Therapist-guided internet-delivered trauma-focused CBT for adolescents with PTSD: A feasibility trial

ObjectivesTrauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric posttraumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12-week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD, and to explore preliminary changes in PTSD symptoms. DesignSingle-group feasibility trial. SettingSave the Children, Sweden. ParticipantsTwenty-two adolescents (13-17 years, 82% female) with primary PTSD. InterventionsA 12-week, therapist-guided, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint child-caregiver activities. OutcomesFeasibility measures included recruitment pace, participant retention, treatment adherence (module completion), and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects, and reported adverse events. Preliminary treatment effects were evaluated as within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2). Assessments occurred at baseline, during treatment, post-treatment, and at 1-month follow-up (primary endpoint). ResultsRecruitment was completed after seven months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Clinically meaningful within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohens d = 1.27) and CATS-2 (Cohens d = 1.51). ConclusionsTherapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable, and associated with clinically meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness, and long-term outcomes. Trial registrationClinicalTrials.gov NCT06185244. Article SummaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIFirst internet-delivered TF-CBT trial for young people with PTSD C_LIO_LIUse of clinician-rated PTSD symptoms (CAPS-CA-5) in combination with validated self-report measures. C_LIO_LIThe intervention was developed in close collaboration with clinicians, alongside contributions from young people. C_LIO_LIAbsence of a control group. C_LI