Feasibility and predictors of change of narrative exposure therapy for displaced populations: a repeated measures design

Rina S Ghafoerkhan,Willem F Scholte,Henriette E Van Heemstra,Evelien Snippe,Jackie June F Ter Heide,Linda M Verhaak,Paul A Boelen,Simone M De La Rie,Joriene R J Van Der Kolk

doi:10.1186/s40814-020-00613-1

Abstract

BackgroundDisplaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD). At the same time, these victims are known to benefit less from trauma-focused therapy (TFT) and to be less compliant to treatment. The objective of this paper is to describe the rationale and research protocol of an ongoing trial that aims to evaluate different variables that might influence the feasibility of TFT for the study population. Specifically, perceived daily stress, emotion regulation, and mood are investigated as predictors of change in PTSD symptoms during a trauma-focused therapy (narrative exposure therapy (NET)). The feasibility of administering measures tapping these constructs repeatedly during treatment will also be evaluated.Methods/designUsing an observational treatment design, 80 displaced victims of interpersonal violence will be measured before, during, and after partaking in NET. Several questionnaires tapping PTSD plus the aforementioned possible predictors of PTSD change will be administered: Post-traumatic Stress Disorder Checklist-5, Perceived Stress Scale, Difficulties in Emotion Regulation Scale-18 (pre-test, post-test, and follow-up),subscale impulsivity of the Difficulties in Emotion Regulation Scale-18, Perceived Stress Scale short version, Primary Care Post-traumatic Stress Disorder and a single Mood item (each session). Multilevel modelling will be used to examine the relation between the possible predictors and treatment outcome.DiscussionThe present study is the first to examine the interplay of facilitating and interfering factors possibly impacting treatment feasibility and effectiveness in displaced victims of interpersonal violence with PTSD receiving NET, using repeated measures. The current study can help to improve future treatment based on individual characteristics.Trial registrationNetherlands Trial Register: NTR7353, retrospectively registered. Date of registration: July 11, 2018.

Highlights

Displaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD)
Inclusion criteria Patients will be included in the study if they are displaced victims of interpersonal violence, aged 18 years or older, if they have PTSD as a primary diagnosis established by a psychiatrist or clinical psychologist during intake, if individual narrative exposure therapy (NET) in an outpatient setting has been indicated for them and if they are cognitively able to give informed consent to participate in the study
Among the growing number of forcibly displaced people worldwide, many are suffering from trauma-related mental health problems

Summary

Introduction

Displaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD). When entering a host country, these displaced persons are usually referred to as either ‘refugees’, ‘asylum seekers’, ‘trafficked human beings’, ‘illegal immigrants’ or ‘undocumented people’, depending on their trauma background and legal status. These groups overlap in their experience of forced migration, their marginalized social position, and the challenges they encounter. Displaced people suffering from PTSD could benefit from trauma-focused therapy (TFT). TFT is a psychological intervention aiming to decrease PTSD symptoms by fostering the processing of traumatic memories

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Conclusion