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

Type of Study: Randomized controlled trial
Number of Participants: 38

Population:

• Age — 12–18 years (Mean=14.05 years)
• Race/Ethnicity — Israeli
• Gender — 63% Female and 37% Male
• Status — Participants were adolescents, fluent in Hebrew, with a primary diagnosis of post-traumatic stress disorder (PTSD) related to a single traumatic event.

Location/Institution: Bar-Ilan University, Ramat-Gan, Israel

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy and maintenance of developmentally adapted Prolonged Exposure Therapy for Adolescents (PE-A) compared with active control time-limited dynamic therapy (TLDP-A) for decreasing posttraumatic and depressive symptoms in adolescent victims of single-event traumas. Participants were randomly assigned to one of the two treatment groups. Measures utilized include the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL), the Children’s Global Assessment Scale (CGAS), the Child PTSD Symptom Scale (CPSS), the Beck Depression Inventory (BDI), and the Working Alliance Inventory. Results indicate that both treatments resulted in decreased posttraumatic stress disorder and depression and increased functioning. PE-A exhibited a greater decrease of posttraumatic stress disorder and depression symptom severity and a greater increase in global functioning than did TDLP-A. After treatment, 68.4% of adolescents beginning treatment with PE-A and 36.8% of those beginning treatment with TLDP-A no longer met diagnostic criteria for posttraumatic stress disorder. Treatment gains were maintained at 6- and 17-month follow-ups. Limitations include a small sample and reliance on self-reported measures.

Length of controlled postintervention follow-up: 6 and 17 months.

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

Type of Study: Randomized controlled trial
Number of Participants: 61

Population:

• Age — 12–18 years (Mean=15.3 years)
• Race/Ethnicity — 56% Black, 18% White, 16% Hispanic, 7% Other/No Response, and 3% Biracial
• Gender — 100% Female
• Status — Participants were adolescent girls seeking treatment at a rape crisis center.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effects of Prolonged Exposure Therapy for Adolescents (PE-A) compared with supportive counseling for adolescents with post-traumatic stress disorder (PTSD). Participants were randomized to receive PE-A or supportive counseling. Measures utilized include the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child PTSD Symptom Scale–Interview (CPSS-I), the Child PTSD Symptom Scale–Self-Report (CPSS-SR), the Children’s Depression Inventory (CDI), the Children’s Global Assessment Scale (CGAS), and the Expectancy of Therapeutic Outcome for Adolescents (ETO-A). Results indicate that after treatment, participants who received PE-A 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. Limitations include the use of pre-randomization preparatory sessions, which may reduce generalizability and introduce possible sample bias, and lack of generalizability to other types of trauma or to males.

Length of controlled postintervention follow-up: 3, 6, and 12 months.

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

Type of Study: Randomized controlled trial
Number of Participants: 61

Population:

• Age — 13–18 years (Mean=15.3 years)
• Race/Ethnicity — 56% Black, 18% White, 16% Hispanic, 7% Other, and 3% Biracial
• Gender — 100% Female
• Status — Participants were adolescent girls seeking treatment at a rape crisis center.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Foa et al. (2013). The purpose of the study was to examine the effects of Prolonged Exposure Therapy for Adolescents (PE-A) to assess whether changes in negative trauma-related cognitions play an important role in reducing symptoms of post-traumatic stress disorder (PTSD) and depression. Participants were randomly assigned to PE-A or client-centered therapy (CCT). Measures utilized include the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child PTSD Symptom Scale–Interview (CPSS-I), the Child PTSD Symptom Scale–Self-Report (CPSS-SR), the Children’s Depression Inventory (CDI), the Children’s Global Assessment Scale (CGAS), and the Expectancy of Therapeutic Outcome for Adolescents (ETO-A). Results indicate that after treatment, participants who received PE-A showed that change in negative trauma-related cognitions mediated change in PTSD symptoms and depressive symptoms, whereas change in PTSD and depressive symptoms did not mediate change in negative cognitions. Limitations include the use of prerandomization preparatory sessions, which may reduce generalizability and introduce possible sample bias, lack of generalizability due to gender, and reliability on self-reported measures.

Length of controlled postintervention follow-up: 3 months.

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 & Adolescent Psychology, 46(4), 500–510. https://doi.org/10.1080/15374416.2015.1012722

Type of Study: Randomized controlled trial
Number of Participants: 61

Population:

• Age — 12–18 years
• Race/Ethnicity — 56% Black, 18% White, 16% Hispanic, 7% Other, and 3% Biracial
• Gender — 100% Female
• Status — Participants were adolescent girls seeking treatment at a rape crisis center.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the sample as Foa et al. (2013). The purpose of the study was to investigate the relationship between changes in post-traumatic stress disorder (PTSD) and depression during Prolonged Exposure Therapy for Adolescents (PE-A) and client-centered therapy (CCT). Participants were randomly assigned to PE-A or CCT. Measures utilized include the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS), Beck Depression Inventory, and the Child PTSD Symptom Scale–Self-Report (CPSS-SR). Results indicate that there is a reciprocal but asymmetrical relationship between changes in PTSD and depression during treatment in the overall sample. However, analysis showed that the reciprocal relation was observed only during PE-A. Reductions in PTSD led to reductions in depression to a greater extent than vice versa. For participants receiving CCT, reduction in PTSD led to reductions in depression but not vice versa. Limitations include the possible sample bias, lack of generalizability due to gender, and lack of follow-up.

Length of controlled postintervention follow-up: None.

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. The British Journal of Psychiatry, 213(4), 587–594. https://doi.org/10.1192/bjp.2018.130

Type of Study: Randomized controlled trial
Number of Participants: 63

Population:

• Age — PE-A: Mean=15.19 years; SC: Mean=15.5 years
• Race/Ethnicity — PE-A: 9 African and 22 Mixed Parentage; SC: 10 African and 22 Mixed Parentage
• Gender — PE-A: 26 Female and 5 Male; SC: 29 Female and 3 Male
• Status — Participants were adolescents who had experienced or witnessed an interpersonal trauma and had chronic PTSD (>3 months).

Location/Institution: Cape Town, South Africa

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the comparative effectiveness Prolonged Exposure Therapy for Adolescents (PE-A) and supportive counselling (SC) in adolescents with post-traumatic stress disorder (PTSD). Participants were randomly assigned to either PE-A or SC. Measures utilized include the Child PTSD Symptom Scale–Interview (CPSS-I), the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), the Child PTSD Symptom Scale – Self Report (CPSS-SR), the Children’s Global Assessment Scale (CGAS), the Beck Depression Inventory (BDI), and the Expectancy of Therapeutic Outcome for Adolescents (ETO-A). Results indicate that participants receiving PE-A experienced greater improvement on the PTSD symptom severity scale than those receiving SC. A similar effect size was maintained at 3-month and 6-month follow-up assessments. Limitations include administration of assessment tools that have not been specifically validated in a South African context, underrepresentation of males in the sample, and the burden of time and effort invested in weekly supervision of nonspecialist health workers (NSHWs).

Length of controlled postintervention follow-up: 3 and 6 months.

Brown, L. A., Belli, G., Suzuki, N., Capaldi, S., & Foa, E. B. (2020). 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

Type of Study: Randomized controlled trial
Number of Participants: 61

Population:

• Age — PE-A: Mean=15.4 years; CCT: Mean=15.3 years
• Race/Ethnicity — PE-A: 68% Black, 26% White, and 7% Hispanic/Latino; CCT: 43% Black, 30% White, 17% Hispanic/Latino, 7% Biracial, and 3% Other
• Gender — PE-A: 100% Female; CCT: 100% Female
• Status — Participants were adolescent females with post-traumatic stress disorder (PTSD) from sexual assault.

Location/Institution: A rape crisis center in Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Foa et al. (2013). The purpose of the study was to explore whether post-traumatic stress disorder (PTSD) treatment, in particular Prolonged Exposure Therapy for Adolescents (PE-A), reduces suicidal ideation (SI) in adolescents and whether the degree of reduction in PTSD was associated with reduction in suicidal ideation. Participants were randomly assigned to either PE-A or client-centered therapy (CCT). Measures utilized include the Child PTSD Symptom-Scale Interview (CPSS-I), the Beck Depression Inventory (BDI), and the Child PTSD Symptom Scale – Self Report (CPSS-SR). Results indicate that there was a significant reduction in suicidal ideation during treatment across all participants. The time in treatment × condition interaction was significant, indicating a significantly steeper reduction in suicidal ideation in PE-A compared to in CCT. The degree of reduction in PTSD and depression symptoms in treatment and follow-up was associated with the speed of suicidal ideation reduction in treatment and follow-up. Adolescents randomized to PE-A had significantly faster reductions in suicidal ideation compared to those randomized to CCT. Greater reduction in PTSD and depression symptoms were associated with faster reduction in suicidal ideation. Limitations include the use of a single-item measure for SI, did not include a measure of suicide attempts, participants were all female and experienced the same index trauma (sexual assault), and the modest sample size.

Length of controlled postintervention follow-up: 3, 6, and 12 months.

Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2022). Long-term follow-up of a randomised controlled trial of Prolonged Exposure Therapy and supportive counselling for post-traumatic stress disorder in adolescents: A task-shifted intervention. Psychological Medicine, 52(6), 1022–1030. https://doi.org/10.1017/S0033291720002731

Type of Study: Randomized controlled trial
Number of Participants: 63

Population:

• Age — PE-A: Mean=15.19 years; SC: Mean=15.5 years
• Race/Ethnicity — PE-A: 9 African and 22 Mixed Parentage; SC: 10 African and 22 Mixed Parentage
• Gender — PE-A: 26 Female and 5 Male; SC: 29 Female and 3 Male
• Status — Participants were adolescents with post-traumatic stress disorder (PTSD).

Location/Institution: Cape Town, South Africa

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Rossouw et al. (2018). The purpose of the study was to evaluate the maintenance of treatment gains achieved in a comparative study of effectiveness of Prolonged Exposure Therapy for Adolescents (PE-A) and supportive counselling (SC). Participants were randomly assigned to either PE-A or SC. Measures utilized include the Child PTSD Symptom Scale–Self Report (CPSS-SR), the Child PTSD Symptom Scale – Interview (CPSS-I), the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), the Children’s Global Assessment Scale (CGAS), the Beck Depression Inventory (BDI), and the Expectancy of Therapeutic Outcome for Adolescents (ETO-A). Results indicate that participants in both the PE-A and SC treatment groups attained a significant reduction in post-traumatic stress disorder (PTSD) symptoms and maintained this reduction in PTSD symptoms at 12- and 24-month assessment. Participants receiving PE-A experienced greater improvement on the PTSD symptom severity scale than those receiving SC at 12-months follow-up and at 24-months follow-up. Limitations include that except for the BDI, other assessment tools used have not been specifically validated in a South African context; male adolescents were under-represented in this sample; and the data about other treatments that participants may have received between-treatment termination, and the 12- and 24-month assessments were not recorded.

Length of controlled postintervention follow-up: 1 and 2 years.