Adolescents girls with sexual abuse-related posttraumatic stress disorder (PTSD) experienced greater benefit from prolonged exposure therapy (a type of therapy that has been shown effectiveness for adults) than from supportive counseling, according to a study appearing in the December 25 issue of JAMA.
"Adolescence is a unique developmental stage that is associated with increased exposure to traumatic events that can lead to PTSD," according to background information in the article. "Prolonged exposure therapy is the most studied evidence-based, theory-driven treatment for adults with PTSD, but it is rarely provided to adolescents because of concern that it may exacerbate PTSD symptoms or the belief that patients must master coping skills before exposure can safely be provided." Prolonged exposure therapy is a form of behavior therapy and cognitive behavioral therapy, characterized by re-experiencing the traumatic event through remembering it and engaging with, rather than avoiding, reminders of the trauma (triggers).
Edna B. Foa, Ph.D., of the University of Pennsylvania, Philadelphia, and colleagues hypothesized that a prolonged exposure program modified for adolescents (prolonged exposure-A) would be superior to supportive counseling in reducing interviewer-assessed PTSD severity, rate of PTSD diagnosis, self-reported PTSD severity and depression, and improving general functioning. The trial included 61 adolescent girls with PTSD; counselors who had not previously administered prolonged exposure therapy provided the treatments in a community mental health clinic. Participants were randomized to receive fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30). Follow-up was 12 months.
Participants who received prolonged exposure showed greater improvement in PTSD symptoms and were more likely to lose their PTSD diagnosis and be classified as good responders than those who received supportive counseling. Also, participants who received prolonged exposure demonstrated greater improvement in depressive symptoms and functioning than those who received supportive counseling. The superiority of prolonged exposure over supportive counseling was also evident at 12-month follow-up.
"An important clinical implication of these results is the feasibility of disseminating and implementing prolonged exposure-A in community mental health clinics for adolescents who are motivated to participate in treatment. Prolonged exposure-A was successfully implemented by counselors with no prior training in evidence-based treatments and with relatively little supervision from experts. This is important because the need for evidence-based treatment of PTSD far exceeds the availability of these services," the authors write.
Sean Perrin, Ph.D., of Lund University, Lund, Sweden, comments on the findings of this study in an accompanying editorial.
"Findings from the current report by Foa et al should allay therapist concerns about any potential harmful effects of exposure and the need for extensive preparation of the patient for exposure. The heightened arousal that accompanies exposure to traumatic reminders in session usually dissipates within a few sessions and leads to rapid reductions in symptoms between sessions. Thus, the heightened arousal that many therapists fear causing by leading the patients through exposure exercises is an expected and integral part of the recovery progress."
"In the future, greater efforts are needed to increase awareness about the safety, tolerability, and effectiveness of treatments like prolonged exposure. Research is also needed to determine the minimum amount of training and supervision for therapists to effectively deliver prolonged exposure and similar exposure-focused treatments to patients with PTSD and other anxiety disorders."
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