Prolonged Exposure Therapy for Adolescents with PTSD

Target Population

PE-A is designed to treat adolescents (aged 13-18) who are diagnosed with PTSD or who manifest trauma-related symptoms.

Dosage

PE-A is typically delivered in an individual format over 10-15 sessions. Sessions are held once or twice a week for approximately 60-90 minutes each.

Location/Delivery Setting

Recommended Locations/Delivery Settings

PE-A is typically delivered in a clinical setting.  

Location/Delivery Settings Observed in the Research

• Mental Health Center, Treatment Center, Therapist Office

Education, Certifications and Training

Prolonged Exposure (PE) therapy is delivered by licensed mental health professionals or those working under a licensed mental health professional. The treatment and manuals are designed for use by therapists who are familiar with cognitive behavioral therapy (CBT) or who have participated in intensive PE workshops conducted by a trainer certified by the Center for the Treatment and Study of Anxiety (CTSA).

 

The CTSA offers trainings and consultation that lead to three levels of certification: PE Therapist, PE Consultant, and PE Trainer. To become a PE Therapist, individuals must complete a 4-day intensive workshop, complete at least two PE cases under a certified PE Consultant, and be recommended by a certified PE Consultant. To become a PE Consultant, individuals must be a certified PE Therapist, complete at least five PE cases, and complete a 5-day intensive workshop. To become a PE Trainer, individuals must be a certified PE Consultant, complete at least 15 PE cases, observe two intensive workshops, and complete a 3-day PE Trainer’s Workshop.

Program or Service Documentation

Book/Manual/Available documentation used for review

Foa, E. B., Chrestman, K. R., & Gilboa-Schechtman, E. (2009). Prolonged Exposure Therapy for Adolescents with PTSD: Emotional processing of traumatic experiences [Therapist guide]. Oxford University Press.

Available languages

Materials for PE–A are available in English, Spanish, and Japanese.

Other supporting materials

PE Therapist Training

PE Certification Program

Adolescent Patient Workbook

For More Information

Website: https://www.med.upenn.edu/ctsa/workshops_pet.html

Phone: (215) 746-3327

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review	Number of Studies Identified and Reviewed for Prolonged Exposure Therapy for Adolescents with PTSD
Identified in Search	5
Eligible for Review	1
Rated High	1
Rated Moderate	0
Rated Low	0
Reviewed Only for Risk of Harm	0

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings
Child well-being: Behavioral and emotional functioning	0.58 22	1 (11)	58	Favorable: 4 No Effect: 7 Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings	Months after treatment when outcome measured
Child well-being: Behavioral and emotional functioning	0.58 22	1 (11)	58	Favorable: 4 No Effect: 7 Unfavorable: 0	-
Study 10954 - PE-A vs. Supportive Counseling (Brownlow, 2016)
Child PTSD Symptom Scale: Insomnia	0.58 21	-	49	-	0
Child PTSD Symptom Scale: Nightmares	0.31 12	-	49	-	0
Study 10954 - PE-A vs. Supportive Counseling (Foa, 2013)
Child PTSD Symptom Scale: Interview	0.59 * 22	-	53	-	0
DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children: % Diagnosed PTSD	0.62 23	-	58	-	0
Children's Depression Inventory	0.54 20	-	44	-	0
Children's Global Assessment Scale	0.68 * 25	-	43	-	0
Child PTSD Symptom Scale: Interview	0.52 19	-	54	-	12
DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children: % Diagnosed PTSD	0.54 20	-	55	-	12
Child PTSD Symptom Scale: Self-Report	0.55 20	-	54	-	12
Children's Depression Inventory	0.58 * 21	-	54	-	12
Children's Global Assessment Scale	0.92 * 32	-	53	-	12

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.

The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.

For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.

Characteristics of the Participants in the Studies with Moderate or High Ratings
Study Location	Study Year	Age or Grade-level	Race, Ethnicity, Nationality	Gender	Populations of Interest*	Household Socioeconomic Status
Study 10954 - PE-A vs. Supportive Counseling
Characteristics of the Children and Youth
Philadelphia, PA, USA	--	Average age: 15 years	56% African American 18% White 16% Hispanic 3% Biracial 1% Other or no response	100% Girls	100% DSM-IV diagnosis of chronic or subthreshold PTSD related to sexual abuse; 52% Reported repeated (two or more) sexual assaults; 30% Reported being sexually assaulted by a blood relative; 20% Endorsed chronic victimization defined as reporting sexual abuse occurring "more than 99" times; 57% Had one or more comorbid psychiatric diagnoses; Most common disorders: 48% Major depression disorder, 16% Obsessive-compulsive disorder, 15% Generalized anxiety disorder, 8% Attention-deficit hyperactivity disorder, 8% Specific phobia	--

“--” indicates information not reported in the study.

* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.

Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated High

Study 10954

Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013). Prolonged Exposure vs supportive counseling for sexual abuse–related PTSD in adolescent girls: A randomized clinical trial. JAMA, 310(24), 2650-2657. https://doi.org/10.1001/jama.2013.282829

McLean, C. P., Yeh, R., Rosenfield, D., & Foa, E. B. (2015). Changes in negative cognitions mediate PTSD symptom reductions during client-centered therapy and Prolonged Exposure for adolescents. Behaviour Research and Therapy, 68, 64-69. https://doi.org/10.1016/j.brat.2015.03.008

Brownlow, J. A., McLean, C. P., Gehrman, P. R., Harb, G. C., Ross, R. J., & Foa, E. B. (2016). Influence of sleep disturbance on global functioning after posttraumatic stress disorder treatment. Journal of Traumatic Stress, 29(6), 515-521. https://doi.org/10.1002/jts.22139

Capaldi, S., Asnaani, A., Zandberg, L. J., Carpenter, J. K., & Foa, E. B. (2016). Therapeutic alliance during Prolonged Exposure versus client-centered therapy for adolescent posttraumatic stress disorder. Journal of Clinical Psychology, 72(10), 1026-1036. https://doi.org/10.1002/jclp.22303

Kaczkurkin, A. N., Asnaani, A., Zhong, J., & Foa, E. B. (2016). The moderating effect of state anger on treatment outcome in female adolescents with PTSD. Journal of Traumatic Stress, 29(4), 325-331. https://doi.org/10.1002/jts.22116

Zandberg, L., Kaczkurkin, A. N., McLean, C. P., Rescorla, L., Yadin, E., & Foa, E. B. (2016). Treatment of adolescent PTSD: The impact of Prolonged Exposure versus client-centered therapy on co-occurring emotional and behavioral problems. Journal of Traumatic Stress, 29(6), 507-514. https://doi.org/10.1002/jts.22138

McLean, C. P., Su, Y.-J., Carpenter, J. K., & Foa, E. B. (2017). Changes in PTSD and depression during Prolonged Exposure and client-centered therapy for PTSD in adolescents. Journal of Clinical Child and Adolescent Psychology, 46(4), 500-510. https://doi.org/10.1080/15374416.2015.1012722

Brown, L. A., Belli, G., Suzuki, N., Capaldi, S., & Foa, E. B. (2019). Reduction in suicidal ideation from Prolonged Exposure Therapy for adolescents. Journal of Clinical Child and Adolescent Psychology, 49(5), 651-659. https://doi.org/10.1080/15374416.2019.1614003

This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)

Studies Not Eligible for Review

Study 10993

Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., Apter, A., Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., & Apter, A. (2010). Prolonged Exposure versus Dynamic Therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 1034-1042. https://doi.org/10.1016/j.jaac.2010.07.014

Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., & Apter, A. (2016). 'Prolonged Exposure versus Dynamic Therapy for adolescent PTSD: A pilot randomized controlled trial': Corrigendum. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), 920-920. https://doi.org/10.1016/j.jaac.2016.06.018

Shalom, J. G., Gilboa-Schechtman, E., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., van Oppen, P., van Balkom, A. J. L. M., & Aderka, I. M. (2018). Intraindividual variability in symptoms consistently predicts sudden gains: An examination of three independent datasets. Journal of Consulting and Clinical Psychology, 86(11), 892-902. https://doi.org/10.1037/ccp0000344

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 11001

Hunter, J. (2010). Prolonged Exposure treatment of chronic PTSD in juvenile sex offenders: Promising results from two case studies. Child & Youth Care Forum, 39(5), 367-384. https://doi.org/10.1007/s10566-010-9108-4

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 11045

Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018). Prolonged Exposure Therapy and supportive counselling for post-traumatic stress disorder in adolescents: Task-shifting randomised controlled trial. British Journal of Psychiatry, 213(4), 587-594. https://doi.org/10.1192/bjp.2018.130

Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018). Prolonged Exposure Therapy and supportive counselling for posttraumatic stress disorder in adolescents in a community-based sample, including experiences of stakeholders: Study protocol for a comparative randomized controlled trial using task-shifting. BMC Psychiatry, 18(1), 288. https://doi.org/10.1186/s12888-018-1873-x

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 11046

Rossouw, J., Yadin, E., Alexander, D., Mbanga, I., Jacobs, T., & Seedat, S. (2016). A pilot and feasibility randomised controlled study of Prolonged Exposure treatment and supportive counselling for post-traumatic stress disorder in adolescents: A third world, task-shifting, community-based sample. Trials, 17, 1-9. https://doi.org/10.1186/s13063-016-1677-6

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).