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Comment & Response
July 24, 2019

Posttraumatic Stress Disorder and Cognitive Processing Therapy in Youth–Reply

Author Affiliations
  • 1Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
  • 2Hochschule Döpfer, University of Applied Sciences, Research Center, Köln, Germany
  • 3Psychiatric University Hospital Regensburg, Regensburg, Germany
  • 4Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany
JAMA Psychiatry. 2019;76(10):1097-1098. doi:10.1001/jamapsychiatry.2019.1971

In Reply In her letter, Ferguson suggests psychopharmacological treatment as a possible confounder in our randomized clinical trial comparing developmentally adapted cognitive processing therapy (D-CPT) and wait-list with treatment advice (WL/TA) in 88 adolescents and young adults with abuse-related posttraumatic stress disorder (PTSD).1 She requests information on whether participants could have ongoing medication management appointments and clarification of the phrasing of the inclusion criterion, “had to be receiving no or stable psychopharmacological medication (for ≥3 weeks).”1 The answer to the first question is yes. If participants were undergoing pharmacological treatment (from a psychiatrist or other physician), they were allowed to continue to do so and to have medication management appointments; we only excluded participants receiving ongoing psychotherapy. However, to enter the trial, participants who were receiving psychopharmacological medication had to have been taking the same dosage for at least 3 weeks. However, medication at baseline cannot be regarded as a possible confounder. Initial baseline randomization checks resulted in 9 of 44 participants (20%) in WL/TA and 10 of 43 (23%) in D-CPT receiving stable psychopharmacological medication (χ = 0.10; P = .75; n = 87; 1 participant in D-CPT met the inclusion/exclusion criteria, but detailed documentation on medication was missing). As participants in WL/TA were given recommendations for psychotherapists in their area, they were, at least in theory, more likely to receive medication after entering the trial in the event that a psychiatrist/general practitioner was consulted too. Again, this would not be a confounding variable but an inherent potential component of WL/TA. However, we did not encourage participants in WL/TA to seek pharmacological treatment but explicitly encouraged them to seek psychotherapy, as their primary diagnosis was PTSD, which leads us to the second part of Ferguson’s comment.

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