Age-Appropriate CPT Improves Abuse-Related PTSD in Young People

By Marilynn Larkin

April 17, 2019

NEW YORK (Reuters Health) - For young people with abuse-related posttraumatic stress disorder (PTSD), developmentally adapted cognitive processing therapy (D-CPT) can be an effective treatment, researchers in Germany say.

"CPT is one of the most extensively studied therapies for adults suffering from PTSD and is highly recommended for treating this population," Dr. Rita Rosner of Catholic University Eichstatt-Ingolstadt told Reuters Health by email.

"With D-CPT, we introduce an age-appropriate version of CPT," she said. "Our results show that D-CPT resulted in greater improvement than a wait-list condition and was well tolerated by adolescents and young adults with abuse-related PTSD."

Dr. Rosner and colleagues randomized 88 individuals, ages 14 to 21, with childhood abuse-related PTSD to D-CPT or a waitlist/treatment advice (WL/TA) control group in which participants were advised to seek therapy while waiting seven months (until after the three-month follow-up) to receive the intervention. Participants' mean age was 18; about 85% were female; and 26% had an immigration background.

Comorbidities were common, with 47% of participants having one or two comorbid conditions and 33%, three or more. Frequent disorders (DSM-IV) included mood disorders (50%), anxiety disorders (40%) and nicotine dependence (38%).

CPT was adapted to the needs of the participants by (1) starting with a commitment phase to enhance treatment motivation and therapeutic alliance, and establish the framework for therapy; (2) integrating emotion management techniques early on; (3) increasing treatment intensity by providing the middle part of the protocol (i.e., actual CPT) at a high frequency of about 15 sessions in four weeks; and (4) giving special consideration to developmental tasks, such as career choice and romantic relationships.

The primary outcome, PTSD symptom severity, was assessed in clinical interviews. Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation.

As reported online April 10 in JAMA Psychiatry, the 44 participants receiving D-CPT showed greater improvement than the WL/TA participants with respect to PTSD severity (mean Clinician-Administered PTSD Scale for Children and Adolescents DSM-IV scores, 24.7 vs. 47.5). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 vs. 47.3).

Treatment success was greatest during the trauma-focused/high-frequency core phase. D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the post-treatment assessment. For example, mean post-treatment scores for borderline symptoms were 14.1 versus 32.0, and for depression, 12.8 versus 25.8 (higher scores indicate more severe symptoms).

Dr. Rosner noted that because 26% of patients were from immigrant families, the team believes the intervention will be equally effective in other countries and cultures. "However, she noted, "evidence is sparse for treatment efficacy in low- and middle-income countries."

"Next steps should include studies with dismantling designs to further address the question as to whether emotion regulation training should precede trauma-focused interventions in this age group," she said. "Moreover, dissemination and implementation of this effective intervention should be (required), especially in areas where adolescents with a history of abuse can be found - e.g. the child and adolescent welfare system."

"We believe the treatment will be cost-effective in the long run," she added. "As child sexual abuse is not only related to PTSD but to a number of comorbid mental disorders, health problems, and welfare dependence in adulthood, the ecological burden of PTSD is high."

"Early intervention may prevent symptoms from becoming chronic and can thus save healthcare costs," she said. "But more importantly, later suffering of patients can be reduced."

Dr. Nicki Nance, an associate professor of human services and psychology at Beacon College in Leesburg, Florida, said in an email to Reuters Health, "Although the results suggest that D-CPT is effective, further research is indicated to determine if the same developmental adaptations to other therapies would yield the same results."


JAMA Psychiatry 2019.