Comparing Behavioral Therapies for Treating Adolescents With Post-Traumatic Stress Disorder Related to Sexual Abuse

Adolescents who have experienced childhood sexual abuse (CSA) frequently develop
post-traumatic stress disorder (PTSD), substance abuse problems, and re-victimization during
their teenage years. PTSD is a type of anxiety disorder that often occurs following a
traumatic event, such as violent personal assault, natural or human-caused disasters,
accidents, or military combat. PTSD is characterized by persistent frightening thoughts and
memories of the traumatic ordeal, emotional numbness, sleep problems, and anxiousness.
Because of the high prevalence of CSA and the association between CSA, PTSD, and other
serious mental disorders, it is essential that efficient, effective, and readily available
treatments are developed for adolescents with PTSD brought on by sexual assault. This study
will evaluate the comparative effectiveness of prolonged exposure therapy and supportive
counseling in treating adolescents with PTSD that is related to childhood sexual abuse or
assault.

Participants in this 1-year study will be randomly assigned to receive one of the following
two treatments: prolonged exposure therapy for adolescents (PE-A) or client centered therapy
(CCT). PE-A will involve three phases: psychoeducation and planning; exposure; and relapse
prevention and graduation. PE-A and CCT participants will attend 14 sessions over 18 weeks,
including up to 5 hours with their parents or guardians. During the first three sessions,
participants will briefly discuss the CSA and learn breathing techniques. For PE-A
participants, sessions 4 through 12 will focus on repeatedly confronting the trauma memory
to allow participants to thoroughly process the trauma and reduce fear and anxiety. PE-A
participants will also complete homework assignments designed to expose them to experiences
that are safe but may remind them of past traumatic events or trigger anxiety. In CCT
sessions, the therapist will help participants identify daily stresses and will discuss them
in a supportive, non-directive way, with a focus on problem solving. Topics may include
everyday life difficulties, directly or indirectly related to CSA, or discussion of the CSA
itself. All participants will attend follow-up visits at Week 19 (immediately
post-treatment) and 3, 6, and 12 months post-treatment.

Inclusion Criteria:

- Primary diagnosis of PTSD or subthreshold PTSD related to CSA or rape

- Adolescent and parent/guardian are literate in English

- If currently on psychotropic medication, dose is stable

Exclusion Criteria:

- Suicidal ideation with intent

- Pervasive developmental disorder or Aspergers disorder

- Mental retardation

- Psychotic disorder

- Thought disorder or conduct disorder

- Alcohol or substance dependence disorder

- Primary diagnosis other than PTSD

- Concurrent trauma-focused therapy