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Prolonged Exposure Versus Dynamic Therapy for Adolescent PTSD: A Pilot Randomized Controlled Trial

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Objective

To examine the efficacy and maintenance of developmentally adapted prolonged exposure therapy for adolescents (PE-A) compared with active control time-limited dynamic therapy (TLDP-A) for decreasing posttraumatic and depressive symptoms in adolescent victims of single-event traumas.

Method

Thirty-eight adolescents (12 to 18 years old) were randomly assigned to receive PE-A or TLDP-A.

Results

Both treatments resulted in decreased posttraumatic stress disorder and depression and increased functioning. PE-A exhibited a greater decrease of posttraumatic stress disorder and depression symptom severity and a greater increase in global functioning than did TDLP-A. After treatment, 68.4% of adolescents beginning treatment with PE-A and 36.8% of those beginning treatment with TLDP-A no longer met diagnostic criteria for posttraumatic stress disorder. Treatment gains were maintained at 6- and 17-month follow-ups.

Conclusions

Brief individual therapy is effective in decreasing posttraumatic distress and behavioral trauma-focused components enhance efficacy.

Clinical trial registry information

Prolonged Exposure Therapy Versus Active Psychotherapy in Treating Post-Traumatic Stress Disorder in Adolescents, URL: http://clinicaltrials.gov, unique identifier: NCT00183690.

Section snippets

Participants

The characteristics of the sample are presented in Table 1. Inclusion criteria were age 12 to 18 years, a primary diagnosis of PTSD related to a single traumatic event, and fluency in Hebrew. Exclusion criteria were organic brain damage, mental retardation, an ongoing trauma-related threat, suicidal ideation posing imminent danger, current substance dependence, pending legal issues, initiation of treatment with psychotropic medication within the previous 6 weeks, and ongoing psychological

Sample Characteristics

Descriptive statistics for the sample are presented in Table 1. Of 38 participants, 24 (63%) were girls, 18 (47%) were living with both their biological parents, five (13%) were on stable psychiatric medication regiment, and 31 (81%) had at least one comorbid disorder—19 had one additional internalizing disorder, five had an additional externalizing disorder, and six had internalizing and externalizing disorders. No differences were found between treatment conditions at baseline on any

Discussion

The present study compared PE-A, a directive, trauma-focused cognitive-behavioral treatment, with TLDP-A, a nondirective, nontrauma-focused psychodynamic treatment, in adolescents with PTSD resulting from single-event trauma. The TLDP-A treatment served as a credible active control condition. Both interventions were successful in decreasing distress and increasing functioning after treatment and at 6- and 17-month follow-ups. Importantly, in an ITT sample, PE-A was superior to TLDP-A in

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    This study was funded by grant NIMH R34 MH71660-01 awarded to Dr. Gilboa-Schechtman.

    Disclosure: Drs. Gilboa-Schechtman, Aderka, Foa, Powers, Yadin, Rachamin, and Apter, Ms. Shafran, and Ms. Rosenbach report no biomedical financial interests or potential conflicts of interest.

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