{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:58:23Z","timestamp":1786978703890,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Trauma\u2010focused cognitive\u2010behavioral therapies (TF\u2010CBTs) are efficacious in children and adolescents with post\u2010traumatic stress disorder (PTSD). However, there is limited evidence in youth exposed to multiple traumas, especially in real\u2010world settings. This paper reports on a pragmatic randomized controlled trial (RCT) evaluating whether one form of TF\u2010CBT, cognitive therapy for PTSD (CT\u2010PTSD), was effective for PTSD following multiple trauma exposure in 8\u201017\u00a0year\u2010olds attending UK mental health services, relative to treatment\u2010as\u2010usual (TAU). Youth with PTSD (N=120) following multiple traumas were randomly allocated to receive CT\u2010PTSD or TAU. At baseline, complex PTSD diagnosis was common (55.0% of cases), and a large proportion of youth had comorbid mental disorders. The primary outcome was the score on the Child Revised Impact of Event Scale, 8\u2010item version (CRIES\u20108) at post\u2010treatment. Secondary outcomes included the CRIES\u20108 score at 11 months post\u2010randomization, and several measures of PTSD, anxiety, depression, suicidal ideation, affect regulation, irritability, and general functioning at post\u2010treatment and 11 months post\u2010randomization. CT\u2010PTSD was not found to be significantly superior to TAU on the CRIES\u20108 at post\u2010treatment (adjusted difference: \u20133.80, 95% CI: \u20137.56 to \u20130.06, p=0.095; Hedges' g=\u20130.37, 95% CI: \u20130.78 to 0.03), but it was superior to TAU when patients who had received TF\u2010CBT were excluded from that arm (adjusted difference: \u20134.60, 95% CI: \u20138.36 to \u20130.81, p=0.047; g=\u20130.46, 95% CI: \u20130.89 to \u20130.04). CT\u2010PTSD was also superior to TAU on the CRIES\u20108 at 11 months (adjusted difference: \u20135.38, 95% CI: \u20138.88 to \u20131.87, p=0.003; g=\u20130.46, 95% CI: \u20130.90 to \u20130.02), and in a mixed\u2010effect model incorporating all time points (p=0.007). Evidence of superiority for CT\u2010PTSD was observed on parent\u2010reported emotional difficulties at post\u2010treatment and 11 months; and on child\u2010reported total anxiety and depression, total anxiety, panic and separation anxiety, and parent\u2010reported affect dysregulation and irritability at 11 months. Treatment withdrawal rate was low. Despite high baseline levels of comorbidity and impairment not seen in previous trials, CT\u2010PTSD was not associated with significant deterioration or adverse events. This pragmatic trial is likely to contribute to the optimization of psychological intervention in youth with PTSD following multiple traumas, accompanied by severe comorbid mental disorders, in routine settings.<\/jats:p>","DOI":"10.1002\/wps.21355","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T08:23:34Z","timestamp":1757924614000},"page":"422-434","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A pragmatic randomized controlled trial of cognitive therapy for post\u2010traumatic stress disorder in children and adolescents exposed to multiple traumatic stressors: the\n                    <scp>DECRYPT<\/scp>\n                    trial"],"prefix":"10.1002","volume":"24","author":[{"given":"Richard","family":"Meiser\u2010Stedman","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology and Psychological Therapies, Norwich Medical School University of East 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