title: Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Participants received fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00417300.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia.
authors.forename: Carmen P
authors.initials: CP
authors.lastname: McLean
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Capaldi
authors.affiliation: Department of Psychology, Southern Methodist University, Dallas, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Rosenfield
mesh_terms: D000293:Adolescent; D003376:Counseling; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012742:Sex Offenses / Q000523:psychology*; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*