Cognitive behavioural therapy (CBT) as an early intervention for PTSD in youth: preliminary efficacy and mechanisms of a

Following horrific or life threatening events (e.g. serious accidents, violence, or natural disasters) children and adolescents can, like adults, develop post-traumatic stress disorder (PTSD). PTSD is a serious anxiety disorder that can cause major disruption to an individual's functioning, and if left untreated can persist for years or even decades.
Recent research suggests that severe early PTSD symptoms put youth at high risk of developing chronic PTSD. Furthermore, it has been shown that that the development of PTSD in this age group is related to certain psychological processes, i.e. their memories of the trauma, and particular ways of thinking about and coping with the trauma. This understanding has led to the development of a psychological treatment for PTSD in youth. This treatment, cognitive behavioural therapy (CBT), has been shown to successfully treat chronic PTSD in children and adolescents.
The proposed research seeks to examine whether CBT might be an effective treatment for PTSD in the first few months following a trauma, and investigate in greater detail which psychological and biological processes lead to the development of early PTSD in young people. This research will inform how PTSD in young people can be best treated at an early stage.

Aims
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur in children and adolescence in response to trauma, e.g. road traffic accidents (RTAs) or natural disasters. While many children and adolescents recover unaided following a trauma, a significant minority experience chronic PTSD that may persist for years or even decades, and remain at increased risk of experiencing other emotional disorders in adulthood. The application of cognitive models of PTSD to youth has resulted in a successful cognitive behavioural therapy (CBT) treatment for chronic PTSD in this age group. However, an effective treatment is needed for acute PTSD in youth, before the child's developmental trajectory is compromised. The proposed study will investigate whether CBT, developed using the existing research for this age group, is an effective treatment in the acute phase.
Objectives
These are to:
1) Test the effectiveness of CBT as an early intervention for PTSD in youth;
2) Investigate the course and prevalence of PTSD within the early phase post-trauma (i.e. the first 2 months); and
3) Explore cognitive and biological correlates of PTSD.
Design
The proposed fellowship would comprise:
1) A prospective study of child and adolescent assault and RTA survivors in the first two months post-trauma;
2) Aa between-groups comparison (PTSD vs trauma-exposed non-PTSD vs non-trauma exposed) of cognitive processes and psychophysiological dysregulation in trauma-exposed and non-trauma exposed children and adolescents; and
3) An RCT of CBT for acute PTSD in youth, using a wait list control.
Methodology
Participants would be 8-18 year old non-sexual assault and RTA survivors, recruited from an A&E department. Participants would be asked to complete structured PTSD interviews at 2-4 weeks and 2 months post-trauma. Participants with PTSD at the 2-month assessment (along with a non-PTSD trauma-exposed control group) will be asked to complete a variety of cognitive and psychophysiological dysregulation tasks. Participants with PTSD will be invited to take part in an RCT for CBT for acute PTSD, and be randomised to either 10 sessions of CBT (over 10 weeks) or a 10 week wait list condition. Post-treatment assessments will be conducted by assessors blind to treatment status.
Scientific and medical opportunities
The proposed fellowship would provide clear guidelines for early interventions for PTSD in youth, and influence the development of future policy (e.g. NICE guidelines). Furthermore, the study will provide significant experimental evidence concerning the cognitive and biological mechanisms underlying acute PTSD in this age group.