Efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder: a systematic review protocol

Abstract

Review question/objective The objective of this review is to identify the efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder. Background The most prominent disorder related to traumatic experiences is posttraumatic stress disorder (PTSD) that has specific symptoms which occur in response to trauma exposure as determined by the Diagnostic Staticall Manual (DSM). Among individuals exposed to trauma, approximately 25% to 30% develop PTSD with the rate of the disorder depending on the experience of trauma.1 PTSD is often caused by traumatic events like sexual abuse, physical maltreatment, car accidents, criminal attacks, bombings, rape or torture.2 It has been estimated that most Americans (81.7%) will be exposed to a trauma during their lifetime3 and 6.8% will meet criteria for PTSD at some point in their lives.4 Epidemiologic community surveys in war-torn areas found PTSD point prevalence rates between 15% and 50% among different refugee populations.5 Studies have suggested functional impairment occurs in traumatized children including problems with cognitive and school performance. A survey on trauma-related impairment in children in Sri Lanka showed that 25% of the severe trauma experienced children met the criteria for a diagnosis of PTSD. The traumatized children reported problems with their daily life such as problems in school performance, social withdrawal, depressive symptoms and poor physical health.6 Randomized controlled treatment trials have revealed that trauma-focused treatments can effectively ease symptoms in patients who suffer from PTSD.2,7 Narrative exposure therapy (NET) was recently developed as a standardized, short-term treatment that focuses exclusively on the reconstruction of episodic trauma memory through a detailed and emotional narration of the biography, with particular emphasis on the traumatic events and a focus on achieving habituation to the emotional responses at the end. Therefore, this treatment can potentially preclude a mixture of therapeutic methods such as the application of both psychotherapy and pharmacotherapy in a single patient. University of Konstanz, Germany studied the efficacy of NET as evaluated in a randomized controlled trial in Sudanese refugees living in a Ugandan refugee settlement who were diagnosed as suffering from PTSD. The results indicated that NET is an approach that shows potential for the treatment of PTSD in refugees living in unsafe conditions.8 Instead of asking the patient to define a single event, which is difficult in repeated and multiple traumas, asking the patient to construct a narrative of their whole life with therapist assistance is encouraging.9 Thus, this idea indicates NET is better in assessing many traumatic life events in a patient's life in a more timely and organized way than other psychotherapies. Since PTSD is a problem, there is no clear first choice treatment for the problem. Several randomized controlled trials have showed the efficacy of NET; however there is no existing evidence based review on this topic so this review will be important.