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
Open accessAbstract
BACKGROUND: There is a dearth of empirical evidence on the effectiveness of pharmacological and nonpharmacological treatments for adolescents with post-traumatic stress disorder (PTSD) in developing country settings. The primary aim of this study was to demonstrate that Prolonged Exposure Treatment for Adolescents (PE-A) and supportive counselling (SC) are implementable by nurses in a South African context. A secondary aim was to perform a preliminary analysis of the effectiveness of registered nurses delivering either PE-A or SC treatment to adolescents with PTSD. It is hypothesised that PE-A will be superior to SC in terms of improvements in PTSD symptoms and depression. METHOD: A pilot, single-blind, randomised clinical trial of 11 adolescents with PTSD. Nurses previously naïve to Prolonged Exposure (PE) Treatment and SC provided these treatments at the adolescents' high schools. Data collection lasted from March 2013 to October 2014. Participants received twelve 60-90-min sessions of PE (n = 6) or SC (n = 5). All outcomes were assessed before treatment, at mid-treatment, immediately after treatment completion and at 12-month follow-up. The primary outcome, PTSD symptom severity, was assessed with the Child PTSD Symptom Scale-Interview (CPSS-I) (range, 0-51; higher scores indicate greater severity). The secondary outcome, depression severity, was assessed with the Beck Depression Inventory (BDI) (range, 0-41; higher scores indicate greater severity). RESULTS: Data were analysed as intention to treat. During treatment, participants in both the PE-A and SC treatment arms experienced significant improvement on the CPSS-I as well as on the BDI. There was a significant difference between the PE-A and SC groups in maintaining PTSD and depression at the 12-month post-treatment assessment, with the participants in the PE-A group maintaining their gains both on PTSD and depression measures. CONCLUSION: The treatment was adequately implemented by the nurses and well-tolerated by the participants. Preliminary results suggest that the delivery of either intervention led to a significant improvement in PTSD and depression symptoms immediately post treatment. The important difference was that improvement gains in PTSD and depression in the PE-A group were maintained at 12-month follow-up. The results of this pilot and feasibility study are discussed. TRIAL REGISTRATION: Pan African Clinical Trials Registry: PACTR201511001345372 , registered on 11 November 2015.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Prolonged Exposure Therapy for Adolescents (PE-A) produces sustained improvements in PTSD and depression symptoms up to 12 months post-treatment.
“researchers in the studies [49,52] highlight the sustained improvements in PTSD and depression symptoms with Prolonged Exposure Therapy for Adolescents (PE-A) up to 12 months post-treatment.”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [52]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · cited 1× · see citing works
“The Beck Depression Inventory (BDI) is a self-report that evaluates depression severity [23].”
BackgroundEmotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396 · cited 1× · see citing works
“PE is a theory-driven treatment that is based on Emotional Processing Theory [16] which conceptualises chronic PTSD as a failure to process the traumatic memory due to a strong tendency to avoid trauma reminders and the consequential erroneous beliefs about the world being extremely dangerous and about the self as bei…”
BackgroundMeany, J. O., Rogers, C. R., Dorfman, E., Gordon, T., & Hobbes, N. (1951) · The American Catholic Sociological Review · doi:10.2307/3707825 · Cited by 4,192 · see citing works
The traumatic impact of child sexual abuse: A conceptualization.
Finkelhor, D., & Browne, A. (1985) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1985.tb02703.x · Cited by 1,891 · cited 1× · see citing works
“SC is based on the Traumagenic Dynamics Model [29] of symptom formation after child sexual abuse and the Rogerian psychotherapy model [30].”
MethodSheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05305whi · Cited by 1,730 · see citing works
Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.4.692 · Cited by 1,590 · see citing works
A Multisite, Randomized Controlled Trial for Children With Sexual Abuse–Related PTSD Symptoms
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200404000-00005 · Cited by 1,123 · cited 1× · see citing works
“Variants of SC are widely used in rape crisis centres and other community settings to treat sexually abused children [25].”
BackgroundThe Child PTSD Symptom Scale: A Preliminary Examination of its Psychometric Properties
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3003_9 · Cited by 1,103 · see citing works
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.5.953 · Cited by 931 · cited 1× · see citing works
“PE for adults has been shown to be effective within a community setting [18] and meets the requirements for dissemination.”
BackgroundTraumas and Posttraumatic Stress Disorder in a Community Population of Older Adolescents
GIACONIA, R. M., REINHERZ, H. Z., SILVERMAN, A. B., PAKIZ, B., FROST, A. K., & COHEN, E. (1995) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199510000-00023 · Cited by 413 · cited 1× · see citing works
“It has been reported [7] that 41% of adolescents with PTSD meet the criteria for major depression by age 18, compared to 8% among their peers, and that PTSD was associated with a significantly increased risk for social anxiety (33%), specific phobia (29%), alcohol dependence (46%), and drug dependence (25%).”
BackgroundMcDonagh, A., Friedman, M. J., McHugo, G. J., Ford, J. D., Sengupta, A., Mueser, K. T., Demment, C. C., Fournier, D. A., Schnurr, P. P., & Descamps, M. J. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.3.515 · Cited by 404 · see citing works
Williams, D. R., HERMAN, A. A. B., Stein, D. J., Heeringa, S. G., Jackson, P. B., Moomal, H., & Kessler, R. C. (2007) · Psychological Medicine · doi:10.1017/s0033291707001420 · Cited by 302 · cited 1× · see citing works
“Those unable to access private care suffer further since there is a 75% probability that they will not receive the professional attention that they require [10].”
BackgroundTrauma exposure and post-traumatic stress symptoms in urban African schools
Seedat, S., Nyamai, C., Njenga, F. G., Vythilingum, B., & Stein, D. J. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.184.2.169 · Cited by 258 · cited 16× · see citing works
“Author details 1Stellenbosch University, Stellenbosch, Western Cape, South Africa.”
BackgroundInfluentialLund, C., Kleintjes, S., Kakuma, R., & Flisher, A. J. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0078-5 · Cited by 224 · see citing works
Foa, E., Gillihan, S. J., & Bryant, R. (2013) · Psychological Science in the Public Interest · doi:10.1177/1529100612468841 · Cited by 211 · cited 1× · see citing works
“Given the considerations described earlier, successful dissemination of treatments for PTSD in developing countries requires that a treatment (1) have solid evidence for efficacy for a wide range of traumas, (2) be effective for patients with varied demographic backgrounds, (3) be effective for patients with complex p…”
BackgroundProlonged Exposure Versus Dynamic Therapy for Adolescent PTSD: A Pilot Randomized Controlled Trial
Gilboa‐Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., Rosenbach, L., Yadin, E., & Apter, A. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.07.014 · Cited by 197 · see citing works
Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013) · JAMA · doi:10.1001/jama.2013.282829 · Cited by 194 · cited 5× · see citing works
“2Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.”
BackgroundResultInfluentialFactors Related to Posttraumatic Stress Disorder in Adolescence
Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., & Cloitre, M. (2012) · Trauma, Violence, & Abuse · doi:10.1177/1524838012447698 · Cited by 192 · see citing works
Das‐Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0154478 · Cited by 149 · cited 2× · see citing works
“A more recent study examining the rates of PTSD in grade-8 adolescents (14–15 years old) within the greater Cape Town area showed a prevalence of 21% [3].”
BackgroundMcLean, C. P., & Foa, E. B. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.94 · Cited by 148 · cited 2× · see citing works
“Prolonged Exposure (PE) Treatment is a traumafocussed, exposure-based treatment for adults with PTSD following diverse types of traumas with great empirical support, including in a large number of randomised controlled trials (RCTs) [15].”
BackgroundDissemination of exposure therapy in the treatment of posttraumatic stress disorder
Cahill, S. P., Foa, E. B., Hembree, E. A., Marshall, R. D., & Nacasch, N. (2006) · Journal of Traumatic Stress · doi:10.1002/jts.20173 · Cited by 142 · cited 1× · see citing works
“Due to the relative ease of training, PE has been widely disseminated around the world and, following a relatively brief training, nonspecialists have been taught to successfully provide PE [15, 17].”
BackgroundBrent, D. A., Perper, J. A., MORITZ, G., Liotus, L., Richardson, D., CANOBBIO, R., SCHWEERS, J., & Roth, C. (1995) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199502000-00016 · Cited by 114 · see citing works
Mental illness and lost income among adult South Africans
Lund, C., Myer, L., Stein, D. J., Williams, D. R., & Flisher, A. J. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0587-5 · Cited by 87 · cited 1× · see citing works
“28 psychiatrists for every 100,000 people [9] presents a”
BackgroundThe Child PTSD Symptom Scale: Psychometric properties in female adolescent sexual assault survivors.
Gillihan, S. J., Aderka, I. M., Conklin, P. H., Capaldi, S., & Foa, E. B. (2012) · Psychological Assessment · doi:10.1037/a0029553 · Cited by 79 · see citing works
van Ginneken, N., Tharyan, P., Lewin, S. A., Rao, G. N., Romeo, R., & Patel, V. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149 · Cited by 69 · see citing works
Young, A., & Merlo, G. (2023) · CRC Press eBooks · doi:10.1201/b22810-33 · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [27]Foa EB Chrestman K Gilboa-Schechtman E Prolonged exposure manual for children and adolescents suffering from PTSD 2008 New York Oxford University Press
Cited by
Sorted by citations
van Ginneken, N., Chin, W. Y., Lim, Y. C., Ussif, A., Singh, R. K., Shahmalak, U., Purgato, M., Rojas‐García, A., Uphoff, E., McMullen, S., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub3 · Cited by 195 · see citing works
Bastien, R. J., Jongsma, H. E., Kabadayi, M., & Billings, J. (2020) · Psychological Medicine · doi:10.1017/s0033291720002007 · Cited by 94 · see citing works
“…symptoms improved in the PE group and this was maintained at follow-up SC group also improved at post-treatment, but these gains were not maintained Rossouw et al. (2018) South Africa 15.35 (13–18) Adolescents who had experienced a trauma and had chronic PTSD (>3 months) 63 (31 PE; 32 SC) 55 F…”
BackgroundResultInfluentialRossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.130 · Cited by 71 · see citing works
Gee, B., Reynolds, S. A., Carroll, B., Orchard, F., Clarke, T., Martin, D., Wilson, J., & Pass, L. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13209 · Cited by 71 · see citing works
Kirlić, N., Cohen, Z. P., & Singh, M. K. (2020) · Adversity and Resilience Science · doi:10.1007/s42844-020-00001-x · Cited by 41 · see citing works
de Haan, A., Meiser‐Stedman, R., Landolt, M. A., Kuhn, I. L., Black, M., Klaus, K., Patel, S. D., Fisher, D. J., Haag, C., Ukoumunne, O. C., et al. (2023) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(23)00253-5 · Cited by 37 · see citing works
“…et al (2015) 39 Meiser-Stedman et al (2017) 40 Murray et al (2015) 41 Peltonen et al (2019) 42 Rosner et al (2019) 43 Rossouw et al (2016; pilot) 44 Rossouw et al (2018) 45 Smith et al (2007) 47 King et al (2000) CBTs-TF was associated with lower mean post-traumatic stress symptoms after…”
BackgroundGkintoni, E., Kourkoutas, E., Yotsidi, V., Stavrou, P. D., & Prinianaki, D. (2024) · Children · doi:10.3390/children11050579 · Cited by 37 · see citing works
“Furthermore, researchers in the study [49,52] showcase how cultural contexts can influence treatment outcomes, demonstrating the effectiveness of trauma-focused interventions in diverse settings like South African schools.”
BackgroundBröcker, E., Olff, M., Suliman, S., Kidd, M., Mqaisi, B., Greyvenstein, L., Kilian, S., & Seedat, S. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2107359 · Cited by 28 · see citing works
“…the limited mental health resources in South Africa and other LMICs, the feasibility of task-shifting with the involvement of volunteer counsellors and a freely available app is encouraging (De Kock & Pillay, 2018; Petersen et al., 2012; Rossouw et al., 2016, 2018; Spedding et al., 2015).”
BackgroundVogel, A., & Rosner, R. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-019-00305-0 · Cited by 25 · see citing works
Davaasambuu, S., Hauwadhanasuk, T., Matsuo, H., & Szatmári, P. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.01.020 · Cited by 25 · see citing works
Zhao, Y., Hagel, C., Tweheyo, R., Sirili, N. S., Gathara, D., & English, M. (2021) · Human Resources for Health · doi:10.1186/s12960-021-00637-5 · Cited by 24 · see citing works
Davaasambuu, S., Phillip, H., Ravindran, A., & Szatmari, P. (2019) · Community Mental Health Journal · doi:10.1007/s10597-019-00420-w · Cited by 23 · see citing works
van de Water, T., Rossouw, J., Yadin, E., & Seedat, S. (2017) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-017-0187-y · Cited by 23 · see citing works
Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2020) · Psychological Medicine · doi:10.1017/s0033291720002731 · Cited by 16 · see citing works
van de Water, T., Rossouw, J., Yadin, E., & Seedat, S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0199816 · Cited by 16 · see citing works
MYERS, B. J., Carney, T., Johnson, K., Browne, F. A., & Wechsberg, W. M. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.102628 · Cited by 14 · see citing works
Adolescents’ Experience of Stigma When Accessing School-Based PTSD Interventions
van de Water, T., Rossouw, J., van der Watt, A. S. J., Yadin, E., & Seedat, S. (2018) · Qualitative Health Research · doi:10.1177/1049732318761365 · Cited by 13 · see citing works
Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1873-x · Cited by 7 · see citing works
“A pilot study of 12 participants [38] was used to determine the final assessment battery (from the included battery) that will be used for the study.”
BackgroundMethodCognitive Behavioral Therapy in South Africa
Andersen, L. S., Rossouw, J., & Kagee, A. (2022) · Springer eBooks · doi:10.1007/978-3-030-82555-3_28 · Cited by 3 · see citing works
Wiśniewska-Szeplewicz, D., Stanisławska–Kubiak, M., Andrusiewicz, M., Katolyk, H. V., Stanisławska, M., Malak, R. E., & Mojs, E. H. (2026) · International Journal of Social Psychiatry · doi:10.1177/00207640261433234 · Cited by 1 · see citing works
“…witnessing, hobbies) can vary with cultural context, and therefore, interventions must be culturally sensitive, respecting local family dynamics, educational environments, and specific community coping strategies to ensure effectiveness and relevance (Gkintoni et al., 2024; Rossouw et al., 2016).”
Arora, S., & Satapathy, S. S. (2024) · Indian Journal of Psychological Medicine · doi:10.1177/02537176241255643 · Cited by 3 · see citing works
Eating disorder in 17th century France – psychiatry in history
Wilkinson, G. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.162
REBT-CBT in the Treatment of Trauma Among Children and Adolescents
Rossouw, J. (2020) · Springer eBooks · doi:10.1007/978-3-030-53901-6_9
Zhao, Y., Hagel, C., Tweheyo, R., Sirili, N. S., Gathara, D., & English, M. (2021) · Figshare · doi:10.6084/m9.figshare.15109980
Zhao, Y., Hagel, C., Tweheyo, R., Sirili, N. S., Gathara, D., & English, M. (2021) · Figshare · doi:10.6084/m9.figshare.15109983
Rossouw, J., Yadin, E., Alexander, D., & Seedat, S. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2721926
“…that Prolonged Exposure for Adolescents (PE-A) and Supportive Counselling (SC) could be successfully delivered by newly trained and supervised non-specialist health workers in a community-based, school setting, with both interventions perceived as acceptable and feasible (Rossouw et al., 2016).”
- Authors
- Rossouw, J., Yadin, E., Alexander, D., Mbanga, I., Jacobs, T., & Seedat, S.
- Affiliations
- Stellenbosch University (ZA)
- University of Pennsylvania (US)
- Corresponding author
- Rossouw, Jaco
- Venue
- Trials
- Published
- 2016-11-17
- Volume
- 17
- Issue
- 1
- Pages
- 548-548
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC5114829
- OpenAlex
- W2554338385
- Cited by
- 26
- References
- 27
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 1
- FWCI
- 4.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- SUNScholar (Stellenbosch University) (submittedVersion)
- Funders
- SURMEPI
- South African Research Chairs Initiative in PTSD
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, adolescents, supportive counseling, task shifting, community mental health services, developing countries, depression, treatment feasibility, treatment implementation, PTSD symptom severity, maintenance therapy, South Africa, school-based intervention, Beck Depression Inventory
- MeSH terms
- Adolescent, Counseling, Feasibility Studies, Female, Humans, Male, Pilot Projects, Stress Disorders, Post-Traumatic, Single-Blind Method
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
