Efficacy Of Narrative Exposure Therapy Research Articles

The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan

ObjectivesPost-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan. MethodsA two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups. ResultsPost NET intervention, significant reductions in PTSD (t = −10.00, P < 0.001), anxiety (t = −9.46, P < 0.001), and depression (t = −6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen’s d = 0.73) and depression (Cohen’s d = 0.79) symptoms and notably large for anxiety symptoms (Cohen’s d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate. ConclusionsThe results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants’ satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.

The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: update to the study protocol for the multi-center randomized controlled trial YOURTREAT

BackgroundThe trial YOURTREAT aims to compare the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) with treatment as usual (TAU) for the treatment of young refugees in Germany. This update outlines changes made to the study protocol in response to the current COVID-19 pandemic with the aim of allowing the continuation of the clinical trial while ensuring the safety of the staff and the participants, maintaining methodological quality, and ensuring compliance with legal regulations.MethodsThe major amendments to the original study protocol include (1) the possibility of using telehealth technology for the conduction of diagnostic and therapy sessions, (2) a reduction of the diagnostic set, and (3) an increased flexibility in the time frame of the study protocol.DiscussionThe adaptations to the study protocol made it feasible to continue with the trial YOURTREAT during the COVID-19 pandemic. Although the diagnostic set had to be shortened, the primary outcomes and the main secondary outcomes remain unimpaired by the amendment. Therefore, we expect the trial to provide evidence regarding effective treatment options for young refugees in Germany, a population that has received little scientific attention so far and has only very limited access to mental health care in the German health care system. In light of the current pandemic, which globally increases the risk of mental problems, the situation for young refugees is likely to aggravate further. Thus, the clinical and social relevance of the present trial YOURTREAT is even more important in these particular times.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00017222. Registered on May 15, 2019

Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial.

Background: Comorbid Posttraumatic Stress Disorder (PTSD) increases the already high symptom burden of patients with Borderline Personality Disorder (BPD). As the gold standard for BPD treatment, Dialectical Behavior Therapy (DBT), does not focus on PTSD, other treatment approaches are needed. Narrative Exposure Therapy (NET) was designed to address multiple traumatic events and may be especially useful in this patient group. The aim of the present study was to determine the efficacy of NET compared to DBT based treatment (DBT-bt) in a randomized controlled trial.Methods: Female patients (n = 60) with BPD and comorbid PTSD were randomized to either a 10-week residential NET or DBT-bt. The primary outcome was change in PTSD severity as assessed by the Clinician Administered PTSD Scale (CAPS). Mixed linear models as well as reliable change, remission, and response rates were used to compare improvement across treatment groups.Results: Mixed linear model showed that patients in both treatments improved significantly over time across all outcome measures. This improvement was not more pronounced in NET (no significant time × type of treatment effect). However, NET resulted in a higher remission rate as compared to DBT-bt. PTSD remission was accompanied by BPD remission in all cases.Conclusions: This study shows the value of trauma-focused therapy in patients with BPD and PTSD for recovery in both disorders. To shorten the duration of both illnesses as much as possible, future studies should focus on the factors predicting treatment success and enabling patients to benefit from trauma-focused treatment as soon as possible.Trial registration: ClinicalTrials.gov, identifier: NCT02517723.

Narrative exposure therapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials.

Narrative exposure therapy (NET) is a psychological intervention conditionally recommended for the prevention and intervention of posttraumatic stress disorder (PTSD). Previous study reported that NET had medium effect on PTSD, but the evidence base of NET is still weak. In this article, we conducted a meta-analysis to explore the efficacy of NET for PTSD symptom reduction and loss of diagnosis. Databases were searched for randomized controlled trials of NET for PTSD. Effect sizes were calculated by Hedges' g and ratio of risk (RR) with 95% confidence intervals (CIs). Study heterogeneity was assessed by Q, Tau2 and I2 and explored by subgroup analyses and metaregression analyses. 18 studies which met full inclusion criteria were included. The finding showed that NET had moderate between-group effect size (g = -.57, 95% CI [-0.87, -0.28], p < .01) and large within-group effect size (g = -1.31, [-1.54, -1.09], p < .01) at first postintervention assessment. The mean RR of loss of diagnosis between NET and comparators was 2.20 ([1.23, 3.92], p < .01). However, there were no differences between groups in both symptom reduction and loss of diagnosis when accounting for publication bias. And the heterogeneity could not be explained sufficiently. Although the article indicated the efficacy of NET for PTSD symptom reduction and the loss of diagnosis, it is difficult to draw meaningful conclusions considering the heterogeneity and publication bias in samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder.

Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. The study had a single-group, pre-test-post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months' follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (-6.0 difference, 95%CI -10.0 to -2.0), and decreased further to 24.5 at T2 (-13.4 difference, 95%CI -17.4 to -9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators

Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET). Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short- (< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression. Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term. Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.

Efficacy and cultural adaptations of narrative exposure therapy for trauma-related outcomes in refugees/asylum-seekers: A systematic review and meta-analysis

Abstract Refugees/asylum-seekers are more likely to have experienced traumatic events than the general population in high-income countries. Narrative Exposure Therapy (NET) was developed to treat trauma within this population. This review aimed to determine (1) the efficacy of NET and (2) if the interventions have been successfully culturally adapted. Databases were searched from January 2002 to September 2020, for peer-reviewed randomised controlled trials (RCT) of NET published in English, involving adult refugees/asylum-seekers with any trauma disorder, resettled in high-income countries. Data were extracted and risk of bias assessed using the Cochrane data collection forms, and meta-analyses were conducted for depression and trauma symptom change. Cultural adaptations were assessed using a structured framework. Six RCTs (total n = 272) met eligibility criteria. All reported significant reductions in trauma symptoms in the NET group but only two studies found a significant reduction in depression symptoms. Meta-analyses showed medium-large between-groups effect sizes in favour of NET (depression −0.59 [−1.07, −0.11]; trauma −0.75 [−1.19, −0.31]), with substantial heterogeneity. The most common cultural adaptations were in language and context. NET was shown to be a potentially beneficial intervention for treating trauma-related outcomes. However, studies should be more transparent regarding any attempts to make interventions more culturally appropriate.

The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: study protocol for a multi-center randomized controlled trial (YOURTREAT)

BackgroundGermany hosts a large number of refugees from war-affected countries. The integration of refugees, in particular young refugees from the Middle East, is one of the major current social challenges in Germany. Mental disorders, first of all post-traumatic stress disorder (PTSD) that results from war experiences, are common among young refugees and interfere with quality of life as well as functional integration. Evidence regarding effective treatment options for this population is scarce. In this trial, we aim to evaluate the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) for the treatment of young refugees in Germany.MethodsIn a rater-blinded, multi-center, randomized-controlled trial, KIDNET is compared to treatment as usual (TAU) within the general health care system. A total number of 80 young refugees who fulfill the diagnostic criteria of PTSD will be randomized to either KIDNET or TAU. Diagnostic interviews will take place at baseline before treatment as well as 6 and 12 months thereafter. They will assess exposure to traumatic events, PTSD and comorbid symptoms, as well as parameters of integration.DiscussionThe results of this study should provide evidence regarding effective treatment options for young refugees in Germany, a population that has been understudied and received only limited access to mental health care so far. Next to the effects of treatment on mental health outcomes, integration parameters will be investigated. Therefore, this study should provide broad insights into treatment options for young refugees and their potential implications on successful integration.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS), ID: DRKS00017222. Registered on 15 May 2019.

The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence-A randomized controlled trial.

The mental health needs of women affected by intimate partner violence (IPV) and living under continuous domestic violence are currently not well understood. The present study investigates the feasibility and efficacy of narrative exposure therapy (NET), compared with commonly used counselling (treatment-as-usual, TAU), in a group of currently IPV-affected women in Tehran, Iran. Forty-five IPV-affected women with a diagnosis of post-traumatic stress disorder (PTSD) were randomized to 10 to 12 sessions of either NET (n=24) or TAU (n=21). Primary outcome measures, including PTSD, depression, and perceived stress symptoms, were examined at pretreatment and 3- and 6-month follow-ups. IPV experiences, general lifetime traumatic events, childhood adversities, borderline symptoms, and daily functioning impairment were also inspected. NET participants showed a significantly greater symptom reduction in comparison with the TAU group in PTSD, depression, and perceived stress at both follow-ups. Improvement in daily functioning and reduction of IPV experiences and borderline symptoms at 3- and 6-month follow-ups were pronounced but not significantly different between the two treatment groups. IPV-affected women living under continuous threat and violence would benefit from trauma-focused interventions such as NET.

On the efficacy of Narrative Exposure Therapy

In their review article, Mundt et al. (2014), ‘Evaluating interventions for posttraumatic stress disorder in lowandmiddle income countries:Narrative ExposureTherapy’ , (Intervention, this issue) evaluated Narrative Exposure Therapy (NET) asan example ofa short-term treatment for posttraumatic stress disorder that is applied in low and middle income, post con£ict settings.They concluded that it is premature to recommend NETas a treatment approach. In this response, the clinicians and researchers who developedNETargue that the paper by Mundt et al. does not correctly represent the rationale of NETand that the methodological critique of theNETtrials in the article is biased. Compared to other types of psychotherapy and psychosocial interventions in post con£ict settings, the evidence base of NET is strong, and the application of NETwithin a sustainable mental healthcare system can be recommended.

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

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.

A randomised controlled pilot study: the effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake.

BackgroundPost-Traumatic Stress Disorder (PTSD) is a common psychological reaction after large-scale natural disasters. Given the number of people involved and shortage of resources in any major disaster, brief, pragmatic and easily trainable interventions are needed. The aim of this study is to evaluate the efficacy of Narrative Exposure Therapy (NET) as a short-term treatment for PTSD using Chinese earthquake survivors.MethodsA randomized waiting-list control pilot study was conducted between December 2009 and March 2010, at the site of the Sichuan earthquake in Beichuan County, China. Adult participants with newly diagnosed Post Traumatic Stress Disorder (PTSD) were randomly allocated to Narrative Exposure Therapy (NET) or a Waiting-List (WL) condition. The latter received NET treatment after a two-week waiting period. To compare the effectiveness of NET in traumatised earthquake survivors, both groups were assessed on PTSD symptoms, general mental health, anxiety and depression, social support, coping style and posttraumatic change before and after treatment and two months post treatment.ResultsAdult participants (n=22) were randomly allocated to receive NET (n=11) or WL (n=11). Twenty two participants (11 in NET group, 11 in WL) were included in the analysis of primary outcomes. Compared with WL, NET showed significant reductions in PTSD symptoms, anxiety and depression, general mental stress and increased posttraumatic growth. The WL group later showed similar improvements after treatment. These changes remained stable for a two-month follow-up. Measures of social support and coping showed no stable effects.ConclusionsNET is effective in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors. The findings help advance current knowledge in the management of PTSD after natural disasters and inform future research. Larger sample sizes are needed to extend the present findings.Trial registrationChinese Clinical Trial Registry ChiCTR-TRC-12002473