Original Investigation |

Prolonged Exposure vs Supportive Counseling for Sexual Abuse–Related PTSD in Adolescent Girls:  A Randomized Clinical Trial

Edna B. Foa, PhD1; Carmen P. McLean, PhD1; Sandra Capaldi, PsyD1; David Rosenfield, PhD2
[+] Author Affiliations
1Department of Psychiatry, University of Pennsylvania, Philadelphia
2Department of Psychology, Southern Methodist University, Dallas, Texas
JAMA. 2013;310(24):2650-2657. doi:10.1001/jama.2013.282829.
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Published online

Importance  Evidence-based treatments for posttraumatic stress disorder (PTSD) have not been established for adolescents despite high prevalence of PTSD in this population.

Objective  To examine the effects of counselor-delivered prolonged exposure therapy compared with supportive counseling for adolescents with PTSD.

Design, Setting, and Participants  A single-blind, randomized clinical trial of 61 adolescent girls with PTSD using a permuted block design. Counselors previously naive to prolonged exposure therapy provided the treatments in a community mental health clinic. Data collection lasted from February 2006 through March 2012.

Interventions  Participants received fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30).

Main Outcomes and Measures  All outcomes were assessed before treatment, at mid-treatment, and after treatment and at 3-, 6-, and 12-month follow-up. The primary outcome, PTSD symptom severity, was assessed by the Child PTSD Symptom Scale–Interview (range, 0-51; higher scores indicate greater severity). Secondary outcomes were presence or absence of PTSD diagnosis assessed by the DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children and functioning assessed by the Children’s Global Assessment Scale (range, 1-100; higher scores indicate better functioning). Additional secondary measures, PTSD severity assessed by the Child PTSD Symptom Scale–Self-Report (range, 0-51; higher scores indicate greater severity) and depression severity assessed by the Children’s Depression Inventory (range, 0-54; higher scores indicate greater severity), were also assessed weekly during treatment.

Results  Data were analyzed as intent to treat. During treatment, participants receiving prolonged exposure demonstrated greater improvement on the PTSD symptom severity scale (difference between treatments in improvement, 7.5; 95% CI, 2.5-12.5; P < .001) and on all secondary outcomes (loss of PTSD diagnosis: difference, 29.3%, 95% CI, 20.2%-41.2%; P = .01; self-reported PTSD severity: difference, 6.2; 95% CI, 1.2-11.2; P = .02; depression: difference, 4.9; 95% CI, 1.6-8.2; P = .008; global functioning: difference, 10.1; 95% CI, 3.4-16.8; P = .008). These treatment differences were maintained through the 12-month follow-up: for interviewer-assessed PTSD (difference, 6.0; 95% CI, 1.6-10.4; P = .02), loss of PTSD diagnosis (difference, 31.1; 95% CI, 14.7-34.8; P = .01), self-reported PTSD (difference, 9.3; 95% CI, 1.2-16.5; P = .02), depression (difference, 7.2; 95% CI, 1.4-13.0; P = .02), and global functioning (difference, 11.2; 95% CI, 4.5-17.9; P = .01).

Conclusion and Relevance  Adolescents girls with sexual abuse–related PTSD experienced greater benefit from prolonged exposure therapy than from supportive counseling even when delivered by counselors who typically provide supportive counseling.

Trial Registration  clinicaltrials.gov Identifier: NCT00417300

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Consort Diagram of Participant Flow Through the Protocol

Prolonged exposure–A indicates prolonged exposure program modified for adolescents.

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