Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action

Richard Meiser-Stedman, Patrick Smith, Anna McKinnon, Clare Dixon, David Trickey, Anke Ehlers, David M. Clark, Adrian Boyle, Peter Watson, Ian Goodyer, Tim Dalgleish

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Background: Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however considerable natural recovery may still occur up to six months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2-6 months post-trauma).

Methods: Twenty-nine youth (8-17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2-6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n=14) or waiting list (WL; n=15) for 10 weeks.
Results: Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at post-treatment (intent-to-treat, 95% CI for difference .04-.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-months post-treatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviors, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings.

Conclusions: This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of “watchful waiting” into the 2-6 month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required.
Original languageEnglish
Pages (from-to)623–633
Number of pages11
JournalJournal of Child Psychology and Psychiatry
Issue number5
Early online date15 Dec 2016
Publication statusPublished - May 2017


  • Post-traumatic stress disorder
  • cognitive therapy

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