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  1. Narrative Exposure Therapy for Traumatized Children and Adolescents (KidNET)

Narrative Exposure Therapy for Traumatized Children and Adolescents (KidNET)

Program Goals/ Target Population

Narrative Exposure Therapy for traumatized children and adolescents (KidNET) is an individual-level psychosocial treatment that aims to reduce posttraumatic stress disorder (PTSD) symptoms in traumatized refugee children. Targeted behaviors include PTSD–related symptoms and behaviors, as well as other mental health symptoms and the ability to function. The treatment reduces 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.


 

KidNET was developed to meet the need for psychosocial services by traumatized refugee children who have experienced war or other forms of organized violence and who live in exile. Traumatized refugee youth are at high risk of mental health disorders and have high rates of PTSD symptoms.


 

Program Activities

A therapist works with a youth diagnosed with PTSD to construct a detailed chronological biographical narrative. This narrative focuses on traumatic events experienced by the youth in both the home and host countries. Over the course of eight treatment sessions, the youth is asked to recall his or her life and include details of the traumatic events he or she has experienced.


 

To facilitate the narrative process and the use of language to create the narrative, the therapist uses several strategies. First, the child is given a rope to symbolize his or her life and help in the construction of a lifeline narrative. The therapist encourages the child to place stones along the rope to represent sad or fearful events and flowers to represent joyful or happy events. The therapist then explores these events with the child to investigate current and past emotional, physiological, cognitive, and behavioral reactions to the narrative. The therapist can also use these details to help counter avoidance.


 

To encourage construction of the narrative, the therapist can also use reenactment of body positioning during a traumatic event (e.g., such as crouching during bombing) and drawings. These tools can help generate appropriate language for writing the narrative.


 

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. During this process, the therapist needs to demonstrate empathic understanding, active listening, congruency, and unconditional positive regard.


 

The process concludes when the patient shows evidence of habituation to the emotional reactions to these traumatic events. The child receives a written biography at the end of treatment.


 

Active parental involvement is not needed.


 

Program Theory

KidNET is a short-term therapeutic approach based on cognitive–behavioral principles such as habituation and rooted in neurocognitive memory theory which explains how traumatic memories are organized and stored in the brain and the effect of trauma on memory. For people who have experienced multiple traumas over a period of time, constructing a coherent narration of the events is difficult but necessary for a therapeutic effect. The exposure of a patient to memories in a safe environment can eventually inhibit the fear response.


 

Narrative Exposure Therapy (NET) and KidNET expand on the classical form of trauma exposure therapy, where patients are asked to identify their most traumatic event. Most traumatized refugees, however, have experienced multiple traumatic events, and so NET and KidNET patients are encouraged to construct biographical narratives that can encompass these multiple traumatic events.


 

Key Personnel

Currently, the program is delivered by clinical psychologists. Therapists receive training in NET. To communicate with refugee populations, translators are used when needed.

Intervention ID
117
Ages

7 to 16

Rating
Promising
Outcomes

Study 1

PTSD Symptoms

According to Ruf and colleagues (2010), youth receiving Narrative Exposure Therapy for traumatized children and adolescents (KidNET) showed clinically significant improvement in symptoms of posttraumatic stress disorder (PTSD) and functioning. The overall symptom severity in the KidNET group decreased by 60 percent (effect size 1.9). No significant change was found in control group youth. At the 6-month interview, 70 percent of the control group (9 children) still presented with PTSD, compared to 17 percent (2 children) of the KidNET group. These symptom reductions among the KidNET youth remained stable at the 12-month follow-up assessment.


 

Symptom Clusters

Significant effects were also found for the symptom clusters of intrusions and avoidance. KidNET youth improved on intrusions, avoidance and numbing, hyperarousal, and functional impairment. In control group youth, the only significant change was found for intrusion symptoms.


 

Comorbid Disorders

No significant differences were found between the two groups in comorbid disorders at 6 months.

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