Cited by 102Posttraumatic Stress Disorder ResearchChild Abuse and TraumaPsychotherapy Techniques and Applications

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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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Rosner, Rita, Rimane, Eline, Frick, Ulrich, Gutermann, Jana, Hagl, Maria, Renneberg, Babette, Schreiber, Franziska, Vogel, Anna, Steil, Regina·2019·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2018.4349PMC PMC6495346

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Abstract

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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“The flow of participants through the trial as well as the main outcomes has been described by Rosner et al. (2019).”
BackgroundMethodSelf-citation
Routineversorgung für Jugendliche und junge Erwachsene mit Posttraumatischer Belastungsstörung nach sexualisierter und physischer Gewalt in Deutschland
Vogel, A., Steil, R., Comteße, H., Eilers, R., Renneberg, B., & Rosner, R. (2021) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000346 · Cited by 5
Self-citation
Long-term effects of dialectical behaviour therapy for posttraumatic stress disorder and cognitive processing therapy 9 months after treatment termination
Vonderlin, R., Priebe, K., Müller‐Engelmann, M., Fydrich, T., Steil, R., Resick, P. A., Schmahl, C. G., Lindauer, P., Kleindienst, N., & Bohus, M. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2393061 · Cited by 4
“Authors in the field propose different perspectives on this issue, with some advocating ‘phase-based treatments’ (Cloitre et al., 2002) that prioritise emotion regulation before focusing on traumatic memories (Cloitre et al., 2002; Cloitre et al., 2010; Harned et al., 2018; Rosner et al., 2019).”
BackgroundSelf-citation
Reframing the Victim–Offender Overlap: Moral Injury and Adolescent Offending
Alexander, A. R., & Kerig, P. K. (2025) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-025-00520-y · Cited by 5
“…to MI (Wachen et al., 2017); if this is the case, a benefit of such approaches is that developmental adaptations have been found efficacious for youth (e.g., Matulis et al., 2014; Rosner et al., 2019; Steil et al., 2022), including youth with systems involvement (e.g., Clemens et al., 2021).”
Afraid and Awake
Fellman, V., Heppell, P. J., & Rao, S. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2023.06.015 · Cited by 7
Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review
Protić, S., Wittmann, L., Taubner, S., Cerón, S. C., Ioannou, Y., Heinonen, E., Saliba, A., Moreno-Peral, P., Volkert, J., Barkauskienė, R., et al. (2024) · Trauma Violence & Abuse · doi:10.1177/15248380231223264 · Cited by 4
“…since only two studies represented original research (Meiser-Stedman et al., 2017; Smith et al., 2007); all others reported results of secondary analyses of the data from either a Norway study (Jensen et al., 2014) or two studies from Germany (Goldbeck et al., 2016; Rosner et al., 2019).”
Psychogenic Nonepileptic Seizures Associated with an Eating Disorder and PTSD Are Responsive to Cognitive Processing Therapy
Gearhart, M. G., & Brewerton, T. D. (2023) · Case Reports in Psychiatry · doi:10.1155/2023/5539951 · Cited by 4
DBT-PTSD-EA: Behandlung der posttraumatischen Belastungsstörung nach interpersoneller Traumatisierung in der Kindheit bei Adoleszenten mit Borderline-Symptomatik
Cornelisse, S., Biermann, M., Enning, F., Schmahl, C. G., & Kleindienst, N. (2021) · Der Nervenarzt · doi:10.1007/s00115-021-01151-8 · Cited by 4
Novel psychedelic interventions for post-traumatic stress disorder and their promise for precision medicine
Dodds, C., Dawson, R. L., Lim, A., Tye, S. J., & Nasrallah, F. A. (2025) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253251396255 · Cited by 4
How often do community-based mental health providers educate and initiate PTSD treatment following training? Answering the question of reach
Dondanville, K. A., Fina, B. A., Steigerwald, V. L., McCarthy, K., Worley, C. B., Straud, C. L., Moring, J. C., Rozek, D. C., & Initiative, F. T. S. S. T. (2021) · Implementation Research and Practice · doi:10.1177/26334895211011771 · Cited by 3
“Research in both CPT and PE also has established efficacy for the treatment of adolescents with PTSD (GilboaSchechtman et al., 2010; Rosner et al., 2019).”
Background
Does attachment predict the outcome of cognitive processing therapy for posttraumatic stress disorder in adolescent patients with interpersonal traumatization?
Rimane, E., Steil, R., Renneberg, B., & Rosner, R. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1977866 · Cited by 3
Self-citation
Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study
Kaur, A., Brown, M. J., James, T. A., Nkwonta, C. A., & Hart, M. J. (2023) · AIDS Care · doi:10.1080/09540121.2023.2208323 · Cited by 5
“A randomized control trial among CSA survivors by Rosner et al. showed that cognition therapies were more e ﬀ ective than treatment-driven therapies (Rosner et al., 2019).”
Background
Transtorno de estresse pós-traumático (TEPT) em crianças e adolescentes: impactos e tratamentos
Soares, M., Caixeta, C. A. S., & Amâncio, N. D. F. G. (2023) · Research Society and Development · doi:10.33448/rsd-v12i1.39296 · Cited by 4
Post-traumatic Stress Disorder in Children and Adolescents
Steil, R., & Rosner, R. (2022) · Springer eBooks · doi:10.1007/978-3-662-64057-9_22 · Cited by 3
Self-citation
Fear-related anxiety disorders and posttraumatic stress disorder
Moreland-Capuia, A. R., Vahabzadeh, A., Gillespie, C. F., & Ressler, K. J. (2023) · Neurobiology of Brain Disorders · doi:10.1016/b978-0-323-85654-6.00005-8 · Cited by 3
Therapeutic alliance during trauma focused treatment in adolescent and young adult patients with PTSD
Grass, A., Rosner, R., Ciner, A., Renneberg, B., & Steil, R. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-06410-x · Cited by 3
Self-citation
Association between estimated intelligence quotient and treatment outcome in young patients with posttraumatic stress disorder treated with developmentally adapted cognitive processing therapy
Steil, R., Weiss, J., Renneberg, B., & Rosner, R. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2548364 · Cited by 2
Self-citation
Effectiveness of Trauma-Focused Interventions in Reducing Externalizing Behaviors Among Traumatized Adolescents: A Systematic Review and Meta-Analysis
Jiang, S., Cheng, Y., Qian, W., Dong, Z., Chen, Z., & Shui, L. (2025) · Trauma Violence & Abuse · doi:10.1177/15248380251388127 · Cited by 2
“The intervention sessions ranged from 8 (Zandberg et al., 2016) to 30 (Rosner et al., 2019).”
Influential
Evidenzbasierte Psychotherapie posttraumatischer Belastungsstörungen – ein Update
Steil, R., Maercker, A. R. A., Jaworski, L., Bachem, R., & Eberle, D. J. (2024) · Der Nervenarzt · doi:10.1007/s00115-024-01694-6 · Cited by 2
Self-citation
Key mental health differences in conflict-related sexual violence and how sex, severity, and early intervention impact on improvement: a retrospective observational study
Martínez‐Torre, S., Sordo, L., Benito, M. J. S., Llosa, A. E., Maldonado, A. C., Umar, R. D., Usman, J., & Glaría, C. C. (2024) · Conflict and Health · doi:10.1186/s13031-024-00620-6 · Cited by 2
“…to compare our results against focus on the effectiveness of therapeutic modalities in high-income countries on young adults with abuse-related post-traumatic stress disorder, but no consensus exists on treatment modality or duration, especially in relation to differences between sexes [55, 56].”
Result
Impacts of traumatic lifetime event on the likelihood of divorce
Rezapour, M., & Preprint, A. (2024) · Discover Psychology · doi:10.1007/s44202-024-00272-w · Cited by 2
Correction to: Acceptability, Feasibility, and Preliminary Effectiveness of Group Cognitive Processing Therapy with Female Adolescent Survivors of Commercial Sexual Exploitation in Cambodia
Clemans, T. A., White, K. L., Fuessel‐Herrmann, D., Bryan, C. J., & Resick, P. A. (2021) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00412-7 · Cited by 3
Gastrointestinal symptoms in abused nonpatient women
Pallotta, N., Ribichini, E., Pezzotti, P., Belardi, F., Ciccantelli, B., Rivera, M., & Corazziari, E. S. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03498-x · Cited by 1
Psychological Interventions for Reducing Interpersonal Problems and Enhancing Interpersonal Competence among Adolescents with Posttraumatic Stress Symptoms: A Meta-Analysis
Ong, S. E.-Y., Forooshani, S. A., Izadikhah, Z., & Krishnamoorthy, G. (2026) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-026-00854-x · Cited by 1
“…in Goldbeck et al., 2016, Hébert & Amédée, 2020, and Kramer & Landolt, 2014), the Youth Self-Report (YSR; Achenbach, 1991, in Lee & Jeon, 2021, Rosner et al., 2019, and Vogel et al., 2020), Experiences in Close Relationships - Revised Questionnaire (ECR-R; Ehrenthal et al., 2009, in Rimane et…”
Effectiveness of Interventions for Interpersonal Functioning Among Adolescents With Posttraumatic Stress Symptoms: A Meta‐Analysis
Ong, S. E.-Y., Forooshani, S. A., Izadikhah, Z., & Krishnamoorthy, G. (2026) · Journal of Adolescence · doi:10.1002/jad.70197 · Cited by 1
“…2001, in Goldbeck et al. 2016; Hébert and Amédée 2020 and Kramer and Landolt 2014), the Youth Self‐Report (YSR; Achenbach 1991, in Lee and Jeon 2021; Rosner et al. 2019 and Vogel et al. 2020), the Behavior Assessment System for Children (BASC; Reynolds and Kamphaus 1992, in Balluerka et al. 2015;…”
Cognitive Processing Therapy for PTSD and Bipolar Disorder Comorbidity: A Case Study
Moring, J. C., Koch, L. M., Cherrington, A., Peterson, A. L., & Resick, P. A. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.10.004 · Cited by 1
Trauma and Posttraumatic Stress in Transitional-Age Youth
Kletter, H., Trager, E., Kang, J., Friedman, M., & Reicherter, D. (2021) · Springer eBooks · doi:10.1007/978-3-030-62113-1_8 · Cited by 1
The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes
Moring, J. C., Peterson, A. L., Straud, C. L., Ortman, J. A., Mintz, J., Young‐McCaughan, S., McGeary, C. A., McGeary, D. D., Litz, B. T., Macdonald, A., et al. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22982 · Cited by 1
Posttraumatische Belastungsstörung in Kindheit und Jugend
Schmid, M., & Fegert, J. M. (2022) · Springer Reference Medizin · doi:10.1007/978-3-662-49289-5_109-1 · Cited by 1
Incorporating Case Formulation into the Delivery of Cognitive Processing Therapy
Galovski, T. E., McSweeney, L. B., & Galovski, S. E. (2025) · CBT: science into practice · doi:10.1007/978-3-031-87356-0_15 · Cited by 1
Posttraumatische Belastungsstörung bei Kindern und Jugendlichen
Steil, R., & Rosner, R. (2019) · Springer eBooks · doi:10.1007/978-3-662-58470-5_22 · Cited by 1
Self-citation
Behandlung der posttraumatischen Belastungsstörung bei Kindern und Jugendlichen – ein Fallbeispiel
Vogel, A., & Rosner, R. (2019) · PiD - Psychotherapie im Dialog · doi:10.1055/a-0771-5028
“So wurde beispielsweise eine entwicklungsangepasste Form der CPT für Jugendliche speziell nach sexuellem und körperlichem Missbrauch entwickelt und erfolgreich evaluiert [10][15], bei der die CPT in zeitlich intensivierter Form u.”
BackgroundSelf-citation
Posttraumatic Stress Disorder and Cognitive Processing Therapy in Youth–Reply
Rosner, R., Frick, U., & Steil, R. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.1971
Self-citation
Posttraumatic Stress Disorder and Cognitive Processing Therapy in Youth
Ferguson, K. B. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.1968
Emerging as an effective therapy: CPT is put to the test
Galovski, T. E., Nixon, R. D. V., & Kaysen, D. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816715-1.00004-2
Potenziale, Grenzen und Risiken von helfenden und schützenden Interventionen
Jud, A., & Fegert, J. M. (2023) · Springer eBooks · doi:10.1007/978-3-662-66900-6_30
Posttraumatische Belastungsstörung in Kindheit und Jugend
Schmid, M., & Fegert, J. M. (2024) · Springer Reference Medizin · doi:10.1007/978-3-662-66744-6_109
Literaturverzeichnis zu Voderholzer (Hrsg.): Therapie psychischer Erkrankungen, 20. Auflage
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-21224-6.00055-4
Vol 18. Iss. 1
(2025) · Discussions · doi:10.28953/2997-2582.1203
Avaliação de psicoterapia em adolescentes sobreviventes de abuso sexual: uma revisão sistemática
Cavalcante, B. R., Antunes, M. C., & Aznar-Blefari, C. (2024) · REVISTA INTERNACIONAL CONSINTER DE DIREITO · doi:10.19135/revista.consinter.00019.39
Intervention of Healthcare Professionals for Patients With Experience of Child Maltreatment and Mental Disorders: A Systematic Review and Meta Analyses
Nagai, S., & Shinozaki, E. (2024) · Journal of Japan Academy of Nursing Science · doi:10.5630/jans.44.678
Additional file 1 of Challenges in recruiting and retaining adolescents with abuse-related posttraumatic stress disorder: lessons learned from a randomized controlled trial
Vogel, A., Comteße, H., & Rosner, R. (2020) · Figshare · doi:10.6084/m9.figshare.12144618
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Additional file 2 of Challenges in recruiting and retaining adolescents with abuse-related posttraumatic stress disorder: lessons learned from a randomized controlled trial
Vogel, A., Comteße, H., & Rosner, R. (2020) · Figshare · doi:10.6084/m9.figshare.12144624
Self-citation
Preliminary treatment outcomes of transition-aged youth receiving cognitive processing therapy for PTSD: A brief report
Tissera, T., Levitt, E. E., Boyd, J. E., Hewitt, J., Ip, J., Rosenau, F., & Hatchard, T. (2026) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2026.100636
Perspectives on implementation of cognitive processing therapy for post-traumatic stress disorder in a tertiary mental health care setting in India: A qualitative study
Krishnakumari, K., Munivenkatappa, M., Hegde, S., & Muralidharan, K. (2026) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2026.100672
Promise and Equity Gaps in Online Care for Posttraumatic Stress in Children
Rangel, S. J. (2026) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2026.1135
Spezifisch Belastungs-assoziierte Störungen
Kapfhammer, H., Eberle, D. J., & Maercker, A. (2026) · Springer Reference Medizin · doi:10.1007/978-3-642-45028-0_71-2
Diagnosis and Treatment of Trauma in Adolescents: A Doctoral-Level Clinical Psychology Course
Cervantes, J. (2026) · doi:10.56902/etdcrp.2026.10
Diagnostik und Behandlung der PTBS bei Kindern und Jugendlichen
Schreyer, B., Georg, A. K., Landolt, M. A., Jacobsen, B., Lehmann, K., Leithner, C., & Rosner, R. (2026) · Trauma und Gewalt · doi:10.21706/tg-20-3-198
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: Rosner, Rita
Rimane, Eline
Frick, Ulrich
Gutermann, Jana
Hagl, Maria
Renneberg, Babette
Schreiber, Franziska
Vogel, Anna
Steil, Regina
Venue: JAMA Psychiatry
Publisher: American Medical Association (AMA)
Published: 2019-05-01
Volume: 76
Issue: 5
Pages: 484
ISSN: 2168-622X (ISSN-L)
DOI: 10.1001/jamapsychiatry.2018.4349
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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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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