Feasibility and acceptability of therapist-guided, asynchronous, internet-delivered trauma-focused CBT for adolescents with PTSD: a single-group feasibility trial in Sweden

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Large effect sizes: CAPS-CA-5 Cohen's d=1.27, CATS-2 Cohen's d=1.51

• Primary Outcome: Feasibility and acceptability demonstrated with high retention and satisfaction

• Nnt Or Sensitivity: 47.6% of participants no longer met PTSD criteria at 1-month follow-up

• Confidence Interval: Not reported in abstract

Clinical Application

Highly feasible given Australia's digital health infrastructure and telehealth adoption post-COVID-19 Aligns with Australian Digital Health Strategy and could complement existing headspace services. May be suitable for PBS-subsidised psychological therapy programs and fits RACGP guidelines for adolescent mental health care delivery Australian adolescents aged 13-17 years with PTSD, particularly in rural/remote areas with limited access to specialist trauma services

Abstract

OBJECTIVES: Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic 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. DESIGN: Single-group feasibility trial. SETTING: Save the Children, Sweden. PARTICIPANTS: Twenty-two adolescents (13-17 years, 82% female) with primary PTSD. INTERVENTIONS: A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent-caregiver activities. OUTCOMES: Feasibility 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. 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) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint). RESULTS: Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen's d=1.27) and CATS-2 (Cohen's d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD. CONCLUSIONS: Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes. TRIAL REGISTRATION NUMBER: NCT06185244.

References

1. 1.Mattelin, E., Weyler, H., Andersson, R., Paulsen, J., Tielman, S., Vikgren, A., Bondjers, K., Serlachius, E., Mataix-Cols, D., & Bragesjö, M. (2026). Feasibility and acceptability of therapist-guided, asynchronous, internet-delivered trauma-focused CBT for adolescents with PTSD: a single-group feasibility trial in Sweden. BMJ Open. https://doi.org/10.1136/bmjopen-2026-117024