Prolonged exposure för tonåringar – en litteraturöversikt

Teenagers are at high risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). This literature study evaluates the evidence for one of the treatment protocols, Prolonged Exposure for Adolecescents (PE-A), as well as looking at the clinical implications of the studies that have been done. Reviews in databases resulted in nine articles, four of them were randomized controlled studies (RCTs) and five were clinical studies without control group (non-RCTs). The RCTs were evaluated with the Cochrane Risk of bias Tool and RCT of Psychotherapy Quality Rating Scale. Non-RCTs were evaluated using four aspects: relevance, selection bias, weakness in design, and the possibility to generalize the results to clinical situations. The result of all four RCTs showed that PE-A has a good effect and that it is better than the treatments compared with. All four RCTs were considered being of good quality. The non-RCTs showed similar results but were of varied scientific quality. The conclusion of this literature study is that PE-A has a good effect treating teenagers with PTSD and that the studies that have been done are of sufficient quality to say that PE-A should be recommended as treatment for teenagers. The most important clinical implication was that PE-A should be considered as first choice treatment for adolescent PTSD together with Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Future research will have to compare the interventions with promising evidence, mainly TF-CBT and PE-A. Studies also need to show what interventions work best for which groups of patients.
Tonåringar löper hög risk att utsättas för traumatiska händelser och utveckla posttraumatiskt stressyndrom (PTSD). En litteraturstudie gjordes för att undersöka vilken kvalitet evidensen för behandlingsformen Prolonged Exposure (PE-A) har för tonåringar, samt kliniska implikationer av den forskning som har gjorts. Sökningen efter litteratur resulterade i nio artiklar, fyra randomiserade kontrollerade studier och fem kliniska studier utan kontrollgrupp. De randomiserade, kontrollerade studierna granskades med hjälp av Cochrane Risk of bias Tool och RCT of Psychotherapy Quality Rating Scale. Övriga artiklar granskades utifrån fyra områden: relevans, selektionsbias, svagheter i design samt generaliserbarhet. Samtliga fyra randomiserade kontrollerade studier visade att PE-A ger god effekt och var bättre än jämförelsegruppen. Studierna bedömdes vara av god kvalitet. Studierna med annan design visade på likande resultat men bedömdes ha varierande kvalitet. Den sammantagna slutsatsen var att PE-A har tillräckligt vetenskapligt stöd för att rekommenderas som behandlingsmetod för tonåringar med PTSD. Den viktigaste kliniska implikationen var att PE-A kan betraktas som förstahandsval jämte TF-KBT för behandling av tonåringars PTSD. Framtida forskning behöver jämföra de interventioner som i nuläget har lovande evidens, framför allt TF-KBT och PE-A. Det behövs också studier som ger svar på vilka interventioner som ger bäst resultat för olika patienter.