scholarly journals Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

2019 ◽  
Vol 214 (06) ◽  
pp. 369-377 ◽  
Author(s):  
J.C.G. Lely ◽  
J.W. Knipscheer ◽  
M. Moerbeek ◽  
F.J.J. ter Heide ◽  
J. van den Bout ◽  
...  
Keyword(s):  
Older Adults ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Post Traumatic Stress ◽  
Narrative Exposure Therapy ◽  
Post Traumatic

BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

scholarly journals Treatment of adult post-traumatic stress disorder using a future-oriented writing therapy approach

2009 ◽  
Vol 2 (4) ◽  
pp. 243-255 ◽  
Author(s):  
Reginald D. V. Nixon ◽  
Leonard W. Kling
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Expressive Writing ◽  
Stress Disorder ◽  
Post Treatment ◽  
Future Research ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Ptsd Severity

AbstractThe aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

scholarly journals Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis

2020 ◽  
Vol 50 (4) ◽  
pp. 542-555 ◽  
Author(s):  
Ifigeneia Mavranezouli ◽  
Odette Megnin-Viggars ◽  
Caitlin Daly ◽  
Sofia Dias ◽  
Nicky J. Welton ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Treatment ◽  
Post Traumatic Stress ◽  
Psychological Treatments ◽  
Self Help ◽  
Remission Rates ◽  
Post Traumatic

AbstractBackgroundPost-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder affecting a significant minority of people exposed to trauma. Various psychological treatments have been shown to be effective, but their relative effects are not well established.MethodsWe undertook a systematic review and network meta-analyses of psychological interventions for adults with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1–4-month follow-up, and remission post-treatment.ResultsWe included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing (EMDR) [standardised mean difference (SMD) −2.07; 95% credible interval (CrI) −2.70 to −1.44], combined somatic/cognitive therapies (SMD −1.69; 95% CrI −2.66 to −0.73), trauma-focused cognitive behavioural therapy (TF-CBT) (SMD −1.46; 95% CrI −1.87 to −1.05) and self-help with support (SMD −1.46; 95% CrI −2.33 to −0.59) appeared to be most effective at reducing PTSD symptoms post-treatment v. waitlist, followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support and counselling. EMDR and TF-CBT showed sustained effects at 1–4-month follow-up. EMDR, TF-CBT, self-help with support and counselling improved remission rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence.ConclusionsEMDR and TF-CBT appear to be most effective at reducing symptoms and improving remission rates in adults with PTSD. They are also effective at sustaining symptom improvements beyond treatment endpoint. Further research needs to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD and also the impact of severity and complexity of PTSD on treatment outcomes.

Beliefs, sense of control and treatment outcome in post-traumatic stress disorder

2002 ◽  
Vol 32 (1) ◽  
pp. 157-165 ◽  
Author(s):  
M. LIVANOU ◽  
M. BAOŞĞLU ◽  
I. M. MARKS ◽  
P. DE SILVA ◽  
H. NOSHIRVANI ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Treatment ◽  
Controlled Study ◽  
Sense Of Control ◽  
Post Traumatic Stress ◽  
Post Traumatic

Background. Few studies have shown that maladaptive beliefs relate to treatment outcome.Method. In a randomized controlled study, 87 patients with post-traumatic stress disorder (PTSD) had exposure therapy alone or cognitive restructuring alone, or both combined, or relaxation. Independent blind assessors assessed patients at pre-, mid- and post-treatment and at follow-up; at those times patients rated cognitive, behavioural and emotional aspects of their disorder.Results. Baseline beliefs about mistrust, helplessness, meaninglessness and unjustness of the world related to baseline PTSD symptoms but did not predict treatment outcome, though improvement in certain beliefs correlated with more symptom improvement. Several ‘key’ beliefs changed after, and none before, symptoms improved. At post-treatment, sense of control and attribution of gains to personal efforts predicted maintenance of gains at follow-up.Conclusions. Baseline beliefs and improvement in beliefs did not predict outcome. Post-treatment sense of control/internal attribution predicted maintenance of gains at follow-up. How much sense of control is produced by or causes improvement deserves testing.

scholarly journals Implementing Narrative Exposure Therapy for unaccompanied asylum-seeking minors with post-traumatic stress disorder: A pilot feasibility report

2019 ◽  
Vol 25 (1) ◽  
pp. 213-226 ◽  
Author(s):  
Glorianne Said ◽  
Dorothy King
Keyword(s):  
Clinical Practice ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Functional Outcomes ◽  
Stress Disorder ◽  
Exposure Therapy ◽  
Routine Clinical Practice ◽  
Post Traumatic Stress ◽  
Narrative Exposure Therapy ◽  
Post Traumatic

There are high rates of post-traumatic stress disorder (PTSD) in unaccompanied asylum-seeking minors (UAM) and there is a requirement for feasible, acceptable and evidence-based treatments. Narrative Exposure Therapy (NET) is a short-term treatment for PTSD following multiple traumatic events. This article aims to examine the applicability of NET for UAM in routine clinical practice and to provide preliminary feasibility, acceptability and effectiveness data. The participants were four UAM receiving NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted to understand the acceptability of this approach and standardised measures of PTSD were used to provide preliminary data regarding the effectiveness of NET for these clients. The clients attended NET consistently with few missed appointments. At post-treatment, two clients’ symptom scores were below the clinical cut-off for PTSD and all three clients who completed NET met reliable improvement criteria. The clients reported improvements in functional outcomes and mentioned that they would encourage other young people with similar difficulties to engage in NET. This study was limited by the small sample size and naturalistic time limitations in clinicians’ contracts. This article highlights that it is possible to implement NET within routine clinical practice and observed improvements in PTSD symptoms and functional outcomes for UAM.

Unaccompanied minors’ experiences of narrative exposure therapy

2021 ◽  
Vol 14 ◽  
Author(s):  
Glorianne Said ◽  
Yaman Alqadri ◽  
Dorothy King
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Exposure Therapy ◽  
Refugee Children ◽  
List Type ◽  
Post Traumatic Stress ◽  
Unaccompanied Minors ◽  
Narrative Exposure Therapy ◽  
Post Traumatic

Abstract Despite the understanding that unaccompanied minors’ (UAM) experience high rates of post-traumatic stress, the provision of evidence-based trauma-focused therapies is low for this population. Narrative exposure therapy (NET) is an effective short-term intervention for treating post-traumatic stress disorder (PTSD) after multiple traumatic experiences, such as those experienced by UAM. Within the existing literature, there is a lack of research investigating unaccompanied minors’ experiences of NET or any trauma-focused therapy. Participants were four UAM experiencing PTSD who formed part of a pilot delivery of NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted and transcripts were analysed using interpretative phenomenological analysis (IPA). This project identified five themes that encapsulated unaccompanied minors’ experiences of receiving NET, including the process of preparing for this therapy, what it was like to receive it, and the differences they identified at the end of treatment. The significance of this taking place within a safe therapeutic relationship was explored within the context of the attachment losses experienced by UAM, and the impact this has on emotion regulation was considered. The potential of a reduction in PTSD symptoms facilitating a positive spiral in adolescence was reflected on within this paper. Key learning aims (1) To understand the experience of unaccompanied asylum-seeking minors (UAM) receiving narrative exposure therapy (NET) for post-traumatic stress disorder. (2) To understand the key concerns and motivators for UAM when considering engaging in NET. (3) To understand how these experiences relate to theoretical frameworks and the existing literature relating to emotional difficulties in adolescence.

Videoconferencing psychotherapy for veterans with PTSD: Results from a randomized controlled non-inferiority trial

2019 ◽  
Vol 26 (9) ◽  
pp. 507-519 ◽  
Author(s):  
Lin Liu ◽  
Steven R Thorp ◽  
Lucy Moreno ◽  
Stephanie Y Wells ◽  
Lisa H Glassman ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Treatment ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Treatment Change ◽  
Randomized Controlled ◽  
Post Traumatic

Introduction Veterans with post-traumatic stress disorder (PTSD) face significant barriers that make it less likely for them to pursue treatment. A randomized controlled non-inferiority trial was used to determine if providing psychotherapy for PTSD via videoconference (VC) is as effective as in-person (IP) psychotherapy. Methods All eligible veterans ( n = 207) received cognitive processing therapy (CPT) to treat PTSD symptoms in one of the two treatment modalities. Participant symptoms were collected at baseline, post-treatment, and six months after treatment completion. The primary outcome measure, the Clinician-Administered PTSD Scale (CAPS), was used to assess PTSD diagnosis and symptom severity. Secondary outcomes included two self-report measures of symptom severity, the Post-traumatic Stress Disorder Checklist – Specific (PCL–S) for PTSD and the Patient Health Questionnaire – 9 (PHQ–9) for depressive symptoms. A linear mixed-effects model was used to assess non-inferiority for participants who completed treatment (completers) and those who were randomized to treatment (intention-to-treat (ITT)). Results Both completer and ITT analyses showed that improvement in CAPS scores in the VC condition was non-inferior to that in the IP condition at six-month follow-up, but VC was inferior to IP for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL–S and PHQ–9 in both post-treatment change and six-month follow-up change, and the ITT analysis supported the significant non-inferiority for PCL at post-treatment change. Discussion These findings generally suggest that CPT delivered via VC can be as effective as IP for reducing the severity of PTSD symptoms.

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