LAUSR

ABSTRACT Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed. Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents. Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11–19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6. Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen’s d = 0. 60, p < .01) and three-month follow-up (Cohen’s d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen’s d = 0.51, p = .03) and three-month follow-up (Cohen’s d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively). Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure. HIGHLIGHTS Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is one of the leading evidence-based treatments for child and adolescent posttraumatic stress, but an abbreviated version has not been evaluated in low- and middle-income countries (LMICs). At post-treatment and three-month follow-up, eight sessions of TF-CBT were more effective than treatment-as-usual in reducing posttraumatic stress and depression symptoms in an LMIC sample of South African adolescents exposed to multiple traumas. Effect sizes were similar to those reported for standard length TF-CBT, indicating that abbreviated TF-CBT may be a suitable option for resource-constrained child and adolescent mental health services in LMICs.