Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse: A Randomized Clinical Trial
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Importance: Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. Objective: To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. Design, Setting, and Participants: This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. Interventions: Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. Main Outcomes and Measures: All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. Results: The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The 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 posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). Conclusions and Relevance: Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. Trial Registration: German Clinical Trials Register identifier: DRKS00004787.
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There are many additional evidence-based treatment models that reduce trauma symptoms associated with CSA and/or operate on one or more of the transdiagnostic mechanisms linking CSA with psychopathology.
“There are many additional evidence-based treatment models that reduce trauma symptoms associated with CSA and/or operate on one or more of the transdiagnostic mechanisms linking CSA with psychopathology”
From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Rosner et al. 2019
In a recent multicenter randomized clinical trial, compared to WL/TA, participants receiving D-CPT showed greater improvement in PTSD severity and comorbidity at posttreatment and at the 3-month follow-up.
“Compared to WL/TA, participants receiving D-CPT showed greater improvement in PTSD severity and comorbidity at posttreatment and at the 3-month follow-up.”
From Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. (2021) · cites this paper as [37]
In our study, we found a large effect size for interview-rated PTSS in the WL/TA group, with one-third of WL/TA participants receiving some kind of professional support.
“In our study, however, we found a large effect size for the interview-rated PTSS in the WL/TA group (for details see [37]) with one-third of WL/TA-participants receiving some kind of professional support.”
From Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. (2021) · cites this paper as [37]
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Self-citation
- Authors
- Rosner, R., Rimane, E., Frick, U., Gutermann, J., Hagl, M., Renneberg, B., Schreiber, F., Vogel, A., & Steil, R.
- Affiliations
- Catholic University of Eichstätt-Ingolstadt (DE)
- TH Köln - University of Applied Sciences (DE)
- Goethe University Frankfurt (DE)
- Freelance researcher in München, Germany
- Freie Universität Berlin (DE)
- Corresponding author
- Rosner, Rita
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-05-01
- Volume
- 76
- Issue
- 5
- Pages
- 484
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6495346
- OpenAlex
- W2938312849
- Cited by
- 102
- References
- 35
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 14 · 2023: 15 · 2022: 14 · 2021: 16 · 2020: 14 · 2019: 9
- FWCI
- 15.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Publication Server of the Catholic University Eichstätt-Ingolstadt (Catholic University of Eichstätt-Ingolstadt) (submittedVersion)
- University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, child sexual abuse, child physical abuse, adolescents, medication adherence, depression, dissociation, borderline symptoms, behavioral problems, waitlist control, trauma-focused psychotherapy, emotion regulation, alliance building, developmental tasks, young adults
- MeSH terms
- Adolescent, Child Abuse, Child Abuse, Sexual, Female, Humans, Male, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome, Adult Survivors of Child Abuse, Young Adult
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