Article

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

Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 6.35). 10/2010; 49(10):1034-42. DOI: 10.1016/j.jaac.2010.07.014
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ABSTRACT 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.
Thirty-eight adolescents (12 to 18 years old) were randomly assigned to receive PE-A or TLDP-A.
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.
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.

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Available from: Eva Gilboa-Schechtman, Dec 24, 2013
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    • "Although more trials of PE for sexually abused children and adolescents are needed, there is no theoretical or practical reason to assume that PE will not be equally effective for PTSD arising from other types of traumas or in children. Two previous controlled trials of patients with PTSD not related to sexual abuse, one trial using PE with adolescents (Gilboa-Schechtman et al 2010) and another using exposure plus cognitive restructuring with children and adolescents (Smith et al 2007), provide some support for such a conclusion. Nevertheless, one potential obstacle to the dissemination of PE and related therapies may be therapists' beliefs about exposure based therapies generally and with children in particular. "
    JAMA The Journal of the American Medical Association 12/2013; 310(24):2619-20. DOI:10.1001/jama.2013.283944 · 30.39 Impact Factor
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    • "In mixed trauma samples (i.e., single assault and road traffic accidents) the addition of cognitive restructuring to exposure methods was superior to exposure alone (Bryant et al. 2008), however the majority of adult studies (with a range of traumas) have presented conflicting evidence, either demonstrating that the combination of cognitive and exposure interventions provided no added benefit (Foa et al. 2005; Resick et al. 2008) or that each component was equally effective in reducing PTSD (Tarrier et al. 1999). Developmentally and theoretically there is no reason why many children with PTSD should not benefit from exposure methods, and indeed some of the studies cited previously provide empirical support for this (e.g., Cohen et al. 2004; Deblinger et al. 1996; Gilboa-Schechtman et al. 2010). "
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    ABSTRACT: The present study compared the efficacy of trauma-focused cognitive behavior therapy (CBT) with trauma-focused cognitive therapy (without exposure; CT) for children and youth with posttraumatic stress disorder (PTSD). Children and youth who had experienced single-incident trauma (N = 33; 7-17 years old) were randomly assigned to receive 9 weeks of either CBT or CT which was administered individually to children and their parents. Intent-to-treat analyses demonstrated that both interventions significantly reduced severity of PTSD, depression, and general anxiety. At posttreatment 65% of CBT and 56% of the CT group no longer met criteria for PTSD. Treatment completers showed a better response (CBT: 91%; CT: 90%), and gains were maintained at 6-month follow-up. Maternal depressive symptoms and unhelpful trauma beliefs moderated children's outcome. It is concluded that PTSD secondary to single-incident trauma can be successfully treated with trauma-focused cognitive behavioural methods and the use of exposure is not a prerequisite for good outcome.
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    ABSTRACT: To assess the efficacy of a modification for Prolonged Exposure (PE) therapy for single incident trauma in youth and examine the effective component(s) of treatment. Fifteen youth (2 boys, 13 girls; mean age= 10.8 years) were treated with a developmentally modified version of PE called Trauma Mastery Therapy (TMT). The youth were evaluated pre-treatment, every 2 treatment sessions, and at 1 month follow-up. Primary outcome measure: the Child PTSD Symptom Scale (CPSS), a self administered PTSD questionnaire. Post-treatment, 13 participants did not meet criteria for PTSD. Patients showed significant improvement at post-treatment. Analysis of variance models with pair-wise contrasts showed significantly higher scores at initiation of treatment as compared to the end of the exposure phase and, to a lesser extent, as compared to the psychoeducational phase, but no further significant improvement following the relapse prevention or follow-up phases. TMT appears to be a promising treatment for single incident trauma in youth. Flexibility within the structure of TMT may facilitate treatment success. The study suggests exposure, and to some extent, psychoeducation, to be important components of treatment. Additional research is required to further validate these initial findings.
    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 05/2011; 20(2):127-33.
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