Nine sessions from nurses with no therapy training still held up five years later

Sixty-three South African adolescents with PTSD were treated by newly trained non-specialist health workers. Gains persisted at 60 months - and prolonged exposure's advantage over supportive counselling, present at every earlier follow-up, had closed by then.

Most trauma-focused therapy trials follow people for a year at most, and most are delivered by specialists in well-resourced settings. This one is neither. Researchers led by Jaco Rossouw randomised 63 adolescents diagnosed with PTSD to prolonged exposure for adolescents or to supportive counselling, both delivered by newly trained and supervised non-specialist health workers - nurses without prior psychotherapy experience - in a low- and middle-income country setting. The protocol averaged nine sessions. PTSD symptom severity was assessed independently on the Child PTSD Symptom Scale, and this report adds a 60-month follow-up to post-treatment, 3-month, 6-month, 12-month and 24-month data published previously. Both groups maintained a significant reduction in PTSD symptoms all the way to five years. The comparison between them is the part worth reading carefully. Prolonged exposure produced greater improvement at every single follow-up point except the last: at 60 months the difference was not significant, p equal to 0.28, with a small-to-moderate effect size of 0.33 still favouring it. So the honest statement is that both treatments lasted, and that the advantage of the trauma-focused one, consistent for four years, could no longer be demonstrated at five - which is not the same as it having disappeared, in a trial of 63 people where the power to detect a modest difference at the final timepoint is limited. The headline is what survived: a brief protocol, task-shifted to nurses with no therapy background, producing improvements that were still there half a decade later.