Post-traumatic stress disorder and its comorbidities in children and adolescents: cognitive phenotypes, treatment, and mechanisms of improvement

Lofthouse, Katie (2025) Post-traumatic stress disorder and its comorbidities in children and adolescents: cognitive phenotypes, treatment, and mechanisms of improvement. Doctoral thesis, University of East Anglia.

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Abstract

Post-traumatic stress disorder (PTSD) is a mental health condition which develops as a reaction to trauma and involves intrusion symptoms such as flashbacks or nightmares, avoidance of trauma-related thoughts or stimuli in the environment, and alterations in arousal or reactivity such as aggression, hypervigilance, or difficulty sleeping. Complex PTSD is a new diagnosis which requires the same core PTSD symptoms alongside emotional dysregulation, relationship difficulties, and negative self-concept.

Cognitive models of PTSD have been developed to understand the condition and aid in intervention development. Gold-standard treatments for PTSD in youth address cognitive-behavioural factors described in the cognitive models. These include trauma-focused cognitive-behavioural therapy (e.g. cognitive therapy for PTSD) and eye movement desensitisation and reprocessing.

This thesis explores the phenotype of youth with PTSD following exposure to multiple traumas using between-groups analyses to identify cognitive-behavioural and psychosocial factors associated with Complex PTSD and hearing voices. Response rates amongst youth for gold-standard PTSD treatments are synthesised in a systematic review and meta-analysis using a novel method to impute response to delineate percentages of participants exhibiting different response levels.

Finally, mediation analysis is conducted to determine whether change in cognitive-behavioural factors over the course of treatment mediates the effect of cognitive therapy for PTSD on PTSD symptom reduction. Responders (defined by 50% reduction in PTSD symptoms) and non-responders are compared to identify psychosocial and cognitive-behavioural mechanisms associated with positive treatment outcomes.

The findings demonstrate that this population has complex needs including comorbidity of mental health difficulties and elevated scores on numerous cognitive-behavioural and psychosocial factors. Change in cognitive-behavioural factors over the course of treatment were predictive of PTSD symptoms at follow-up and responder status, although formal mediation analysis did not identify any factors which met mediation criteria. These findings support the use of gold-standard treatments whilst also highlighting that improvements are possible.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	02 Feb 2026 14:31
Last Modified:	02 Feb 2026 14:31
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101811
DOI:

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