., Method: Structural equation modeling (SEM) and regression analyses were applied to the best-fitting three-factor bifactor model of dissociation found in the same sample of 1,157 treatment-seeking adolescents, most with high levels of trauma exposure, to further elucidate dissociation's construct validity and dimensionality., Results: The general factor was positively yet differentially associated with psychosocial outcomes. A dissociation by age interaction emerged for internalizing problems, demonstrating that the positive association was stronger for older participants. Also, an age of trauma exposure onset by dissociation interaction emerged predicting depression, such that later trauma onset produced a stronger association between dissociation and depression., Conclusions: Traumas occurring in later adolescence may confer greater risk of dissociation. Differential psychosocial outcomes also reinforce why approaching dissociation from a developmental psychopathology lens is important, enhancing the model's generalizability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Concern about symptom worsening with trauma-focused treatment may be one factor hindering the implementation of evidence-based treatments for PTSD, like cognitive processing therapy (CPT), despite evidence for their efficacy. Previous studies have examined the frequency and effect of symptom exacerbation, or temporary symptom increases, on outcomes, but primarily in randomized clinical trials., Method: We examined this issue in a community sample of participants receiving CPT from front-line clinicians learning to deliver CPT in a randomized controlled implementation trial of training strategies. Patient participants ( n = 183) completed self-report measures of PTSD symptoms at each session., Results: Most participants (67.3%) experienced at least one temporary symptom increase during CPT (only 1.6% continued to have higher symptoms by the end of treatment). Demographic variables, comorbid conditions (i.e., depression, anxiety, substance use), and baseline PTSD symptom levels did not predict symptom increases. Importantly, symptom increases did not predict treatment noncompletion, posttreatment PTSD symptom levels, or loss of probable PTSD diagnosis. Moreover, growth curve modeling revealed that temporary symptom increases did not predict the trajectory of PTSD symptoms over the course of treatment., Conclusions: The rates of symptom increases, which were higher than in previous studies, may be attributed to a routine care sample or to the differences in session timing and measurement. These results add to a nascent literature documenting that symptom increases may be a normal, transient part of treatment that do not impact a patient's ability to have symptom improvement during a course of CPT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives: This study examined (a) relationships between trauma-related cognitions and posttraumatic stress disorder (PTSD) symptoms from pretreatment through a long-term period after cognitive-behavioral therapy (CBT) for PTSD and (b) whether these relationships were impacted by treatment type., Method: Participants were 171 women randomized into treatment for PTSD after rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pretreatment, posttreatment, and 3-month, 9-month, and 5-10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure)., Results: Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With 1 minor exception, relationships between beliefs and symptoms were not moderated by treatment type., Conclusions: These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains after CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)