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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

Published online by Cambridge University Press:  06 August 2020

Jaco Rossouw Open the ORCID record for Jaco Rossouw [Opens in a new window] ,
Elna Yadin ,
Debra Alexander  and
Soraya Seedat
Jaco Rossouw*
Affiliation:
Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
Elna Yadin
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Debra Alexander
Affiliation:
Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
Soraya Seedat
Affiliation:
Department of Psychiatry, Stellenbosch University, Stellenbosch, Western Cape, South Africa
*
Author for correspondence: Jaco Rossouw, E-mail: [email protected]
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Abstract

Background

Empirical evidence on the longer-term effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed. The aim of the study was to evaluate the maintenance of treatment gains achieved in a comparative study of effectiveness of prolonged exposure therapy for adolescents (PE-A) and supportive counselling (SC) in adolescents with PTSD up to 24-months post-treatment.

Method

Sixty-three adolescents (13–18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7–14 sessions of treatment provided by trained and supervised non-specialist health workers (NSHWs). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale, at pretreatment, post-treatment, and at 3-, 6-, 12- and 24-months post-treatment follow-up (FU) evaluations.

Results

Participants in both the prolonged exposure and SC treatment groups attained a significant reduction in PTSD symptoms and maintained this reduction in PTSD symptoms at 12- and 24-month assessment. Participants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving SC at 12-months FU [difference in PE-A v. SC mean scores = 9.24, 95% CI (3.66–14.83), p < 0.001; g = 0.88] and at 24-months FU [difference in PE-A v. SC mean scores = 9.35, 95% CI (3.53–15.17), p = 0.002; g = 0.68].

Conclusions

Adolescents with PTSD continued to experience greater benefit from prolonged exposure treatment than SC provided by NSHWs in a community setting 12 and 24 months after completion of treatment.

Keywords

Cognitive-behavioural therapieslow- and middle-income countriespost-traumatic stress disorderrandomised controlled trialtask-shiftingtreatment outcome
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1022 - 1030
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.CrossRefGoogle Scholar
Beck, A. T., Ward, C. H., Mendelsohn, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Bisson, J. I., Berliner, L., Cloitre, M., Forbes, D., Jensen, T. K., Lewis, C., & …Roberts, N. P. (2019). The international society for traumatic stress studies new guidelines for the prevention and treatment of posttraumatic stress disorder: Methodology and development process. Journal of Traumatic Stress, 32, 475–483.CrossRefGoogle ScholarPubMed
Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. The British Journal of Psychiatry, 190, 97–104. https://doi.org/10.1192/bjp.bp.106.021402.CrossRefGoogle ScholarPubMed
Booysen, D. D., & Kagee, A. (2020). The feasibility of prolonged exposure therapy for PTSD in low-and middle-income countries: A review. European Journal of Psychotraumatology, 11(1), 1753941.CrossRefGoogle ScholarPubMed
Ensink, K., Robertson, B., Zissis, C., & Leger, P. (1997). Post-traumatic stress disorder in children exposed to violence. South African Medical Journal, 87, 1526–1530.Google ScholarPubMed
Fazel, M., Stratford, H. J., Rowsell, E., Chan, C., Griffiths, H., & Robjant, K. (2020). Five applications of narrative exposure therapy for children and adolescents presenting with post-traumatic stress disorders. Frontiers in Psychiatry, 11. https://dx.doi.org/10.3389%2Ffpsyt.2020.00019CrossRefGoogle ScholarPubMed
Foa, E. B., Chrestman, K., & Gilboa-Schechtman, E. (2008). Prolonged exposure manual for children and adolescents suffering from PTSD. New York: Oxford University Press.Google Scholar
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001). The child PTSD symptom scale (CPSS): A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30, 376–384.CrossRefGoogle ScholarPubMed
Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013). Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: A randomized clinical trial. Journal of the American Medical Association, 310, 2650–2657.CrossRefGoogle ScholarPubMed
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting Clinical Psychology, 59, 715–723.CrossRefGoogle ScholarPubMed
Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B.,…Ursano, R. J. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23, 537–552.CrossRefGoogle ScholarPubMed
Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., … Apter, A. (2016). Prolonged exposure vs dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1034–1042.CrossRefGoogle Scholar
Gillihan, S. J., AderkaI, M., Conklin, P. H., Capaldi, S., & Foa, E. B. (2013). The Child PTSD Symptom Scale: Psychometric properties in female adolescent sexual assault survivors. Psychological Assessment, 25, 23–31.CrossRefGoogle ScholarPubMed
Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, S. L., Deppe, J., & Steil, R. (2016). Psychological treatments for symptoms of posttraumatic stress disorder in children, adolescents, and young adults: A meta-analysis. Clinical Child and Family Psychology Review, 19, 77. https://doi.org/10.1007/s10567-016-0202-5CrossRefGoogle Scholar
Hinsberger, M., Sommer, J., Kaminer, D., Holtzhausen, L., Weierstall, R., Seedat, S., … Elbert, T. (2016). Perpetuating the cycle of violence in South African low-income communities: Attraction to violence in young men exposed to continuous threat. European Journal of Psychotraumatology, 7, 29099. https://doi.org/10.3402/ejpt.v7.29099CrossRefGoogle ScholarPubMed
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Kline, A. C., Cooper, A. A., Rytwinksi, N. K., & Feeny, N. C. (2017). Long-term efficacy of psychotherapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 59, 30–40. DOI: 10.1016/j.cpr.2017.10.009.CrossRefGoogle ScholarPubMed
McLean, C. P., & Foa, E. B. (2013). Dissemination and implementation of prolonged exposure therapy for posttraumatic stress disorder. Journal of Anxiety Disorders, 27(8), 788–792.CrossRefGoogle ScholarPubMed
Morina, N., Koerssen, R., & Pollet, T. V. (2016). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies. Clinical Psychology Review, 47, 41–54. https://doi.org/10.1016/j.cpr.2016.05.006.CrossRefGoogle ScholarPubMed
Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5(1), 7.CrossRefGoogle Scholar
Peltzer, K. (1999). Posttraumatic stress symptoms in a population of rural children in South Africa. Psychological Reports, 85, 646–650.CrossRefGoogle Scholar
Petersen, I., Lund, C., Bhana, A., Flisher, A. J., & Mental Health and Poverty Research Programme Consortium. (2012). A task shifting approach to primary mental health care for adults in South Africa: Human resource requirements and costs for rural settings. Health Policy and Planning, 27(1), 42–51.CrossRefGoogle ScholarPubMed
Rith-Najarian, L. R., Mesri, B., Park, A. L., Sun, M., Chavira, D. A., & Chorpita, B. F. (2019). Durability of cognitive behavioral therapy effects for youth and adolescents with anxiety, depression, or traumatic stress: A meta-analysis on long-term follow-ups. Behavior Therapy, 50, 225–240. https://doi.org/10.1016/j.beth.2018.05.006.CrossRefGoogle ScholarPubMed
Rossouw, J., Yadin, E., Alexander, D., Mbanga, I., Jacobs, T., & Seedat, S. (2016). A pilot and feasibility randomised controlled study of prolonged exposure treatment and supportive counselling for post-traumatic stress disorder in adolescents: A third world, task-shifting, community-based sample. Trials, 17, 548.CrossRefGoogle ScholarPubMed
Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018). Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: Task-shifting randomised controlled trial. The British Journal of Psychiatry, 213(4), 587–594. https://doi.org/10.1192/bjp.2018.130.CrossRefGoogle ScholarPubMed
Seedat, S., Nyami, C., Njenga, F., Vythilingum, B., & Stein, D.J. (2004). Trauma exposure and post-traumatic stress symptoms in urban African schools. Survey in Cape Town and Nairobi. British Journal of Psychiatry, 184, 169–175.CrossRefGoogle Scholar
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 1, 1228–1231.CrossRefGoogle Scholar
Shahmalak, U., Blakemore, A., Waheed, M. W., & Waheed, W. (2019). The experiences of lay health workers trained in task-shifting psychological interventions: A qualitative systematic review. International Journal of Mental Health Systems, 13(1), 64.CrossRefGoogle ScholarPubMed
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Rogers, J. E., Milo, K. M., … Wilkinson, B. (2010). Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents. Journal of Clinical Psychiatry, 71, 313–326.CrossRefGoogle ScholarPubMed
Suliman, S., Kaminer, D., Seedat, S., & Stein, D. J. (2005). Assessing post-traumatic stress disorder in South African adolescents: Using the child and adolescent trauma survey (CATS) as a screening tool. Annals of General Psychiatry, 4, 2. https://doi.org/10.1186/1744-859X-4-2.CrossRefGoogle ScholarPubMed
Uppendahl, J. R., Alozkan-Sever, C., Cuijpers, P., de Vries, R., & Sijbrandij, M. (2019). Psychological and psychosocial interventions for PTSD, depression and anxiety among children and adolescents in low-and middle-income countries: A meta-analysis. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00933Google ScholarPubMed
van de Water, T., Rossouw, J., van der Watt, A. S., Yadin, E., & Seedat, S. (2018a). Adolescents’ experience of stigma when accessing school-based PTSD interventions. Qualitative Health Research, 28(7), 1088–1098.CrossRefGoogle Scholar
Van de Water, T., Rossouw, J., Yadin, E., & Seedat, S. (2017). Impediments and catalysts to task-shifting psychotherapeutic interventions for adolescents with PTSD: Perspectives of multi-stakeholders. Child and Adolescent Psychiatry and Mental Health, 11(1), 48.CrossRefGoogle ScholarPubMed
Van de Water, T., Rossouw, J., Yadin, E., & Seedat, S. (2018b). Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting. PLoS ONE, 13(7).CrossRefGoogle Scholar
van Meijel, E. P. M., Gigengack, M. R., Verlinden, E., van der Steeg, A. F. W., Goslings, J. C., Bloemers, F. W., … Lindauer, R. J. L. (2019). Journal of Clinical Psychology in Medical Settings, 26, 597. https://doi.org/10.1007/s10880-019-09615-5.CrossRefGoogle Scholar
Ward, C. L., Flisher, A. J., Zissis, C., Muller, M., & Lombard, C. (2003). Reliability of the beck depression inventory and the self-rating anxiety scale in a sample of South African adolescents. Journal of Child and Adolescent Mental Health, 15, 73–75.CrossRefGoogle Scholar
Zang, Y., Su, Y. J., McLean, C. P., & Foa, E. B. (2019). Predictors for excellent versus partial response to prolonged exposure therapy: Who needs additional sessions? Journal of Traumatic Stress, 32(4), 577–585.CrossRefGoogle ScholarPubMed
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