Prolonged Exposure Therapy-Adolescent (PE-A) is a targeted indicated intervention for adolescents between the ages of 13 to 18 years old who have experienced trauma. It is intended for adolescents who are exhibiting post-traumatic stress disorder (PTSD) and related symptoms. It is delivered by mental health professionals individually to young people in once to twice weekly sessions of 60 to 90 minutes’ duration in eight to 15 sessions.
The information above is as offered/supported by the intervention provider.
13 to 18 years old
Individual
Child outcomes:
UK available
UK tested
Prolonged Exposure Therapy-Adolescent (PE-A) is a targeted-indicated intervention for adolescents (between the ages of 13 to 18 years old) who have experienced trauma.
PE-A is delivered in out-patient health settings and community centres and aims to support children to develop emotional processing skills to reduce the impact of their traumatic experiences, resulting in a decrease in symptoms associated with post-traumatic stress disorder (PTSD) and other trauma-related conditions.
PE-A is a form of cognitive behavioural therapy and was adapted from the widely studied and empirically supported adult treatment protocol. It provides psychoeducation about the effects of trauma and then focuses on helping adolescents to systematically and repeatedly confront trauma-related memories (imaginal exposure) and reminders (in vivo exposure).
It is intended for adolescents who are exhibiting PTSD and related symptoms.
13 to 18 years old
Adolescents (between the ages of 13 to 18 years old) who have experienced trauma and are exhibiting PTSD and related symptoms.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Adolescence is a unique developmental stage that is associated with increased exposure to traumatic events that can lead to PTSD.
Science-based assumption
Improved emotional processing can diminish the impact of PTSD and other trauma-related symptoms.
Science-based assumption
Adolescents (between the ages of 13 to 18 years old) who have experienced trauma and are exhibiting PTSD and related symptoms.
Intervention
PE-A provides psychoeducation about the effects of trauma and focuses on helping adolescents to systematically and repeatedly confront trauma-related memories (imaginal exposure) and reminders (in vivo exposure).
Short-term
Children have better emotional processing skills.
Medium-term
The impact of children’s traumatic experiences reduces.
Long-term
Children experience a reduction in symptoms associated with PTSD and other trauma-related conditions.
Adolescents (between the ages of 13 to 18 years old) who have experienced trauma and are exhibiting PTSD and related symptoms.
Prolonged Exposure Therapy-Adolescent is delivered in once to twice weekly sessions of 60 to 90 minutes’ duration in eight to 15 sessions. It is delivered by mental health professionals individually to young people.
PE-A aims to improve the participants’ ability to emotionally process their traumatic experiences and consequently diminish post-traumatic stress disorder and other trauma-related symptoms.
Participants are encouraged to repeatedly approach situations or activities they are avoiding because they remind them of their trauma (in vivo exposure) as well as to revisit the traumatic memory several times through retelling it (imaginal exposure).
Psychoeducation about common reactions to trauma as well as breathing retraining exercises are also included in the treatment.
The practitioner who delivers this intervention is a licensed mental health professional or those working under the supervision of a licensed mental health professional. Psychology, social work, and nursing staff can implement PE-A in their respective roles.
The practitioners have four full days of intervention training.
N/A
Intervention fidelity is maintained through the following processes:
Contact person: Not available
Organisation: Not available
Email address: Not available
Website/s: Not available
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
Prolonged Exposure Therapy-Adolescent’s most rigorous evidence comes from two RCTs which were conducted in the United States and South Africa. The first study is consistent with Foundations’ Level 3 evidence strength threshold, and the second is consistent with Foundations’ Level 2+ evidence strength threshold.
This intervention has evidence from at least one rigorously conducted RCT along with evidence from an additional comparison group study. Consequently, the intervention receives a 3+ rating overall.
Study 1 observed significant increases in children’s loss of a PTSD diagnosis, increased global functioning, decreased externalising symptoms, decreased aggressive behaviour, decreased conduct problems, and decreased suicidal ideation in children in the PE-A group.
Study 2 observed a significant reduction in PTSD symptom severity at 12- and 24-month follow-up and reduction in depressive symptoms at 24-month follow-up in children in the PE-A group.
Prolonged Exposure Therapy-Adolescent can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome, as well as at least one more RCT or QED.
| Identified in search | 12 |
| Studies reviewed | 12 |
| Meeting the L2 threshold | 1 |
| Meeting the L3 threshold | 1 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 10 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 61 girls aged 13 to 18 years old (average age 15.3 years old) who were exhibiting sexual abuse-related PTSD symptoms for at least three months and were seeking treatment at a rape crisis centre |
| Race, ethnicities, and nationalities | 1a, 1c:
1b:
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| Population risk factors | About half of the study sample had one or more than one comorbid psychiatric diagnosis. |
| Timing |
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| Child outcomes |
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| Other outcomes | None |
| Study rating | 3 |
| Citations | Study 1a: Foa, E. B., McLean, C. M., Capaldi, S. & Rosenfield, D. (2013) Prolonged exposure vs supportive counselling for sexual abuses related PTSD in adolescent girls: A randomized clinical trial. JAMA. 310 (24), 2650–2657. Study 1b: 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. Study 1c: 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 & Adolescent Psychology. 49 (5), 651–659. |
| Study design | RCT |
| Country | South Africa |
| Sample characteristics | Sixty-three adolescents (13 to 18 years old) who had witnessed or experienced an interpersonal trauma and were suffering from chronic PTSD for the last three months |
| Race, ethnicities, and nationalities |
|
| Population risk factors |
|
| Timing |
|
| Child outcomes |
|
| Other outcomes | None |
| Study rating | 2+ |
| Citations | 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), 1022–103. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Aderka, I. M., Foa, E. B., Applebaum, E., Shafran, N. & Gilboa-Schechtman, E. (2011a) Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents. Journal of Consulting and Clinical Psychology. 79 (3), 421–425.
Aderka, I. M., Appelbaum-Namdar, E., Shafran, N. & Gilboa-Schechtman, E. (2011b) Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology. 79 (4), 441–446.
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.
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, 1034–1042.
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.
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.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
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Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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