Short- and long-term effectiveness of a Brief Intensive Trauma Treatment for adolescents with PTSD and their caregiver(s): Study protocol of a multicenter randomized controlled trial. (Preprint)

Abstract

BACKGROUND Childhood trauma is pervasive, with approximately 50% of adolescents experiencing at least one potentially traumatic event (PTE) before adulthood. Of PTE-exposed adolescents, 8-33% develop posttraumatic stress disorder (PTSD). PTSD can cause extreme suffering and coincides with a high number of comorbid illnesses and high-risk behaviors. PTSD can be effectively treated in adolescents through weekly sessions of eye movement desensitization and reprocessing (EMDR) or trauma-focused cognitive behavioral therapy (TF-CBT). Despite the availability of these treatments, a substantial amount of severely traumatized adolescents do not receive the available treatment options due to high treatment avoidance. In adolescents who do receive care, a large group youth does not experience sufficient symptom decrease after regular treatment. In addition, dropout rates during prolonged treatment are substantial, varying between 10% and 30%. This underscores the need for innovative and brief trauma treatment. Pilot studies show that Brief Intensive Trauma Treatment (BITT) can be a safe and effective treatment for adolescents with PTSD. However, randomized controlled trials (RCTs) on its effectiveness are crucial and urgently needed. OBJECTIVE This is the first study to test the effectiveness of a one-week BITT in adolescents with PTSD and comorbid symptoms and their caregiver(s). METHODS This multicenter, single-blinded RCT, will be conducted in five youth care centers in the European and Caribbean Netherlands: Levvel, Karakter, Leef! Jeugdzorg, Fornhese-GGz Centraal, and Mental Health Caribbean (Bonaire). We will randomly allocate adolescents (12-18 years old) with PTSD to a BITT (n=50) or waitlist control group (WLCG; n=50). BITT consists of a one-week (i.e., five consecutive workdays) intensive trauma treatment, encompassing daily 90-minute manualized sessions of TF-CBT and EMDR. The day begins and ends with psychomotor therapy. The caregiver(s) receive daily parental counseling sessions consisting of psycho-education and social support skill training. We will conduct measurements at similar time intervals for both groups: at baseline, directly after BITT or WLCG, and at 3, 6, and 9 months follow-up. The WLCG will receive BITT after the 3-months follow-up assessment. We will assess all study parameters using digital/face-to-face questionnaires and (semi) structured interviews conducted by a research psychologist blinded to randomization. We will assess the primary outcome PTSD symptoms using the Child and Adolescent Trauma Screen (CATS-2) and the Clinician-Administered PTSD Scale for Children and Adolescents DSM-5 (CAPS-CA-5). RESULTS . CONCLUSIONS This first, innovative study on the effectiveness of BITT may enhance treatment outcomes for PTSD by preventing dropout, reducing avoidance, shortening therapy duration, and empowering therapists by working together intensively. This research will provide valuable insights across cultures for effective treatment of severely traumatized adolescents who do not benefit sufficiently from regular treatment. CLINICALTRIAL NCT06143982