Program

Sep 16, 2013

OVERVIEW

 Time-limited dynamic psychotherapy for adolescents (TLDP-A) is a psychiatric intervention for teens who have had a traumatic experience and developed symptoms of post traumatic stress disorder (PTSD). It consists of identifying an inter- or intra-personal conflict central to the person’s life, and discussing the adolescent’s issues within the context of that conflict.  An experimental evaluation of the intervention found that, while it was less effective than an alternative therapy in reducing symptoms of  PTSD and depression, and increasing healthy functioning, TLDP-A nonetheless had a significant positive impact.

DESCRIPTION OF PROGRAM

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

TLDP-A is a clinical therapy designed to change ingrained patterns of behavior in relationships and patterns of thought, in order to indirectly reduce symptoms of PTSD in adolescents.  It is based on a similar program for adults. The treatment consists of 15 to 18 50-minute sessions of talking with a trained psychiatrist.  The first few sessions are aimed at building mutual trust and identifying a “central issue,” which is an unresolved conflict in the patient’s life, such as the tension between dependence and independence, or passivity and activity.  Once the central issue has been defined, the remaining sessions consist of the doctor and patient talking about the central issue within the context of the patient’s life and reinterpreting daily difficulties in terms of this central issue.  There are also one to three pre-treatment sessions for case-management with the adolescent and/or their parent(s).

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 related to the trauma, were in immediate danger of suicide, were currently abusing drugs, were recently started on psychotropic medication, or had other 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, although a primary diagnosis of PTSD was a requirement for inclusion in the study.  The 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 TLDP-A treatment (as an active control; N=19), or Prolonged Exposure Therapy for Adolescents (PE-A; N=19).  Subjects in the PE -A group were exposed to PTSD triggers in a safe setting and at home, prompted to recount the memory of the traumatic event multiple times, and taught breathing exercises.  The PE-A 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 6- and 17-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: While TLDP-A was generally less effective than PE-A, there was significant improvement over baseline measurement. Immediately after treatment, TLDP-A had significant impacts on average PTSD symptoms (d=0.87), depressive symptoms (d=0.73), and general functioning (d=1.78). All gains were maintained at the 6- and 17-month follow-ups (except for general functioning, which 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; 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.

Contact Information

Eve Gilboa Schechtman

Bar-Ilan University

Department of Psychology

52900 Ramat-Gan, Israel

gilboae@mail.biu.ac.il

972-3-531-8744

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

Program information last updated on 09/16/2013.