Abstract
BackgroundTrauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD). This includes the treatment of trauma-related suffering in refugee populations. However, there is a lack of knowledge about symptom trajectories in refugees living in volatile conditions. This has led to fear of “retraumatisation” and general skepticism in clinicians concerning the use of exposure therapy.MethodsTo test the relevance of this concern, we investigated PTSD symptom trajectories and potentially influencing factors during the course of Narrative Exposure Therapy (NET) in a refugee sample living in Germany. Refugees filled out the PTSD Checklist prior to each treatment session and also during follow-up interviews. Therapists continuously documented positive and negative life events as well as the content of the treatment sessions. Additionally, structured clinical interviews were conducted pre-treatment and at follow-up time points.ResultsOn average, clients presented with substantial decreases in PTSD symptoms already during and after NET. However, symptom trajectories differed and ranged from fast responders to slow responders to no immediate response during treatment. Importantly, a persistent worsening of symptoms was not observed, also not after exposure to the most distressing events. In contrast, stressful life experiences seemed to aggravate PTSD symptoms.ConclusionsConsistent with earlier studies, NET leads to clinically and behaviorally relevant reductions in PTSD symptoms both throughout and following treatment in refugees living in volatile conditions. Concerns about imaginal exposure in refugees were not substantiated. While stressful life events contributed to transient symptom increases, they weren’t found to prevent the overall effectiveness of NET.Trial registrationNCT02852616.
Highlights
Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD)
(2) We explore the influence of imaginal exposure to the most distressing events as well as treatment-unrelated life stressors on PTSD symptoms during Narrative Exposure Therapy (NET)
The present study addresses these concerns in depicting the long-term benefits of NET, and examining the PTSD trajectories during treatment
Summary
Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD) This includes the treatment of trauma-related suffering in refugee populations. The experience of traumatic events in the home country and during the flight as well as postmigrational stressors lead to substantial prevalence rates of trauma-related suffering, including posttraumatic stress disorder (PTSD), affective, and anxiety disorders [2,3,4]. These high rates of mental health issues remain elevated even after years of living in a host country [5, 6]. Recent studies in refugee populations confirm this by showing that PTSD symptoms often persist across extended periods of time – sometimes for one’s whole life – when no treatment is offered [10, 11]
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