The disaster of September 11 and the constant threat of imminent terrorist activity have brought into the forefront the need to develop and test efficient interventions for trauma-related psychological disturbances such as PTSD. It is important to remember, however, that terror-attacks constitute only one type of trauma and in fact is much less relevant in the US than other types of trauma such as natural disasters, traffic accidents and assault. Notably, data from large-scale epidemiological studies of children, adolescents, and adults indicate a 10% lifetime prevalence of child sexual abuse (CSA). Moreover, 62% of rapes occur during childhood or adolescence. Given the high prevalence of CSA, a clear association between CSA, PTSD, substance abuse, and sexual re-victimization during adolescence, it is of paramount importance to develop efficient, effective, and readily disseminable treatments for adolescents who suffer PTSD and related emotional difficulties as a result of CSA or sexual assault. Presently, there are effective treatment for adults and for children who suffer from CSA and sexual assault related PTSD, but very little is known about how best to treat traumatized adolescents who suffer from PTSD and associated symptoms, including PTSD related to sexual assault. The proposed research aims to examine the efficacy of a cognitive behavioral treatment developed for PTSD in adolescents exposed to CSA and sexual assault. Most importantly, the treatment will be conducted by counselors at a community clinic that provides services to victims of sexual assault across the developmental spectrum. Primary aims are: 1) To compare the immediate outcome of two active treatments, Prolonged Exposure for Adolescents (PE-A) and supportive counseling (SC), in reducing PTSD symptom severity; and 2) To assess maintenance of PE-A treatment gains at follow-up. Secondary aims are: 1) To compare PE-A and SC's effects in reducing secondary psychopathology symptoms; 2) To examine the relationship between change in PTSD symptoms and change in distress-related cognitions and emotions. The proposed research falls squarely within the national health policy and priorities set by the NIH/NIMH Healthy People 2010 by: 1) providing efficacious mental health treatment that promotes the quality and years of healthy life of people suffering from PTSD symptoms; and 2) reducing the mental health access disparity by making specialty mental health resources more accessible to the community at large. [unreadable] [unreadable] [unreadable]