Intensive Trauma-Focused Treatment for Adolescents With Post-Traumatic Stress Disorder (PTSD): Feasibility and Preliminary Effects
Conditions: PTSD - Post Traumatic Stress Disorder
Sponsor: Karolinska Institutet

 
 
 
Principal investigator: Maria Helander, maria.helander@ki.se, 
Centre for Psychiatry Research, Department of Clinical 
Neuroscience, Karolinska Institutet, & Stockholm Health Care 
Services, Region  Stockholm,  Sweden 
Date: August 26, 2025 
      
INTENSIVE TRAUMA-FOCUSED 
TREATMENT FOR 
ADOLESCENTS WITH PTSD: 
FEASIBILITY AND PRELIMINARY 
EFFECTS 
Study Protocol 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
1 
 
Study Protocol 
Intensive Trauma-Focused Treatment for Adolescents With PTSD: Feasibility and 
Preliminary Effects 
 
Post-Traumatic Stress Disorder (PTSD) is associated with a high risk of chronicity if 
untreated (Pietrzak et al., 2012). Rapid and effective interventions are crucial for reducing 
symptom burden and preventing long-term complications. According to treatment guidelines 
(NICE, 2018), the two primary recommended treatments for PTSD in children and 
adolescents are Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2018) 
and Eye Movement Desensitization and Reprocessing (EMDR; Shapiro, 2007), both of which 
are supported by substantial empirical evidence (e.g., Bastien et al., 2020). These treatments 
typically involve 6–9 months of weekly sessions. 
 
A notable challenge in treating adolescents with PTSD is the high rate of premature 
treatment termination (Simmons et al., 2021). Increasing treatment intensity may reduce 
dropout rates, as studies indicate that more frequent sessions lead to greater symptom 
reduction and improved retention (Wachen et al., 2019). In adult populations, intensive 
programs that combine evidence-based therapies such as EMDR and Prolonged Exposure 
(PE), alongside physical activity and psychoeducation, have shown promising results, 
including significant symptom reduction and lower dropout rates (e.g., Tinghög et al., 2024; 
Van Minnen et al., 2020).  
 
While EMDR and exposure-based therapies share some similarities, they operate through 
different mechanisms. TF-CBT utilizes continuous exposure to facilitate habituation and fear 
extinction, whereas EMDR employs dual attention stimulation, often via eye movements. The 
hypothesis that combining both approaches can enhance treatment effects through 
complementary mechanisms (Van Minnen et al., 2020) requires further investigation, 
particularly in an intensive format. 
 
For adolescents, treatment protocols similar to those developed for adults have emerged, 
evaluating variations of 5-8 days of intensive treatment that combines therapeutic modalities 
such as EMDR and CBT-based treatments like PE or TF-CBT, along with parental support 
and physical activity. In the Netherlands, a Brief Intensive Trauma Treatment (KIT; Korte 
Intensieve Traumabehandeling) model has been developed, which combines EMDR with TF-
CBT, physical exercise, and parental support (Albisser et al., 2024). 
Despite promising outcomes indicating rapid symptom alleviation—often within a week—
existing research on intensive trauma treatments for children and adolescents is limited. 
Notably, no randomized controlled trials (RCTs) have been published, and many studies lack 
control groups (van Pelt et al., 2021). Observed results suggest that most participants no 
longer met PTSD diagnostic criteria post-treatment while reporting reduced depressive 
symptoms. However, methodological limitations call for cautious interpretation of these 
findings (Albisser et al., 2024; Rentinck et al., 2025). 
This project is designed as a feasibility study utilizing a within-group design to assess the 
viability and preliminary effects of a Swedish adaptation of the KIT model in preparation for 
a larger RCT. This intensive five-day trauma-focused intervention will incorporate EMDR 
and TF-CBT elements alongside physical activity and parent sessions, targeting adolescents 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
2 
 
with PTSD referred to the Child and Adolescent Psychiatry (CAP) Trauma Unit in Stockholm. 
Ethical approval for the study has been granted (Dnr 2024-05726-02). 
Research Questions 
1. Is the intensive KIT-S intervention a feasible and appropriate treatment approach for 
PTSD in Swedish child and adolescent psychiatry, in terms of clinician experience, 
patient retention, patient satisfaction, and occurrence of adverse effects? 
2. Does KIT-S lead to expected reductions in PTSD symptoms and general psychological 
distress? 
Hypotheses 
1. We hypothesize that intensive trauma-focused psychological treatment with EMDR, 
components of TF-CBT, combined with physical activity and a parent group, will be 
perceived as a feasible, suitable, and acceptable treatment method for PTSD within Swedish 
child and adolescent psychiatry in terms of: 
 a. Clinicians' ratings of whether they find the intensive trauma-focused treatment acceptable, 
appropriate, and feasible.  
 b. The number of patients who complete the treatment without dropping out 
 c. Patients' self-reported satisfaction with the treatment 
 d. The proportion of patients with "adverse effects" 
2. We hypothesize that preliminary results of intensive trauma-focused treatment with EMDR, 
components of TF-CBT, combined with physical activity and a parent group for PTSD, will 
lead to a decrease in symptoms in the expected direction in terms of 
 a. PTSD symptoms 
 b. General mental health 
Method 
Participants 
The study is embedded in routine clinical practice. Both clinicians, patients, and caregivers 
participate in the project after informed consent. The clinical team consists of seven 
psychologists and four social workers with therapist training and extensive experience. 
20 patients with PTSD between 13 and 17 years of age who are referred to the specialized 
trauma unit within Stockholm Child and Adolescent Psychiatry will be included in the study. 
Inclusion criteria are a PTSD diagnosis, no or stable medication involving antidepressants, 
stimulants, and/or antipsychotics, and at least one caregiver who can participate in the 
treatment. Exclusion criteria are high risk for suicide, IQ below 75, and current substance 
abuse. 
Procedure 
Patients who meet the inclusion criteria after assessment at the BUP Trauma Unit are 
informed about the study. If interested, they attend a meeting to receive further verbal and 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
3 
 
written information and provide consent. Inclusion is decided during treatment planning 
meetings. Background data is collected, and a diagnostic interview is scheduled. Upon 
inclusion, an additional session was scheduled with the patient and their caregiver to identify 
target memories, avoidance behaviors, and trauma-related triggers in preparation for intensive 
Patients who declined participation in the study were offered standard trauma treatment at 
the clinic, consistent with the evidence-based care provided to all referred patients. Their 
access to other services within the Trauma Unit remained unaffected. 
Each semester, one to three intensive weeks are held for groups of three patients. Patients 
not interested in the study are offered standard trauma treatment.  
Data is collected using paper-based self-report measures completed by the patient, 
caregiver, and clinician. All rating forms are stored at the CAP Trauma Unit separately from 
medical records in a locked archive. The results of the structured diagnostic interview are 
recorded in the electronic patient journal system, Take Care. 
The clinicians who participate as therapists in the study will give their view on how 
appropriate, acceptable, and feasible the treatment is perceived after completing an intensive 
treatment week, and after all 20 patients have been treated. 
Intervention 
The intensive treatment incorporates core components from Trauma-Focused Cognitive 
Behavioral Therapy (TF-CBT) for children and adolescents (Cohen, Mannarino, & Deblinger, 
2008) as well as the standard EMDR protocol (Shapiro, 2018). The treatment consists of daily 
sessions over five days and includes five 120-minute TF-CBT sessions, four 120-minute 
EMDR sessions, and a concluding joint session with a caregiver during which the patient 
shares their trauma narrative (see Table 1). Following the intensive treatment week, three 
individual follow-up sessions are conducted at one-, two-, and four weeks post-treatment. 
In parallel with the adolescent’s trauma therapy, a caregiver group is offered for parents, 
foster carers, or residential staff. On days one and two, caregivers participate in group 
sessions focused on psychoeducation. The caregiver component is followed by two individual 
caregiver sessions. 
Table 1.  
Intensive Trauma Treatment Schedule  
TIME 
MONDAY 
TUESDAY 
WEDNESDAY THURSDAY FRIDAY 
10.00–12.00 
TF-CBT 
TF-CBT 
Caregiver 
group in 
parallel 
TF-CBT 
TF-CBT 
Caregiver 
group in 
parallel 
TF-CBT + 
Narrative 
Preparation 
12.00–13.00 
LUNCH 
LUNCH 
LUNCH 
LUNCH 
 
13.00–15.00 
EMDR 
EMDR 
TF-CBT 
EMDR 
Individual 
patient and 
caregiver 
Session 
15.15–16.00 
Physical 
Training 
Physical 
Training 
Physical 
Training 
Physical 
Training 
 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
4 
 
Outcome measures 
Measures of acceptability, appropriateness, and feasibility (Weiner et al., 2017). 
Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), 
and Feasibility of Intervention Measure are three rating forms that are considered leading in 
measuring successful implementation (Proctor et al., 2011). Acceptability is defined in terms 
of how well an intervention/intervention/product is perceived as acceptable or satisfactory by 
different stakeholders. Appropriateness refers to how well an intervention fits or is considered 
appropriate in a context. Feasibility refers to the degree to which a new treatment can be used 
successfully within a given context (Proctor et al., 2011). AIM, IAM, and FIM consist of four 
questions each and have good psychometric properties (Cho et al., 2022; Weiner et al., 2017). 
The rating instruments are rated on a 5-point scale from "do not agree at all" to "strongly 
agree". Example questions: AIM: CPP lives up to my expectations, IAM: CPP seems 
appropriate and FIM: CPP seems feasible to implement. 
Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version (CAPS-
CA-5; Nader et al., 1996). The CAPS-CA-5 is a structured diagnostic interview assessing 
PTSD diagnosis (Nader et al., 1996; Pynoos et al., 2015). It contains 30 items and assesses 
symptom severity by combining frequency and intensity ratings on a 0–4 scale, minimum 
value = 0, maximum value = 120 CAPS-CA-5 total symptom severity score is calculated by 
summing severity scores for the 20 DSM-5 PTSD symptoms. Similarly, CAPS-CA-5 
symptom cluster severity scores are calculated by summing the individual item severity scores 
for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C 
(items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20). PTSD diagnostic status 
is determined by first dichotomizing each symptom as "present" or "absent," then following 
the DSM-5 diagnostic rule. A symptom is considered present only if the corresponding item 
severity score is rated 2 ("moderate/threshold") or higher.  
Child and adolescent trauma screen 2 (CATS-2-F; Sacher et al., 2022). Trauma 
symptoms are assessed using the CATS-2, both for the adolescent (CATS-2-U) and for the 
caregiver (CATS-2-F). This trauma questionnaire screens for both trauma history and trauma 
symptoms based on DSM-5 criteria. The CATS-2 consists of two parts. Part one is a screening 
for potentially traumatic events at any point in the individual's life, comprising 15 items 
where the patient can answer YES or NO. Part two is a screening for post-traumatic 
symptoms over the past four weeks, with 20 items and five questions about how the child’s 
daily life has been impacted by these symptoms. The total score for CATS-2-U may vary 
between 0 and 60 points. Each item is rated on a four-point Likert scale between 0 (never) to 
3 (almost always), and the total score is calculated by summing the answers from each item. A 
higher score indicates a worse outcome. 
The Children Impact of Event Scale (CRIES-13; Dyregrov et al., 1996).  CRIES-13 is a 
13-item scale assessing PTSD symptoms using a four-point Likert scale (Not at all, Rarely, 
Sometimes, Often), scored 0,1,3,5 with no reversed items. It includes subscales for intrusion 
(four items), avoidance (four items), and arousal (five items). The total score thus ranges from 
0 to 65 on this 13-item scale. A higher score indicates a worse outcome in terms of PTSD 
symptom burden. CATS-2 (Sacher et al., 2022) is used for both youth and caregivers to screen 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
5 
 
for trauma history and symptoms. It contains two parts: 15 yes/no items for trauma exposure 
and 20 items for PTSD symptoms rated on a 0–3 Likert scale. 
The Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001). The SDQ is a 
25-item scale assessing general psychological functioning. A total difficulties score is 
generated by summing scores from all the scales except the prosocial scale, with a minimum 
value of 0 to a maximum value of 40. Each subscale consists of 5 items each (range 0-2 from 
"not true", to "certainly true". A higher score indicates a worse outcome. 
Client Satisfactory Questionnaire-8 (CSQ-8; Attkisson & Zwick, 1982). The Client 
Satisfaction Questionnaire-8 is an 8-item self-report scale measuring satisfaction with 
treatment. Items are scored on a Likert scale from 1 (low satisfaction) to 4 (high satisfaction) 
with different descriptors for each response point. Total scores range from 8 to 32, with higher 
scores indicating greater satisfaction. 
Adverse events. Clinicians complete a brief checklist with the patient and caregiver each 
morning during the intensive week and at follow-up sessions. Questions include whether the 
patient has self-harmed, had increased suicidal thoughts, or sought emergency psychiatric care 
since the last session.  
Table 2.  
Overview over outcome measures and time points for assessment. 
Note. CAPS-CA-5 = Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version; CRIES-13 =The Children's 
Revised Impact of Event Scale; CATS-2-U/CATS-2-F= Child and Adolescent Trauma Screen 2; SDQ=The Strengths and Difficulties 
Questionnaire; CSQ-8= Client Satisfaction Questionnaire; AIM= Acceptability of Intervention Measure; IAM= Intervention 
Appropriateness Measure; FIM= Feasibility of Intervention Measure.  
Time points for data assessment 
Data is collected at baseline and at five weeks post treatment week for all measures. In 
addition, two of the measures are collected with higher intensity, the CRIES 13, self rated 
measure of PTSD symptoms is collected daily during the treatment week and at one and two 
Measure 
Category 
Instrument 
Items 
Respon-
dent(s) 
Format 
Baseline 
assessment 
Days  
1–5 
Week 
1 
Week 
2 
Week 4 
Week 
5 
Timeline 
 
 
 
 
Pre 
treatment 
Treat
ment 
Post treatment 
Background Background 
Info 
12 
Clinician 
Form 
✓ 
 
 
 
 
 
PTSD 
Diagnosis 
CAPS-CA-
5 
- 
Youth 
Interview 
✓ 
 
 
 
 
✓ 
PTSD 
Symptoms 
CRIES-13 
13 
Youth 
Scale 
✓ 
✓ 
✓ 
✓ 
 
✓ 
PTSD 
Symptoms 
CATS-2-
U/F 
- 
Youth/ 
Caregiver 
Scale 
✓ 
 
✓ 
✓ 
 
✓ 
Mental 
Health 
SDQ (total) 
25 
Youth/ 
Caregiver 
Scale 
✓ 
 
 
 
 
✓ 
Treatment 
Satisfaction 
CSQ-8 
8 
Youth 
Scale 
 
 
 
 
 
✓ 
Implemen- 
tation 
AIM/IAM/ 
FIM 
16 
Clinician 
Scale 
 
 
 
 
 
✓ 
Adverse 
Effects 
Checklist 
3 
Clinician 
Checklist 
✓ 
✓ 
✓ 
✓ 
 
✓ 

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
6 
 
weeks post treatment. The CATS 2 is assessed at one and two weeks post treatment by both 
the patient and the caregiver. See Table 2 for assessment overview. 
Data analysis 
To consider the intervention acceptable, appropriate, and feasible, at least 80% of clinicians 
must rate the method above 50 on a 0–100 scale on the AIM, IAM, and FIM subscales. 
Attrition rates will be compared to dropout rates reported in earlier studies. 
As a pilot study with a limited sample size, inferential statistics are not planned. Instead, 
changes in PTSD symptoms and mental health will be examined descriptively. Planned 
analyses include within-group effect sizes and proportions of patients in full or partial 
remission.  
 References 
Albisser, N., Westerveld, M., Kooij, L., de Keizer-Altink, M., & Lindauer, R. (2024). Korte 
intensieve traumabehandeling bij jongeren. Kind & Adolescent Praktijk, 23(3), 16–24.  
Attkisson, C. C., & Zwick, R. (1982). The client satisfaction questionnaire. Psychometric 
properties and correlations with service utilization and psychotherapy outcome. Evaluation 
and Program Planning, 5(3), 233–237.  
Bastien, R. J. B., Jongsma, H. E., Kabadayi, M., & Billings, J. (2020). The effectiveness of 
psychological interventions for post-traumatic stress disorder in children, adolescents and 
young adults: A systematic review and meta-analysis. In Psychological Medicine (Vol. 50, 
Issue 10, pp. 1598–1612). Cambridge University Press.  
Cho, E., Lyon, A. R., Tugendrajch, S. K., Marriott, B. R., & Hawley, K. M. (2022). Assessing 
provider perceptions of training: Initial evaluation of the Acceptability, Feasibility, and 
Appropriateness Scale. Implementation Research and Practice, 3, 263348952210862. 
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral 
therapy for children and families. Psychotherapy Research, 28(1), 47–57.  
Dyregrov, A., Kuterovac, G., & Barath, A. (1996). Factor analysis of the impact of event scale 
with children in war. Scandinavian Journal of Psychology, 37(4), 339–350.  
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. 
Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1337–1345.  
Hendriks, L., de Kleine, R. A., Heyvaert, M., Becker, E. S., Hendriks, G. J., & van Minnen, A. 
(2017). Intensive prolonged exposure treatment for adolescent complex posttraumatic 
stress disorder: A single‐trial design. Journal of child psychology and psychiatry, 58(11), 
1229-1238.  
Mevissen, L., Ooms-Evers, M., Serra, M., de Jongh, A., & Didden, R. (2020). Feasibility and 
potential effectiveness of an intensive trauma-focused treatment programme for families 
with PTSD and mild intellectual disability. European Journal of Psychotraumatology,11(1).  

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
7 
 
Nader, K., Kriegler, J.A., Blake, D.D., Pynoos, R.S., Newman, E., & Weathers, F.W. (1996). 
Clinician-Administered PTSD Scale, Child and Adolescent Version. [Assessment] 
Department of Veterans Affairs National Center for PTSD.   
Ooms-Evers, M., van der Graaf-Loman, S., van Duijvenbode, N., Mevissen, L., & Didden, R. 
(2021). Intensive clinical trauma treatment for children and adolescents with mild 
intellectual disability or borderline intellectual functioning: A pilot study. Research in 
Developmental Disabilities, 117.  
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012). Psychiatric 
comorbidity of full and partial posttraumatic stress disorder among older adults in the 
United States: Results from wave 2 of the national epidemiologic survey on alcohol and 
related conditions. American Journal of Geriatric Psychiatry, 20(5), 380–390.  
Post-traumatic stress disorder NICE guideline. (2018). www.nice.org.uk/guidance/ng116 
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & 
Hensley, M. (2011). Outcomes for Implementation Research: Conceptual Distinctions, 
Measurement Challenges, and Research Agenda. Administration and Policy in Mental 
Health and Mental Health Services Research, 38(2), 65–76. 
Pynoos, R. S., Weathers, F. W., Steinberg, A. M., Marx, B. P., Layne, C. M., Kaloupek, D. 
G., Schnurr, P. P., Keane, T. M., Blake, D. D., Newman, E., Nader, K. O., & Kriegler, J. 
A. (2015). Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent 
Version. [Assessment] Available from the National Center for PTSD at www.ptsd.va.gov. 
Rentinck, E. M., van Mourik, R., de Jongh, A., & Matthijssen, S. J. (2025). Effectiveness of 
an intensive outpatient treatment programme combining prolonged exposure and EMDR 
therapy for adolescents and young adults with PTSD in a naturalistic setting. European 
Journal of Psychotraumatology, 16(1), 2451478.  
Sachser, C., Berliner, L., Risch, E., Rosner, R., Birkeland, M. S., Eilers, R., Hafstad, G. S., 
Pfeiffer, E., Plener, P. L., & Jensen, T. K. (2022). The Child and Adolescent Trauma 
Screen 2 (CATS-2)—Validation of an instrument to measure DSM-5 and ICD-11 PTSD 
and complex PTSD in children and adolescents.  European Journal of Psychotraumatology, 
13(2), Article 2105580. 
Shapiro, F. (2007). EMDR, Adaptive Information Processing, and Case Conceptualization. 
Journal of EMDR Practice and Research, 1(2), 68–87.  
Simmons, C., Meiser-Stedman, R., Baily, H., & Beazley, P. (2021). A meta-analysis of 
dropout from evidence-based psychological treatment for post-traumatic stress disorder 
(PTSD) in children and young people. In European Journal of Psychotraumatology (Vol. 
12, Issue 1). Taylor and Francis Ltd.  

Study Protocol: Feasibility and preliminary effects of an intensive trauma-focused treatment for Adolescents 
with PTSD 
8 
 
Tinghög, P., Vågbratt, L., Jennstål, J., Bragesjö, M., & Möller, N. (2024). Acceptability and 
Preliminary Effects of Intensive Brief Trauma-Focused PTSD Treatment for Refugees. 
Torture Journal, 34(3), 54–63. 
Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & de Jongh, A. (2020). Sequence matters: 
Combining Prolonged Exposure and EMDR therapy for PTSD. Psychiatry Research, 290.  
van Pelt, Y., Fokkema, P., de Roos, C., & de Jongh, A. (2021). Effectiveness of an intensive 
treatment programme combining prolonged exposure and EMDR therapy for adolescents 
suffering from severe post-traumatic stress disorder. European Journal of 
Psychotraumatology, 12(1).  
Van Woudenberg, C., Voorendonk, E. M., Bongaerts, H., Zoet, H. A., Verhagen, M., Lee, C. 
W., van Minnen, A., & De Jongh, A. (2018). Effectiveness of an intensive treatment 
programme combining prolonged exposure and eye movement desensitization and 
reprocessing for severe post-traumatic stress disorder. European Journal of 
Psychotraumatology, 9(1).  
Wachen, J. S., Dondanville, K. A., Evans, W. R., Morris, K., & Cole, A. (2019). Adjusting the 
Timeframe of Evidence-Based Therapies for PTSD-Massed Treatments. In Current 
Treatment Options in Psychiatry (Vol. 6, Issue 2, pp. 107–118). Springer.  
Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., Boynton, 
M. H., & Halko, H. (2017). Psychometric assessment of three newly developed 
implementation outcome measures. Implementation Science : IS, 12(1), 108.