The disaster of September 11and the constant threat of imminent terrorist activity have brought to the forefront the urgent need to prepare for the mental consequences of such attacks. At present, there is no intervention of known effectiveness for the treatment of single-event traumas, such as terror-attacks, for adolescents. We propose to conduct a treatment development study to design an effective and generalizable protocol aimed to fill this gap. This effort is proposed as a part of the Exploratory Research Grants (R34) Initiative. Adolescence is a unique stage in lifetime development. Developing effective treatments for trauma in this population is crucial given the increased exposure to traumatic events, including terrorist-activity, and the increased risk of depression and suicide following psychological distress in this age group. The major goals of the proposed study are to (a) create a state-of-the-art treatment manual for the treatment of single event traumas such as terror-events and accidents; (b) compare the efficacy of this manualized treatment to treatment as usual; and (c) assess maintenance of gains following treatment discontinuation. In Phase 1, we plan to develop a treatment manual based on the principles of prolonged exposure. This treatment will be developmentally adapted to the particular concerns of adolescents. Eight adolescents with terror related trauma will participate in this phase. These initials cases will be carefully evaluated using measures from patients, family, independent evaluators, and clinicians. This feedback will be utilized to develop and revise a treatment manual. And additional aim of this stage is to develop treatment adherence and compliance ratings for the manual. In phase 2 we plan to compare this new protocol, the Prolonged Exposure for Adolescents (PE-A, =31) to treatment as usual (TAU, n=31). Sixty-two individuals will be randomly assigned to either PEA or to TAU conditions. Outcome evaluations will be conducted at weeks 0 (pre-treatment); 15 (end of treatment); and at 25 weeks (3-month follow-up). It is hypothesized that patients with PTSD who receive PEA will show greater reductions in emotional distress and greater increase in social and emotional functioning as compared to TAU. In phase 3 we expend this protocol to include other traumas such as motor vehicle accidents (N = 6). The long-term goals of this research are to address the critical need for effective treatment of adolescent PTSD following a variety of common traumas and to encourage the dissemination of such measures.
