Rita Rosner1, Eline Rimane1, Ulrich Frick2,3, Jana Gutermann4, Maria Hagl5, Babette Renneberg6, Franziska Schreiber4, Anna Vogel1, Regina Steil4. 1. Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany. 2. Hochschule Döpfer, University of Applied Sciences, Research Centre, University of Applied Sciences, Köln, Germany. 3. Psychiatric University Hospital Regensburg, Regensburg, Germany. 4. Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany. 5. Freelance researcher in München, Germany. 6. Department of Clinical Psychology and Psychotherapy, Freie Universitaet of Berlin, Berlin, Germany.
Abstract
Importance: Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. Objective: To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. Design, Setting, and Participants: This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. Interventions: Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. Main Outcomes and Measures: All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. Results: The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). Conclusions and Relevance: Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. Trial Registration: German Clinical Trials Register identifier: DRKS00004787.
RCT Entities:
Importance: Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. Objective: To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. Design, Setting, and Participants: This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. Interventions: Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. Main Outcomes and Measures: All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. Results: The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPTparticipants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). Conclusions and Relevance: Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. Trial Registration: German Clinical Trials Register identifier: DRKS00004787.
Authors: Bradley V Watts; Paula P Schnurr; Lorna Mayo; Yinong Young-Xu; William B Weeks; Matthew J Friedman Journal: J Clin Psychiatry Date: 2013-06 Impact factor: 4.384
Authors: Ad De Jongh; Patricia A Resick; Lori A Zoellner; Agnes van Minnen; Christopher W Lee; Candice M Monson; Edna B Foa; Kathleen Wheeler; Erik ten Broeke; Norah Feeny; Sheila A M Rauch; Kathleen M Chard; Kim T Mueser; Denise M Sloan; Mark van der Gaag; Barbara Olasov Rothbaum; Frank Neuner; Carlijn de Roos; Lieve M J Hehenkamp; Rita Rosner; Iva A E Bicanic Journal: Depress Anxiety Date: 2016-02-03 Impact factor: 6.505
Authors: Milagros Molero-Zafra; María Teresa Mitjans-Lafont; María Jesús Hernández-Jiménez; Marián Pérez-Marín Journal: Int J Environ Res Public Health Date: 2022-06-17 Impact factor: 4.614
Authors: Jeffrey J Wood; Philip C Kendall; Karen S Wood; Connor M Kerns; Michael Seltzer; Brent J Small; Adam B Lewin; Eric A Storch Journal: JAMA Psychiatry Date: 2020-05-01 Impact factor: 21.596
Authors: Carla Kmett Danielson; Zachary Adams; Michael R McCart; Jason E Chapman; Ashli J Sheidow; Jesse Walker; Anna Smalling; Michael A de Arellano Journal: JAMA Psychiatry Date: 2020-06-01 Impact factor: 21.596
Authors: Andrea E Spencer; Sarah E Valentine; Jennifer Sikov; Amy M Yule; Heather Hsu; Eliza Hallett; Ziming Xuan; Michael Silverstein; Lisa Fortuna Journal: Pediatrics Date: 2021-01 Impact factor: 7.124
Authors: John C Moring; Katherine A Dondanville; Brooke A Fina; Christina Hassija; Kathleen Chard; Candice Monson; Stefanie T LoSavio; Stephanie Y Wells; Leslie A Morland; Debra Kaysen; Tara E Galovski; Patricia A Resick Journal: J Trauma Stress Date: 2020-06-11