Nurses without psychotherapy training treated adolescent PTSD, and it held for five years

Design

randomised controlled trial with 60-month post-treatment follow-up

Population

63 adolescents with diagnosed PTSD, treated by trained non-specialist health workers

Primary outcome

PTSD symptom severity on the Child PTSD Symptom Scale

Effect

significant symptom reduction maintained to 60 months in both arms (F(7,343)=2.86, p<0.01); between-group difference not significant at 60 months (p=0.28, g=0.33)

Sixty-three adolescents with diagnosed PTSD were randomly assigned to prolonged exposure adapted for adolescents or to supportive counselling, both delivered by newly trained and supervised non-specialist health workers - nurses with no prior psychotherapy experience - in a low- or middle-income setting. Treatment averaged nine sessions. This report adds 60-month follow-up to previously published data at 3, 6, 12 and 24 months, with symptoms independently assessed on the Child PTSD Symptom Scale.

Both groups maintained significant symptom reduction to five years (F(7,343) = 2.86, p < 0.01). Prolonged exposure was better than supportive counselling at every earlier timepoint, but by 60 months the difference was no longer significant (p = 0.28, g = 0.33). The honest reading is that the specific advantage of the exposure protocol narrows over time while the gains from both treatments persist.

The finding worth acting on is the workforce one. A brief, manualised protocol, task-shifted to nurses without psychotherapy backgrounds and properly supervised, produced lasting improvement in a population that in most of the world has no access to a trained child psychotherapist at all. That is a service design argument, and it is directly applicable wherever the specialist waiting list is measured in years.

• Treat trained and supervised non-specialist delivery as a viable model for adolescent PTSD, not a compromise.
• Budget for the supervision, which is the part that made this work and the part usually cut first.
• Nine sessions is the tested dose - do not assume a shorter contact achieves the same.
• Both treatments held up; where exposure-trained staff are unavailable, structured supportive counselling is not nothing.
• With 63 adolescents, this establishes durability of benefit, not a reliable comparison between the two therapies.

Why it matters

It answers whether brief task-shifted psychological treatment lasts, which is the objection usually raised against building services around non-specialists.

Don't overread it

Sixty-three adolescents is too few to establish which of the two therapies is superior; the durable finding is that both held, not that they are equivalent.

The statistics, in plain English

The 60-month between-group comparison (p = 0.28, g = 0.33) is the kind of result that is easy to read wrongly. A Hedges' g of 0.33 is a small-to-moderate effect favouring prolonged exposure, and the non-significant p value with 63 participants means the study is too small to confirm it, not that the difference has disappeared. The robust finding is the within-group one: both treatments sustained improvement across five years.

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