Treatment of Traumatized Victims of War and Torture: A Randomized Controlled Comparison of Narrative Exposure Therapy and Stress Inoculation Training

Abstract

Background: The aim of the present randomized controlled trial was to compare the outcome of 2 active treatments for posttraumatic stress disorder (PTSD) as a consequence of war and torture: narrative exposure therapy (NET) and stress inoculation training (SIT). Methods: Twenty-eight PTSD patients who had experienced war and torture, most of them asylum seekers, received 10 treatment sessions of either NET or SIT at the Outpatient Clinic for Refugees, University of Konstanz, Germany. Posttests were carried out 4 weeks after treatment, and follow-up tests were performed 6 months and 1 year after treatment. The main outcome measure was the PTSD severity score according to the Clinician-Administered PTSD Scale (CAPS) at each time point. Results: A significant reduction in PTSD severity was found for NET, but not for SIT. A symptom reduction in the NET group occurred between pretest and the 6-month follow-up examination, the effect size being d = 1.42 (for SIT: d = 0.12), and between pretest and the 1-year follow-up, the effect size being d = 1.59 (for SIT: d = 0.19). The rates and scores of major depression and other comorbid disorders did not decrease significantly over time in either of the 2 treatment groups. Conclusions: The results indicate that exposure treatments like NET lead to a significant PTSD symptom reduction even in severely traumatized refugees and asylum seekers.

Attentional Bias Modification in Posttraumatic Stress Disorder: A Randomized Controlled Trial

“…However, our mean dropout rate (25.2%) fell within the range of dropout rates in cognitive-behavioral therapy (e.g. 32% [19] and 15% [20,21]). …”

Effects of Psychotherapy on DNA Strand Break Accumulation Originating from Traumatic Stress

“…Several other studies have already reported PTSD symptom reduction after NET [28,29,30]; however, the positive impact of psychotherapy on a molecular parameter with potential long-term impact on physical health, i.e., DNA strand breakage, has not been demonstrated before. Although our sampling of tissue in the present study was restricted to PBMCs, we have presented a proof-of-principle for the reversibility of DNA strand breakage, an established risk factor in genomic instability and carcinogenesis, in somatic cells of individuals with PTSD after successful psychotherapy.…”

“…The aim of this procedure is to transform the generally fragmented reports of the implicitly coded traumatic experiences [27] into a coherent narrative, i.e., verbally accessible autobiographic memory. The efficacy of NET in improving PTSD symptomatology has been shown in a series of randomized controlled trials [28,29,30]. …”

Torture and its Consequences, Psychology of

“…Narrative exposure therapy (NET) is an evidence-based treatment approach designed to treat survivors of organized violence who have endured multiple or continuous traumatic stressors and has proven effectiveness in torture survivors (Hensel-Dittmann et al, 2011;Neuner et al, 2010) (see Figure 4). NET addresses both the personal consequences and the political aspects of organized violence and torture.…”