Adaptation and Randomized Controlled Trial of Written Exposure Therapy for Adolescents

The University of California- Los Angeles Posttraumatic Stress Disorder Reaction Index (adolescent and caregiver versions), which are psychometrically strong tools to assess PTSD diagnosis among adolescents, will be administered. Total scores on this measure range from 0 to 108; scores of 35 or higher indicate high likelihood that individuals meet posttraumatic stress disorder (PTSD) diagnostic criteria. Higher scores indicate greater likelihood of meeting diagnostic criteria for PTSD.

The Child and Adolescent Trauma Screen (CATS) youth and caregiver reports (ages 7-17) assess exposure to 15 different types of potentially traumatic events followed by 20-items assessing PTSD symptoms. It is a widely used psychometrically validated tool and will be used to assess the adolescent's trauma exposure history and PTSD symptoms per self and caregiver report. Total scores on this measure range from 0 to 60; scores of 21 or higher indicate elevated symptoms of posttraumatic stress disorder (PTSD). Higher scores indicate greater PTSD symptoms.

The Cognitive Emotion Regulation Questionnaire - Short is an 18-item psychometrically validated measure of emotion regulation strategies and has been used widely with trauma exposed adolescents. The rumination subscale of the CERQ will be used to examine changes in ruminative thinking, a proposed mechanism of WET's action to be tested in the study, over the course of treatment. Total scores on this measure range from 18 to 90. Several subscales are included on this measure: Self-blame, Other-blame, Rumination, Catastrophizing, Putting into perspective, Positive refocusing, Positive reappraisal, Acceptance, and Planning Higher scores indicate higher levels of experiencing each symptom area measured (e.g., higher scores on the self blame subscale indicate greater self-blame; higher scales on the positive re-focusing indicate greater ability to positively refocus).

The Acceptability of Intervention Measure is a 4-item measure used to assess patient perceptions of new interventions, including whether they believe the new treatment is agreeable, palatable, or satisfactory on a five-point Likert scale. This measure will be administered to adolescents and their caregivers to gauge acceptability of the experimental intervention for meeting the needs of the adolescent population. Scores are averaged; total scores on this measure range from 1 to 5. Higher scores indicate greater acceptability of the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

The Feasibility of Intervention Measure is a 4-item measure to assess perceptions of whether an intervention will be able to be successfully implemented within a given agency or setting to a certain population of interest. This measure will be administered to adolescents and caregivers to gauge perceptions of feasibility of WET for delivery with adolescents. Scores are averaged; total scores on this measure range from 1 to 5. Higher scores indicate greater perceived feasibility of the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

The Client Satisfaction Questionnaire (8 item) measure examines satisfaction with treatment services on an 8-item Likert scale to assess perceptions of satisfaction following treatment services. It has been used among adolescent and caregiver populations and has strong psychometric properties. Total scores on this measure range from 8 to 32. Higher scores indicate greater satisfaction with the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

As part of WET, Subjective Units of Distress (SUDS) are verbally reported to examine current emotional arousal in response to exposure. Participants are prompted by the therapist to indicate level of emotional arousal on a scale of 0-100 before and following writing. Higher scores indicate greater levels of distress. Therapists will document reported SUDS weekly.

Questions will include probes about how to enhance the intervention to elicit impressions of the un-adapted content (e.g., written prompt wording, relevance of psychoeducational content, helpfulness), areas in need of adaptation, gaps missing in the manual, and recommendations for adaptations (e.g., wording alterations, content adaptations). Interviews will also inquire about barriers and facilitators to traditional trauma-focused treatment and whether WET meets or does not meet priorities and needs of adolescents with PTSD and their caregivers.

The Mini-International Neuropsychiatric Interview for Children and Adolescents is a structured clinic interview for assessing and diagnosing the most common psychiatric disorders among youth. It will be used to facilitate accurate diagnosis for comorbidities and identify whether participants meet exclusion criteria at baseline (i.e., active psychosis, active suicidal plan and intent, anorexia nervosa, severe substance use withdrawal symptoms). This interview has several subscales that allow for a diagnostic interview to assess common psychiatric conditions among youth and does not have a standardized range of scores.

Revised Children's Anxiety and Depression Scale caregiver and child surveys are 25-item scales assessing for depression and anxiety symptoms among youth. The RCADS-25 is psychometrically strong scales for use with adolescents and caregivers and therefore will be used to assess participant self-reported symptoms of depression and anxiety. Scores range from 0 to 75 and raw scores are converted to T scores in relation to normed data based on same aged peers. Higher scores on this measure indicate greater levels of depression and anxiety.