Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

Abstract

Background Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. Aims We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. Method The study had a single-group, pre-test–post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months’ follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. Results The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (−6.0 difference, 95%CI −10.0 to −2.0), and decreased further to 24.5 at T2 (−13.4 difference, 95%CI −17.4 to −9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. Conclusions NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

Survivor narratives of the Oklahoma City bombing: The story over time

“…Narratives have been successfully used in psychotherapy to improve depression, anxiety and PTSD (Cepeda et al, 2008;Deblinger et al, 2011;Graf et al, 2008;Lely et al, 2019;Mauritz et al, 2020;Morkved et al, 2014), and the findings of this study suggest that they may also have potential in the healing process for disaster trauma. Positive narratives, in particular, have been found to be associated with improved outcomes in narrative therapeutic interventions (Khayyat-Abuaita et al, 2019;Tuval-Mashiach et al, 2004;Westerman et al, 2017), suggesting that integration of positive elements into disaster narratives may help protect individuals against pathological reactions to trauma.…”

Investigating the Efficacy and Experiences With Narrative Exposure Therapy in Severe Mentally Ill Patients With Comorbid Post-traumatic Stress Disorder Receiving Flexible Assertive Community Treatment: A Mixed Methods Study

“…The intervention was evaluated by means of a convergent mixed methods design, including a quantitative and a qualitative strand ( 21 – 23 ). The quantitative strand had a single-group pre-test-post-test repeated-measures design and was published elsewhere ( 19 ). The qualitative strand was based on a grounded theory approach and consisted of individual semi-structured in-depth interviews with all participating patients.…”

“…Demographic data were collected in a former study via the electronic patient record at the baseline and included gender, age, marital status, cultural background, education, living condition, and employment. Clinical characteristics were collected with the M.I.N.I-plus and comprised the primary SMI diagnosis, duration of illness, number of suicide attempts, suicide risks, and substance abuse ( 19 ).…”

“…Quantitative measurements used in this study were assessed as described before ( 19 , 20 ). In short, six quantitative measures of outcomes were used: post-traumatic stress disorder (CAPS) ( 30 ), dissociative symptoms (DES) ( 31 ), severe mental ill symptoms (HoNOS) ( 32 ), CAN ( 33 ), quality of life (MANSA) ( 34 ), and global functioning (GAF) ( 35 ).…”

“…In another article, we described quantitative results, showing that diagnostic PTSD scores decreased from a mean of 37.9 before NET (T0) to 31.9 after post-treatment (T1) (–6.0, 95% CI –10.0 to –2.0) and to 24.5 at follow-up (T2) (–13.4, 95% CI –17.4 to –9.4). Dissociation, psychiatric symptoms, contacts, and medication decreased, global functioning increased, and quality of life and perceived needs did not significantly change ( 19 ).…”