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Temporal sequencing of symptom change in youth receiving treatment for posttraumatic stress disorder and substance use: secondary findings from a randomised controlled trial

Dobson, Olivia ; Peach, Natalie ; Cassar, Joanne ; Isik, Ashling ; Bezzina, Louise ; Schollar-Root, Olivia ; Kihas, Ivana ; Dobinson, Katherine ; Cobham, Vanessa and Barrett, Emma , et al. (2026) In European Journal of Psychotraumatology 17(1). p.1-1
Abstract
Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur in youth. Integrated, trauma-focused treatments are recommended, but evidence in youth is limited and the dynamics of symptom change are poorly understood.
Objectives: We investigated within-treatment changes in PTSD and substance use, and their temporal sequencing, in a randomised controlled trial (RCT) comparing integrated treatment with supportive counselling among youth aged 13–25 years.
Method: Participants (n = 55) were randomised to an integrated, exposure-based treatment, Concurrent Treatment of PTSD and SUD Using Prolonged Exposure – Adolescent version (COPE-A); or supportive counselling, Person-Centred Therapy (PCT).... (More)
Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur in youth. Integrated, trauma-focused treatments are recommended, but evidence in youth is limited and the dynamics of symptom change are poorly understood.
Objectives: We investigated within-treatment changes in PTSD and substance use, and their temporal sequencing, in a randomised controlled trial (RCT) comparing integrated treatment with supportive counselling among youth aged 13–25 years.
Method: Participants (n = 55) were randomised to an integrated, exposure-based treatment, Concurrent Treatment of PTSD and SUD Using Prolonged Exposure – Adolescent version (COPE-A); or supportive counselling, Person-Centred Therapy (PCT). PTSD and substance use symptoms were assessed at each session. Generalised estimating equations were used to analyse symptom change over time, and Spearman’s correlations were used to examine associations between early (sessions 1-5) and later (sessions 5-11) change.
Results: COPE-A showed significantly greater reductions in total PTSD symptom severity during treatment (β = −17.00, 95% CI −29.50 to −4.46); with no between-group differences in substance use quantity or frequency. PTSD symptom clusters improved concurrently, but no temporal relationships were observed. Temporal relationships for substance use change were limited, and changes in PTSD symptoms were not associated with concurrent or subsequent changes in substance use.
Conclusion: Integrated, trauma-focused treatment reduced PTSD symptoms, reinforcing the safety and tolerability of exposure-based therapy in this youth sample with comorbid PTSD-SUD. PTSD improvement was not associated with either concurrent or subsequent reductions in substance use. Understanding temporal patterns of change may help refine models of PTSD-SUD comorbidity and optimise intervention delivery. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
PTSD, substance use disorder, Integrated treatment, Adolescents, Young adults, Randomized controlled trial, temporal sequencing
in
European Journal of Psychotraumatology
volume
17
issue
1
pages
20 pages
publisher
Taylor & Francis
external identifiers
  • pmid:41791032
ISSN
2000-8066
DOI
10.1080/20008066.2026.2630609
project
Randomised controlled trial of an integrated cognitive-behavioural therapy for the treatment of co-occurring post traumatic stress disorder and substance use disorder in adolescents
language
English
LU publication?
yes
id
b4bdc8b5-bb27-421f-bebe-2c827765143d
date added to LUP
2026-03-10 11:26:08
date last changed
2026-03-11 10:04:12
@article{b4bdc8b5-bb27-421f-bebe-2c827765143d,
  abstract     = {{Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur in youth. Integrated, trauma-focused treatments are recommended, but evidence in youth is limited and the dynamics of symptom change are poorly understood.<br/>Objectives: We investigated within-treatment changes in PTSD and substance use, and their temporal sequencing, in a randomised controlled trial (RCT) comparing integrated treatment with supportive counselling among youth aged 13–25 years.<br/>Method: Participants (n = 55) were randomised to an integrated, exposure-based treatment, Concurrent Treatment of PTSD and SUD Using Prolonged Exposure – Adolescent version (COPE-A); or supportive counselling, Person-Centred Therapy (PCT). PTSD and substance use symptoms were assessed at each session. Generalised estimating equations were used to analyse symptom change over time, and Spearman’s correlations were used to examine associations between early (sessions 1-5) and later (sessions 5-11) change.<br/>Results: COPE-A showed significantly greater reductions in total PTSD symptom severity during treatment (β = −17.00, 95% CI −29.50 to −4.46); with no between-group differences in substance use quantity or frequency. PTSD symptom clusters improved concurrently, but no temporal relationships were observed. Temporal relationships for substance use change were limited, and changes in PTSD symptoms were not associated with concurrent or subsequent changes in substance use.<br/>Conclusion: Integrated, trauma-focused treatment reduced PTSD symptoms, reinforcing the safety and tolerability of exposure-based therapy in this youth sample with comorbid PTSD-SUD. PTSD improvement was not associated with either concurrent or subsequent reductions in substance use. Understanding temporal patterns of change may help refine models of PTSD-SUD comorbidity and optimise intervention delivery.}},
  author       = {{Dobson, Olivia and Peach, Natalie and Cassar, Joanne and Isik, Ashling and Bezzina, Louise and Schollar-Root, Olivia and Kihas, Ivana and Dobinson, Katherine and Cobham, Vanessa and Barrett, Emma and Perrin, Sean and Bendall, Sarah and Back, Sudie and Brady, Kathleen and Milne, Bronwyn and Teeson, Maree and Mills, Katherine}},
  issn         = {{2000-8066}},
  keywords     = {{PTSD; substance use disorder; Integrated treatment; Adolescents; Young adults; Randomized controlled trial; temporal sequencing}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{1}},
  pages        = {{1--1}},
  publisher    = {{Taylor & Francis}},
  series       = {{European Journal of Psychotraumatology}},
  title        = {{Temporal sequencing of symptom change in youth receiving treatment for posttraumatic stress disorder and substance use: secondary findings from a randomised controlled trial}},
  url          = {{http://dx.doi.org/10.1080/20008066.2026.2630609}},
  doi          = {{10.1080/20008066.2026.2630609}},
  volume       = {{17}},
  year         = {{2026}},
}