Program Goals/Target Population
Narrative Exposure Therapy (NET) is a psychosocial treatment that aims to reduce posttraumatic stress disorder (PTSD) symptoms in traumatized refugee populations still living in dangerous situations (such as refugee camps). It attempts to reduce PTSD symptoms by habituating a patient to his or her emotional reactions to lived traumatic experiences and by creating a coherent narrative of his or her life’s experiences.
The program was developed to meet the need for psychosocial services in refugee camps. Refugee populations often demonstrate high rates of PTSD as a result of traumatic events experienced in war-affected areas. Populations in refugee camps are often impoverished and malnourished, and depend on the humanitarian aid.
The therapist works with a patient diagnosed with PTSD to construct a detailed chronological narrative of his or her biography. Over the course of four treatment sessions, the patient is asked to recall his or her life and include details of the traumatic events he/she has experienced. Frequently, this narrative initially includes fragmented reports of traumatic experience. It is the job of the therapist and patient to create a coherent narrative out of these reports. The process of construction also includes discussions to investigate current and past emotional, physiological, cognitive, and behavioral reactions to the narrative. The narrative is corrected during the course of treatment through multiple readings.
The process concludes when the patient shows evidence of habituation to the emotional reactions to these traumatic events. Patients receive a written biography at the end of treatment.
NET is a short-term therapeutic approach that is based on the principles of cognitive–behavioral exposure therapy and testimony therapy. In exposure therapy, the patient is asked to identify and talk repeatedly about his or her worst traumatic experience. During this conversation, the patient re-experiences the emotions experienced during the traumatic event. This can lead to the habituation of the emotional response, which, in turn, can lessen PTSD symptoms. Often, though, patients such as refugees cannot identify a single traumatic event that led to the development of testimony therapy. In testimony therapy, the patient generates a narrative of his or her life, but focuses on the details of the multiple traumatic events that he or she has experienced.
Currently, the program is delivered by therapists who are doctoral-level psychologists or graduate students with experience in education and counseling. Therapists receive training in NET. To communicate with refugee populations, translators are used. In the future, developers hope that NET can be operationalized so that it can be delivered, at a lower cost, by local staff without any psychosocial educational background.
18 to 100
Posttraumatic Stress Disorder (PTSD)
One year after treatment, Neuner and colleagues (2004) found there were significant differences between the groups of participants in PTSD diagnoses. While 79 percent of the supportive counseling (SC) group and 80 percent of the psychoeducation group met the criteria for PTSD, only 29 percent of the Narrative Exposure Therapy (NET) participants met the criteria for PTSD. The researchers note that scores for PTSD still remained high, but the change was clinically significant. The effect size of the treatment was 0.6.
No significant differences were found in comorbid conditions (e.g., anxiety, depression) between the groups as measured by the Self-Reporting Questionnaire 20.
The NET group showed significant improvement at 1 year compared to the SC group, but not compared to the pscyhoeducation group.
Departures From Refugee Camp
There was a significant difference between the treatment and control groups in rates at which they left the refugee camp. Results showed that 62 percent of the NET participants had left the camp, compared to 7 percent (1 patient) of the SC group and 17 percent (2 patients) from the psychoeducation group.
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