Five-year outcomes in a randomised controlled trial of prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: a task-shifted intervention.

Abstract

Cognitive-behavioural therapies with a trauma focus are effective in reducing posttraumatic stress disorder and other psychological distress in adolescents. Long-term follow-up data on adolescents treated for PTSD remain scarce, with few studies extending beyond 12 months after treatment completion. To evaluate the maintenance of treatment gains in a comparative study of effectiveness of PE-A and SC up to 60 months post-treatment. Sixty-three adolescents diagnosed with PTSD were randomly assigned to either treatment, provided by newly trained and supervised non-specialist health workers. The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale (CPSS). We report on the 60-month post-treatment follow-up, building on post-treatment, 3-month, 6-month, 12-month and 24-month post-treatment data that have been published previously. Participants in both treatment groups maintained a significant reduction in PTSD symptoms up to 60-months post-treatment (F (7, 343)&#x2009;=&#x2009;2.86, <i>p</i>&#x2009;&lt;&#x2009;.01). Participants receiving prolonged exposure experienced greater improvement on the CPSS at all follow-up assessment timepoints, except for the 60-month FU (<i>p</i>&#x2009;=&#x2009;.28; <i>g</i>&#x2009;=&#x2009;0.33). Adolescents with PTSD continued to maintain treatment gains up to 60-months post-treatment. These data, along with findings from the original RCT, indicate that a brief treatment protocol (averaging 9 sessions of PE-A or SC) in a LMIC, task-shifted to be delivered by nurses without prior psychotherapy experience, led to lasting improvements in PTSD and comorbid symptoms for up to five years. The sustained benefits and improved functioning over the first few years post-treatment support expanding both treatments, especially PE-A, in community settings. This study shows that a brief treatment protocol (average of 9 sessions of either prolonged exposure for adolescents or supportive counselling), delivered by psychotherapy-na&#xef;ve nurses in a resource-limited LMIC setting, led to sustained improvement in PTSD symptoms up to five years post-treatment.Participants rated both treatments as very helpful and reported excellent therapeutic alliance with their counsellors.These long-term results support broader implementation of both approaches &#x2013; especially prolonged exposure for adolescents &#x2013; in community settings.