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Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy

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Abstract

Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.

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Abbreviations

A-DES:

Adolescent dissociative experiences scale

ANOVA:

Analysis of variance

AYAs:

adolescents and young adults

BDI-II:

Beck Depression Inventory

BSL-23:

Borderline symptom list 23

CAED:

Clinician-assisted emotional disclosure

CAPS-CA:

Clinician-administered PTSD Scale for children and adolescents

CBT:

Cognitive behavioral therapy

CCT:

Stanford cue-centered therapy

CPT:

Cognitive processing therapy

CPT+A:

Cognitive processing therapy including written accounts

CPTSD:

Complex posttraumatic stress disorder

CT-PTSD:

Cognitive therapy for PTSD in children and adolescents

D-CPT:

Developmentally adapted cognitive processing therapy

DIA-X:

Expert system for diagnosing mental disorders

DSM-IV:

Diagnostic and statistical manual of mental disorders, fourth edition

EMDR:

Eye movement desensitization and reprocessing

ICD-11:

11th version of the International Classification of Diseases

ITT:

Intent-to-treat

KIDNET:

Narrative exposure therapy for children

Kinder-DIPS:

Diagnostic interview for mental disorders in children and adolescents

LOCF:

Last observation carried forward

LOCF:

Last observation carried forward

MANOVA:

Multivariate analysis of variance

NET:

Narrative exposure therapy

PE:

Prolonged exposure

PE-A:

Prolonged exposure for adolescents

PTSD:

Posttraumatic stress disorder

PTSS:

Posttraumatic stress symptoms

RCT:

Randomized controlled trial

RRFT:

Risk reduction through family therapy

SCID-I:

Structured clinical interview for DSM-IV Axis I

SCID-II:

Structured clinical interview for DSM-IV Axis II

STAIR-NT:

Skills training in affect and interpersonal regulation narrative therapy

TARGET:

Trauma affect regulation: guide for education and therapy

Tf-CBT:

Trauma-focused cognitive behavioral therapy

UCLA:

University of California at Los Angeles

PTSD:

Reaction index

YSR:

Youth self-report

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Acknowledgements

We thank all the patients who participated in this trial, and all therapists and raters who administered the interventions and assessments. We also thank proFOR+ , a funding program run by the Catholic University of Eichstätt-Ingolstadt, for funding parts of this research. Finally, we thank Dr. Maria Hagl for her helpful suggestions and comments on earlier drafts of the manuscript.

Funding

Parts of the study were funded by proFOR+ , a funding program run by the Catholic University of Eichstätt-Ingolstadt.

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Correspondence to Anna Vogel.

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RR was paid fees for workshops and presentations on PTSD treatment and has co-authored a book on Cognitive Processing Therapy. AV has no conflict of interest.

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All procedures were in accordance with the ethical standards of the institutional review board of the Catholic University of Eichstätt-Ingolstadt, Germany (approval given on 04.06.2013), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from every participant included in the study and from the participant’s parents or guardian in the case of minors.

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Vogel, A., Rosner, R. Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy. Clin Child Fam Psychol Rev 23, 122–152 (2020). https://doi.org/10.1007/s10567-019-00305-0

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