Brief guided written exposure therapy for PTSD and complex PTSD in adolescents: a pilot randomized controlled trial

Posttraumatic stress disorder (PTSD) is prevalent among adolescents, yet evidence-based treatments remain inaccessible to most. Complex PTSD (CPTSD), recently recognized in ICD-11, lacks empirical evidence to guide intervention in this population. Guided Written Exposure (GWE) is a brief, non-phased trauma-focused treatment with established efficacy in adults. This pilot trial evaluated the feasibility and preliminary efficacy of group-delivered GWE for adolescent PTSD and CPTSD. Fifty-three adolescents (aged 13–17) with PTSD symptoms following diverse trauma exposures were randomized to five-session group GWE ( n = 27) or waitlist ( n = 26). Primary outcomes were PTSD and CPTSD symptoms. Secondary outcomes included depression, anxiety, and affective and behavioral problems. Assessments occurred at baseline, post-intervention, 1-month, and 3-month (GWE only) follow-up. Treatment effects were analyzed using linear mixed-effects models. GWE produced significantly greater reductions than waitlist in PTSD ( d = − 1.15, 95% CI [− 1.89, − 0.41]) and CPTSD symptoms ( d = − 0.97, 95% CI [− 1.70, − 0.23]) at post-treatment, with gains maintained through 3-month follow-up. Depression and affective and behavioral problems also improved significantly. Retention was high (92.6%) with no adverse events. Anxiety did not differ between groups. Group-delivered GWE demonstrates promise as a brief, scalable intervention for posttraumatic stress symptoms, particularly in low-resource settings, and provides preliminary support that non-phased trauma-focused approaches may be feasible for adolescents with CPTSD. Replication in larger trials is warranted. ClinicalTrials.gov (NCT06403449). Registered on 3 May 2024.