Exploratory Analyses of Cognitive Schemas for Child and Adolescent Sexual Abuse Survivors: Implications for the Research to Practice Gap

By Gonzalez, Jennifer E.; Wheeler, Naomi J. et al. | Journal of Mental Health Counseling, January 2017 | Go to article overview

Exploratory Analyses of Cognitive Schemas for Child and Adolescent Sexual Abuse Survivors: Implications for the Research to Practice Gap


Gonzalez, Jennifer E., Wheeler, Naomi J., Daire, Andrew P., Journal of Mental Health Counseling


Childhood abuse is pervasive and can contribute to long-term adverse consequences for the victim. Child advocacy centers (CAC) provide a community-based and coordinated response to intervention, including mental health counseling. Although evidence-based treatments include techniques to address problematic thinking, these are reported as less preferred and underused by CAC counselors. The present study employs multivariate analysis to examine the influence of cognitive schemas on treatment outcomes for 58 children who received services from a CAC. We found significant improvements in pre to post scores on the Trauma Symptom Checklist for Children (TSCC) subscales for depression and anxiety. Additionally, treatment outcomes of participants with clinically significant pre-Trauma and Attachment Belief Scale (TABS) total scores significantly differed from participants with non-significant pre-TABS scores. Clinical and research implications are presented related to counseling services for survivors of child abuse.

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Each year, almost four million children are classified as substantiated victims of child abuse in the United States (U.S. Department of Health and Human Sendees, 2013). Child survivors of abuse often experience short- and long-term adverse physical, psychological, and behavioral outcomes (DePanfilis, 2006; Felitti & Anda, 2010). Efficacious prevention and intervention efforts are critical to address this pervasive issue. Empirically supported clinical interventions reduce posttraumatic symptomology, including negative alterations in cognitions, and improve coping for child survivors (Cohen, Mannarinno, & Knudson, 2005; Diehle, Schmitt, Daams, Boer, & Lindauer, 2014; Jones & Morris, 2007; Nolan et al., 2002), yet a paucity of research exists examining the relationship of cognitive schemas to treatment outcomes for child survivors of abuse using a community-based sample. This study aims to strengthen the connection between research and community practice by using archival data from a community-based CAC providing trauma-focused mental health counseling to investigate the influence of cognitive schemas pre-treatment to changes in posttraumatic symptoms in child abuse survivors.

Long-term negative outcomes from child abuse include an increased risk of: (a) academic challenges and learning disabilities (Heim, Shugart, Craighead, & Nemeroff, 2010; Phasa, 2008); (b) mental health disorders such as dissociative identity disorder, depression, post-traumatic stress disorder (PTSD), and disordered eating (Barlow, 2002; Heim, et al., 2010); (c) victimization and perpetration of intimate partner violence (Whitfield, Anda, Dube, & Felitti, 2003); and (d) risky health behaviors, disease and early death (Felitti & Anda, 2010). In addition to the long-term effects across the survivor's life, negative consequences of abuse persist inter-generationally with over one-third of child abuse survivors abusing their offspring as adults (DePanfilis, 2006). In addition, cognitive schemas and beliefs about the self, others and the world may be disrupted following an experience of child abuse, as indicated in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013).

Cognitive schemas are patterns of thought and concepts created to make sense of the world (Sims & Lorenzi, 1992). Schemas represent an array of ideas and ways of understanding and can be positive or negative. Examples of negative self-schemas include abandonment, mistrust, and social isolation (Young, 1999). Child survivors of sexual abuse report alterations in thinking patterns associated with increased fear and the desire for safety (Foster & Hagedorn, 2014). Similarly, adult male survivors of child sexual abuse and their partners identified the relationship of inaccurate cognitions to resilience strategies and the healing process (i.e. …

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