Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting

This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). Adolescent participants and nurse providers were purposively rec...

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Bibliographic Details
Published in:PloS one 2018-07, Vol.13 (7), p.e0199816-e0199816
Main Authors: van de Water, Tanya, Rossouw, Jaco, Yadin, Elna, Seedat, Soraya
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Adults
Africa
Anxiety
Attitude
Behavior therapy
Biology and Life Sciences
Care and treatment
Child & adolescent psychiatry
Children & youth
Clinical trials
Community
Comparative analysis
Content analysis
Control
Counseling
Counseling - economics
Counseling - standards
Counseling psychology
Developing Countries
Exposure
Female
Health aspects
Humans
Internet
Intervention
Male
Medical personnel
Medicine and Health Sciences
Mental depression
Mental disorders
Mental health
Nurse Practitioners - psychology
Nurse-Patient Relations
Nurses
People and Places
Post traumatic stress disorder
Posttraumatic stress disorder
Practice
Psychotherapy
Psychotherapy - economics
Psychotherapy - standards
Randomized Controlled Trials as Topic
Research and Analysis Methods
Retraining
Social Sciences
Stress
Stress Disorders, Post-Traumatic - psychology
Stress Disorders, Post-Traumatic - therapy
Teenagers
Trauma
Youth
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Summary:This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). Adolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention. Regardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive. Both PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0199816