Program

Sep 16, 2013

OVERVIEW

Prolonged Exposure Therapy for Adolescents is a psychiatric intervention for teens who have had a traumatic experience and developed symptoms of post traumatic stress disorder (PTSD).  It consists of exposing the patient to things that make them nervous, as well as to memories of the traumatic event. A study with an active control showed that the intervention improved symptoms of both PTSD and depression, as well as patient functioning in their everyday lives.

DESCRIPTION OF PROGRAM

Target population: Adolescents with PTSD stemming from a single traumatic event

PE-A is a type of individual cognitive behavioral treatment (CBT) used to treat chronic PTSD in adolescents, based on a similar treatment for adults. The intervention consists of twelve to fifteen individual sessions of between sixty and ninety minutes, conducted by a psychiatrist.  It mainly includes training in breathing exercises, exposure to PTSD triggers in a safe setting, recounting the traumatic event, and discussion of future challenges and ways to cope with them.  Patients were additionally given “homework” to expose themselves to things that made them anxious, and subsequently to listen daily to a recording of themselves speaking about the event. There were also one to three pre-treatment sessions for case-management with the adolescent and/or their parent(s).  A manual for this program is available.

EVALUATION OF PROGRAM

Gilboa-Schechtman, E., Foa, E., Shafran, N., et. al. (2010). Prolonged exposure versus dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1034-1042.

Evaluated population: The sample consisted of 38 Israeli adolescents, ages 12 to 18, with a diagnosis of PTSD that was related to a single traumatic event.  Possible participants were excluded if they were not fluent in Hebrew, had organic brain damage or mental retardation, had an ongoing threat from the trauma, were in immediate danger of suicide, were currently abusing drugs, were recently started on psychotropic medication, or had ongoing psychological treatment. Among the participants, 63 percent were female, and 47 percent had married parents.  Eighty-one percent had at least one disorder other than PTSD, though a primary diagnosis of PTSD was a requirement for participation in the study.  The traumatic event that sparked the PTSD varied: for 42 percent of participants, it was a motor vehicle accident; for 21 percent, it was a sexual assault, for 13 percent it was a terrorist attack, and for half-a-percent it was a non-sexual assault.  For the remainder, some other type of trauma was involved.

Approach: Subjects were randomly assigned to either the PE-A treatment (N=19) or to a control treatment (N=19) of Time Limited Dynamic Therapy for Adolescents (TLDT-A).  TLDT-A consisted of “working-through” a central issue (defined in an early session) by talking with a psychiatrist, with conversation directed away from details of the traumatic experience if it came up.  The control condition also included pre-treatment sessions for case-management with the adolescent and/or their parent(s).

PTSD symptoms, depressive symptoms, and general functioning were assessed by self-report before and immediately after treatment, as well as at six and seventeen month follow-ups.  Treatment expectancy, satisfaction with the treatment, and therapeutic alliance at the fourth treatment session were also measured.  Twenty-one percent of the sample were dropped before the end of treatment – half voluntarily, and half because the clinician determined that the patient required medication and was no longer eligible for the study.

Results: Immediately following treatment, PE-A had significant impacts on average PTSD symptoms (d=1.71), depressive symptoms (d=1.06), general functioning (d=3.13), and the proportion of the sample that was below the clinical or impaired range on all three measures.  All gains were maintained at the 6- and 17-month follow-ups (however, general functioning was not measured at the second follow-up).  There were no significant differences in treatment expectancy, satisfaction with the treatment, or therapeutic alliance between the intervention and the control groups; though scores on these measures were generally high.

SOURCES FOR MORE INFORMATION 

References

Gilboa-Schechtman, E., Foa, E., Shafran, N., et. al. (2010). Prolonged exposure versus dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1034-1042.

Website: http://www.med.upenn.edu/ctsa/certification.html

Contact Information

Edna B. Foa

3535 Market Street

Philadelphia, PA 19104

foa@mail.med.upenn.edu

(215) 746-3327

KEYWORDS: Adolescents, Youth, Males and Females, Clinic/Provider-Based, Manual, Counseling/Therapy, Parent or Family Component, Case Management, Depression/Mood Disorders, Other Mental Health

Program information last updated on 09/16/2013. 

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