Prolonged Exposure Therapy for Adolescents with PTSD

Mental Health Supported

Prolonged Exposure Therapy for Adolescents (PE-A) with posttraumatic stress disorder (PTSD) is a cognitive-behavioral approach to treating adolescents who are diagnosed with PTSD or who manifest trauma-related symptoms. PE-A is an adaptation of Prolonged Exposure Therapy for PTSD and is designed to highlight the developmentally appropriate concerns, strengths, and needs of adolescents. It includes increased family involvement and incorporates developmentally-appropriate treatment exercises. PE-A has four phases: (1) pre-treatment preparation; (2) psychoeducation and treatment planning; (3) exposures; and (4) relapse prevention and conclusion of treatment. Phases are designed to allow adolescents to go at their own pace. Adolescents complete developmentally-appropriate homework assignments between sessions. These homework assignments include “in vivo exposure” that require the adolescent to confront situations, people, or objects that they are avoiding due to trauma reminders. Homework assignments also include “imaginal exposure” where adolescents listen to audio recordings of their own retelling of their traumatic experience.


PE-A is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.


Date Research Evidence Last Reviewed: May 2021


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: the California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, previews of the program or service manual and patient workbook, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

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

Contact Information for Developers

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

Phone: (215) 746-3327

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 Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
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 Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child well-being: Behavioral and emotional functioning 0.58
22
1 (11) 58 Favorable: 4
No Effect: 7
Unfavorable: 0
-
Brownlow, 2016
Child PTSD Symptom Scale: Insomnia 0.58
21
- 49 - 0
Child PTSD Symptom Scale: Nightmares 0.31
12
- 49 - 0
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.

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.

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





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).