Adapting Written Exposure Therapy for Adolescents with Posttraumatic Stress Disorder

About This Grant

The objective of the proposed K23 research and training plan is to support Dr. Emily Tilstra-Ferrell in obtaining training needed to become an independent clinical scientist with a program of research focused on developing highly scalable, efficient evidence-based treatments (EBTs) for adolescents with posttraumatic stress disorder (PTSD) that can be delivered in accessible, real-world, multidisciplinary settings. Over four million adolescents in the United States (US) have PTSD. Although PTSD EBTs are available, only one third (37%) of adolescents access these treatments. Among the few who access PTSD EBTs, over one-third (34%) prematurely drop out due to barriers including lengthy protocols (the majority of dropout occurs before session seven). The proposed study directly addresses this clinical gap by adapting Written Exposure Therapy (WET), an EBT for adult PTSD, for adolescents. WET is an efficient, five-session PTSD treatment that is non-inferior to lengthier gold-standard PTSD EBTs for adults. WET addresses many barriers faced by adolescents who seek EBTs for PTSD due its brevity and related cost-effectiveness. However, WET has not been formally adapted or rigorously tested with adolescents. In Aim 1, WET will be adapted following a systematic model: Assessment, Decisions, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT). In Aim 2, a proof- of-concept randomized controlled trial (RCT) will be employed to compare WET to Trauma-Focused Cognitive Behavior Therapy (the gold-standard PTSD EBT for youth) delivered in a pediatric primary care setting to adolescents with PTSD. The final exploratory aim will examine the potential emotional (fear extinction) and cognitive (changes in ruminative cognition) mechanisms of action in WET. The mentorship team is comprised of numerous highly experienced mentors with NIH-funded research related to the proposed project including RCTs for adolescents with PTSD (Primary Mentor: Dr. Carla Kmett Danielson), ADAPT-ITT (Dr. Cristina López), advanced qualitative and mixed methods (Dr. Byron Powell), WET (Dr. Christine Hahn), dissemination and implementation science and EBTs for trauma-exposed youth in primary care settings (Dr. Rochelle Hanson), and longitudinal data analysis (Dr. Naomi Brownstein). The research opportunities, mentorship, and formal coursework afforded by the proposed K23 will ensure Dr. Tilstra-Ferrell gains the following skills needed to achieve her career goals: (1) conducting clinical trials with trauma-exposed adolescents, (2) using qualitative and mixed methods design to adapt and implement EBTs, (3) longitudinal data analysis, (4) dissemination and implementation science methods, and (5) improved scientific communication. The candidate will complete all proposed activities at the Medical University of South Carolina in the National Crime Victims Research and Treatment Center, which is internationally renowned for research on adolescent PTSD EBTs with a strong history of catapulting early career scientists to independence. The proposed K23 will ultimately prepare Dr. Tilstra-Ferrell to launch a program of research developing efficient and scalable PTSD EBTs for adolescents.