Prolonged exposure therapy more effective for sexual abuse-related PTSD

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1. Compared to supportive counseling, prolonged exposure therapy for sexual abuse-related PTSD was more effective at reducing symptoms in adolescent girls. 

2. Improvement in symptoms remained significant up to 12 months after treatment completion. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: This randomized clinical trial found that prolonged exposure therapy for PTSD related to sexual abuse resulted in a greater reduction symptoms than supportive counseling in adolescent girls. This is the first controlled study to demonstrate that prolonged exposure therapy is effective in adolescents with PTSD. The therapeutic intervention evaluated was performed in a community healthcare setting by providers previously inexperienced in prolonged exposure therapy, suggesting this model can be reproduced and applied in various settings. Results are limited by sample size but generate hypotheses for larger studies in a more heterogenous population.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: A meta-analytic review of prolonged exposure for posttraumatic stress disorder

In-Depth [randomized clinical trial]: Girls ages 13-18 with sexual abuse-related PTSD were randomized to receive fourteen sessions of prolonged exposure therapy (n=31) or supportive counseling (n=30). The primary outcome was interview-assessed PTSD symptom severity before treatment, mid-treatment, after treatment and at 3, 6, and 12-months of follow-up. Secondary outcomes included PTSD diagnosis status, global functioning, self-reported PTSD severity, and depression severity. Data were analyzed as intent to treat.

Patient adherence to treatment was 90.8% in the prolonged exposure arm and 90.5% for the supportive counseling. Adolescents receiving prolonged exposure therapy had greater improvement in interview-assessed PTSD symptoms compared with those receiving supportive therapy at post-treatment (p<0.001) and 12-month follow-up (p=0.02). At 12-months, 89.0% of teens who underwent exposure therapy maintained a reversal of their PTSD diagnosis, compared with 54.7% of those in supportive therapy.

By Maren Shapiro and Leah Hawkins, MD, MPH

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