Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators

Abstract

Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET). Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short-(< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression. Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term. Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.

Narrative exposure therapy for survivors of human trafficking: feasibility randomised controlled trial

“…This issue may benefit from further exploration in future research, for example, ascertaining whether any particular adaptations to the standard NET protocol might be helpful for this group. However, of note is that the final outcomes were posttreatment, whereas research 28 indicates benefits of NET over longer follow-up periods.…”

“…10 NET has been widely used in lower-and higher-income countries and with a range of different client groups, including asylum seekers and refugees. 11,12 NET is therefore a good candidate for treating PTSD in survivors of human trafficking. A case series with ten female trafficking survivors with a history of sexual exploitation (who received 10-19 NET sessions) found preliminary evidence for its acceptability and effectiveness.…”

Narrative Exposure Therapy versus treatment as usual in a sample of trauma survivors who live under ongoing threat of violence in Rio de Janeiro, Brazil: study protocol for a randomised controlled trial

“…Evidence-based treatments for PTSD have been developed and tested [15]. Narrative Exposure Therapy (NET) [16] has emerged as an evidence-based treatment for patients in low-and middle-income countries and refugees, all of whom have been exposed to multiple traumatic stressors; for a review and meta-analysis, see Siehl et al [17]. A substantial body of evidence shows the effectiveness of NET for patients who live in relatively safe conditions.…”

Practical guidelines for online Narrative Exposure Therapy (e-NET) – a short-term treatment for posttraumatic stress disorder adapted for remote delivery

“…As storytelling is a frequently occurring mechanism of dealing with upsetting events in many cultures, this pragmatic narrative approach of NET to heal traumatic memories is easily understood and applied in a variety of societies (Robjant & Fazel, 2010) and after multiple and complex traumatization (Schauer, Robjant, Elbert, & Neuner, 2020). Providing approximately 8-12 individual 90minute sessions, NET has been proven to effectively reduce trauma-related mental health symptoms in severely affected individuals (Lely et al, 2019;Siehl, Robjant, & Crombach, 2020). Furthermore, several studies show that the technique can be disseminated effectively, and within a short time period, to professionals and paraprofessionals (Jacob, Neuner, Maedl, Schaal, & Elbert, 2014).…”