Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD?

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load. Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors. Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD. Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load. Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules. ¿ La exposición acumulada de estresores traumáticos predice el resultado del tratamiento de la terapia de tept basada en la exposición implementada en la comunidad? Antecedentes: El trastorno de estrés traumático (TEPT) se asocia con altos niveles de discapacidad funcional, tales como dificultades en el desempeño académico uocupacional yen las relaciones sociales. Con un número creciente de los tipos de eventos traumáticos experimentados (carga traumática), el riesgo de TEPT aumenta en una forma dependiente de la dosis. De la misma forma, altas tasas de TEPT pueden afectar el proceso de reconstrucción en las sociedad post-conflicto. Para abordar estas crecientes necesidades por servicios de salud mental en sociedades con poco acceso acuidado profesional, se ha sugerido el enfoque de cambio de tareas ylas intervenciones basadas en la comunidad. La Terapia de Exposición Narrativa (NET en su sigla en inglés) ha sido desarrollada como un tratamiento de TEPT basado en la exposición, breve ypragmático que puede ser fácilmente entrenado al personal laico. Aun así, permanece incierto si la NET puede ser implementada efectivamente por consejeros laicos entrenados, incluso aaltos niveles de carga traumática. Objetivo: Investigar si la carga traumátic...

The role of community health worker-based care in post-conflict settings: a systematic review

“…, 2018 ; White et al. , 2018 ; Schneider et al. , 2020 ), including 7 randomized control trials ( Bolton et al.…”

Epigenetics of traumatic stress: The association of NR3C1 methylation and posttraumatic stress disorder symptom changes in response to narrative exposure therapy

“…The sample for this study was derived from a large treatment study with survivors of the war between the rebel group Lord's Resistance Army (LRA) and the governmental forces in Northern Uganda cf [6]. We analyzed all study participants who were included into the treatment study (inclusion criteria: diagnosis of PTSD according to DSM-IV, no signs of severe current alcohol or drug abuse, no clinical signs of an acute psychosis, no psychotropic medication) with valid epigenetic data at the pretest and at least one follow-up assessment.…”

“…Responders were defined as individuals with a symptom decline of > 5.37 from pretest (t 1 ) to the last follow-up (t 3 ). This cutoff was identified as a clinically significant change according to the reliable change index in the same population in a previous study by Schneider et al [6]. Accordingly, only individuals with complete data points at the last follow-up (N = 149) were classified as responders or non-responders.…”

“…The modification of such aversive memory traces by means of exposure-based psychotherapy, such as Prolonged Exposure, Cognitive Therapy for PTSD, Eye Movement Desensitization and Reprocessing and Narrative Exposure Therapy (NET), has the highest evidence-base from controlled trials for the treatment of PTSD [2][3][4]. Of the aforementioned treatments, NET has particularly been developed to meet the needs of survivors of multiple and complex trauma, and can be effectively delivered by trained local health workers in low resource settings affected by humanitarian crises [5], such as Northern Uganda [6,7].…”

DNA methylation changes following narrative exposure therapy in a randomized controlled trial with female former child soldiers

“…Phenotype and saliva samples were collected at baseline, 4-month (FU4) and 10-month (FU10) follow-up interviews. Phenotypic data and DNAm processing are described elsewhere 96 , 97 . Baseline biomarker correlates were investigated for clinical outcomes only: PTSD (PDS subscale employed as a structured interview 98 ), depression (HSCL 99 ) and appetitive aggression (AAS).…”