The emerging evidence for Narrative Exposure Therapy: A review. Clinical Psychology Review, 30(8), 1030-1039

Traumatic Stress Service, Clinical Treatment Centre, Maudsley Hospital, Denmark Hill, London SE58AZ, United Kingdom.
Clinical psychology review (Impact Factor: 7.18). 12/2010; 30(8):1030-9. DOI: 10.1016/j.cpr.2010.07.004
Source: PubMed


Individuals who have experienced multiple traumatic events over long periods as a result of war, conflict and organised violence, may represent a unique group amongst PTSD patients in terms of psychological and neurobiological sequelae. Narrative Exposure Therapy (NET) is a short-term therapy for individuals who have PTSD symptoms as a result of these types of traumatic experiences. Originally developed for use in low-income countries, it has since been used to treat asylum seekers and refugees in high-income settings. The treatment involves emotional exposure to the memories of traumatic events and the reorganisation of these memories into a coherent chronological narrative. This review of all the currently available literature investigates the effectiveness of NET in treatment trials of adults and also of KIDNET, an adapted version for children. Results from treatment trials in adults have demonstrated the superiority of NET in reducing PTSD symptoms compared with other therapeutic approaches. Most trials demonstrated that further improvements had been made at follow-up suggesting sustained change. Treatment trials of KIDNET have shown its effectiveness in reducing PTSD amongst children. Emerging evidence suggests that NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised violence, even in settings that remain volatile and insecure.

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Available from: Mina Fazel, May 30, 2014
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    • "Narrative exposure therapy (NET) was designed specifically for survivors of multiple traumas and involves techniques similar to CBT such as exposure and cognitive challenge (Schauer et al. 2005; Dossa & Hatem, 2012). Briefly, NET involves the creation of a chronological account of biography with detailed reconstruction of fragmented trauma memories in order to achieve habituation (Robjant & Fazel, 2010; Ertl et al. 2011). NET has been shown to be effective with asylum seekers and refugees (Neuner et al. 2009; Slobodin & de Jong, 2014). "
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    ABSTRACT: Self-reflection can aid therapist development, particularly interpersonal skills. It can be achieved through using cognitive-behavioural therapy techniques, for example, formulations of the therapist's cognitions and behaviours have been used to aid self-reflection. As interpersonal skills may be an area that benefits from self-reflection, an approach to formulating the interaction between client and therapist may be beneficial. This study reports the use of simple ‘antecedent-belief-consequence’ (ABC) formulations for the client and therapist to conceptualize their interaction. This description of a treatment failure focuses on cross-cultural work with a survivor of torture, where self-reflection may be particularly indicated to promote cultural competence and address the impact of the content on the therapist. ABC formulations for the client and therapist were completed and through this structured self-reflection, the therapist was able to identify the impact of her own beliefs on the process of therapy. This method identified areas for further development and generated hypotheses for how to continue therapy with this client. Using ABC formulations then may provide a useful and structured way to conduct self-reflection with explicit focus on the interaction between client and therapist.
    The Cognitive Behaviour Therapist 01/2015; 8. DOI:10.1017/S1754470X15000203
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    • "Compared to wait-list controls, the KIDNET group demonstrated clinically significant improvements in symptoms and functioning (Ruf et al., 2010). See the NET review of Robjant and Fazel (2010) for further discussion. "
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    ABSTRACT: BackgroundFrom a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions.ObjectiveTo critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model.MethodA narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach.ResultsDifficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy.ConclusionIn this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
    European Journal of Psychotraumatology 07/2014; 5. DOI:10.3402/ejpt.v5.24294 · 2.40 Impact Factor
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    • "Also, cultures that value oral tradition and history telling may find the narrative nature of this approach socially acceptable, thereby potentially countering the stigma associated with traditional mental health services. There is growing support for the value of NET in treating posttraumatic stress in survivors of organized violence, including refugees, across a variety of settings, ethnic groups, and providers (Robjant & Fazel, 2010). Although a few of the original studies of NET were randomized controlled trials with relatively large samples (Neuner, Onyut, Ertl, Odenwald, Schauer, & Elbert, 2008; Neuner, Schauer, Klaschik, Karunakara, & Elbert, 2004), most studies of NET have been uncontrolled or have had small samples. "
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    ABSTRACT: Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the United States reporting elevated posttraumatic stress (N = 63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well-being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2- and 4-month follow-up. Treatment participation (95.1% completion) and study retention (98.4% provided follow-up data) were very high. Significant condition by time interactions showed that those receiving brief NET had greater posttraumatic growth (d = 0.83) and well-being (d = 0.54) through 4 months than controls. Brief NET reduced symptoms of posttraumatic stress (d = -0.48) and depression (d = -0.46) more, but only at 2 months; symptoms of controls also decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of brief NET increased growth and well-being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Iraqi refugees.
    Journal of Traumatic Stress 06/2014; 27(3). DOI:10.1002/jts.21922 · 2.72 Impact Factor
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