The emerging evidence for Narrative Exposure Therapy: a review.

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.

[1]  G. Mezey,et al.  Usefulness and validity of post-traumatic stress disorder as a psychiatric category , 2001, BMJ : British Medical Journal.

[2]  Z. Steel,et al.  Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post‐traumatic stress in Tamil asylum‐seekers: comparison with refugees and immigrants , 1998, Acta psychiatrica Scandinavica.

[3]  T. Elbert,et al.  Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka , 2009, BMC psychiatry.

[4]  P. Lang.  Dead Souls: Or Why the Neurobehavioral Science of Emotion Should Pay Attention to Cognitive Science , 1984 .

[5]  T. Elbert,et al.  Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children. , 2010, Journal of traumatic stress.

[6]  W. Yule.  From pogroms to "ethnic cleansing": meeting the needs of war affected children. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[7]  B. Olatunji,et al.  Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model. , 2009, Clinical psychology review.

[8]  C. Catani,et al.  Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka , 2008, BMC psychiatry.

[9]  Stuart Turner,et al.  Psychological treatments for chronic post-traumatic stress disorder , 2007, British Journal of Psychiatry.

[10]  Judith Lewis Herman,et al.  Complex PTSD: A syndrome in survivors of prolonged and repeated trauma , 1992 .

[11]  B. Rockstroh,et al.  Wiedererfahrung durch Psychotherapie modifiziert Geist und Gehirn* , 2006, Verhaltenstherapie.

[12]  B. Rockstroh,et al.  The influence of Organized Violence and Terror on Brain and Mind : a Co-Constructive Perspective , 2006 .

[13]  B. Rothbaum,et al.  Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD , 1997 .

[14]  N. Grey.  A Casebook of Cognitive Therapy for Traumatic Stress Reactions , 2009 .

[15]  Thomas Elbert,et al.  Self-Regulation of The Brain and Behavior , 1984 .

[16]  M. Conway.  Sensory-perceptual episodic memory and its context: autobiographical memory. , 2001, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[17]  M. Vranesic,et al.  Psychiatric and cognitive effects of war in former yugoslavia: association of lack of redress for trauma and posttraumatic stress reactions. , 2005, JAMA.

[18]  T. Elbert,et al.  War trauma, child labor, and family violence: life adversities and PTSD in a sample of school children in Kabul. , 2009, Journal of traumatic stress.

[19]  T. Elbert,et al.  Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement , 2005, BMC psychiatry.

[20]  B. Green,et al.  Outcomes of Single Versus Multiple Trauma Exposure in a Screening Sample , 2000, Journal of traumatic stress.

[21]  Z. Steel,et al.  Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. , 2009, JAMA.

[22]  T. Elbert,et al.  Narrative exposure therapy in children : a case study , 2004 .

[23]  A. Cienfuegos,et al.  The testimony of political repression as a therapeutic instrument. , 1983, The American journal of orthopsychiatry.

[24]  Zac E. Imel,et al.  The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons. , 2008, Clinical psychology review.

[25]  Nyi Nyi Aung,et al.  Burmese political dissidents in Thailand: trauma and survival among young adults in exile. , 1996, American journal of public health.

[26]  Ann Hackmann,et al.  Cognitive therapy for post-traumatic stress disorder: development and evaluation. , 2005, Behaviour research and therapy.

[27]  P. Lang.  The network model of emotion: motivational connections , 1993 .

[28]  Z. Steel,et al.  Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia , 2004, Australian and New Zealand journal of public health.

[29]  Frank Rösler,et al.  Lifespan development and the brain: The perspective of biocultural co-constructivism , 2006 .

[30]  J. Murphy.  PSYCHOLOGICAL RESPONSES TO WAR STRESS , 1975, Acta psychiatrica Scandinavica. Supplementum.

[31]  T. Elbert,et al.  A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. , 2004, Journal of consulting and clinical psychology.

[32]  P. Schnurr,et al.  Do all psychological treatments really work the same in posttraumatic stress disorder? , 2010, Clinical psychology review.

[33]  T. Elbert,et al.  Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): from neurocognitive theory to field intervention. , 2008, Child and adolescent psychiatric clinics of North America.

[34]  N. Gene-Cos.  Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care , 2006 .

[35]  T. Dalgleish,et al.  A dual representation theory of posttraumatic stress disorder. , 1996, Psychological review.

[36]  T. Elbert,et al.  Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. , 2008, Journal of consulting and clinical psychology.

[37]  T. Elbert,et al.  A NARRATIVE EXPOSURE TREATMENT AS INTERVENTION IN A REFUGEE CAMP: A CASE REPORT , 2002, Behavioural and Cognitive Psychotherapy.

[38]  D. Summerfield,et al.  Psychological responses to war and atrocity: the limitations of current concepts. , 1995, Social science & medicine.

[39]  M. van Ommeren,et al.  Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal. , 1998, JAMA.

[40]  T. Elbert,et al.  Narrative Exposure Therapy versus Interpersonal Psychotherapy , 2009, Psychotherapy and Psychosomatics.

[41]  T. Elbert,et al.  Trauma-related impairment in children--a survey in Sri Lankan provinces affected by armed conflict. , 2009, Child abuse & neglect.

[42]  T. Elbert,et al.  Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. , 2007, Behaviour research and therapy.

[43]  K. Mcinnes,et al.  The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. , 1998, The Journal of nervous and mental disease.

[44]  E. L. Berger,et al.  Research Capacity for Mental Health in Low- and Middle-Income Countries: Results of a Mapping Project , 2010 .

[45]  Chris R Brewin,et al.  Psychological theories of posttraumatic stress disorder. , 2003, Clinical psychology review.

[46]  J. Keil,et al.  Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli - evidence from a randomized controlled treatment trial , 2011, BMC Neuroscience.

[47]  R. Yehuda.  POST-TRAUMATIC STRESS DISORDER , 1985, The Lancet.

[48]  A. Dyregrov,et al.  Trauma Exposure and Psychological Reactions to Genocide Among Rwandan Children , 2000, Journal of traumatic stress.

[49]  D. Silove,et al.  The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. , 1999, The Journal of nervous and mental disease.

[50]  T. Elbert,et al.  Follow Up of A Randomized Controlled Trial Narrative Exposure Therapy: a disseminable, community-based treatment approach for former Child Soldiers , 2008 .

[51]  B. L. Cardozo,et al.  Mental health symptoms following war and repression in eastern Afghanistan. , 2004, JAMA.

[52]  Neil Burgess,et al.  Intrusive Images in Psychological Disorders , 2010, Psychological review.

[53]  Peter J. Lang,et al.  A Bio‐Informational Theory of Emotional Imagery , 1979 .

[54]  Albert Rizzo,et al.  Emerging treatments for PTSD. , 2009, Clinical psychology review.

[55]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[56]  Thomas Elbert,et al.  Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees , 2004, BMC psychiatry.

[57]  N. Haslam,et al.  Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. , 2005, JAMA.

[58]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[59]  J. Halvorsen,et al.  Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: a preliminary uncontrolled trial. , 2010, Scandinavian journal of psychology.

[60]  M. Conway,et al.  The construction of autobiographical memories in the self-memory system. , 2000, Psychological review.

[61]  T. Elbert,et al.  Can Asylum-Seekers with Posttraumatic Stress Disorder Be Successfully Treated? A Randomized Controlled Pilot Study , 2010, Cognitive behaviour therapy.

[62]  Z. Steel,et al.  Compounding of premigration trauma and postmigration stress in asylum seekers. , 1997, The Journal of psychology.

[63]  Judith Cohen,et al.  Treating Trauma and Traumatic Grief in Children and Adolescents , 2006 .

[64]  E. Foa,et al.  Change in rape narratives during exposure therapy for posttraumatic stress disorder , 1995, Journal of traumatic stress.

[65]  A. Blaszczynski,et al.  Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services. , 1997, Psychiatric services.

[66]  D. Summerfield.  The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category , 2001, BMJ : British Medical Journal.

[67]  J. Danesh,et al.  Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review , 2005, The Lancet.

[68]  Thomas Elbert,et al.  Narrative exposure therapy : a short-term intervention for traumatic stress disorders , 2005 .

[69]  T. Elbert,et al.  P0033 - Narrative Exposure Therapy compared to treatment as usual for refugees with PTSD - Preliminary results from a randomized controlled trial , 2008, European Psychiatry.