Is Narrative Exposure Therapy An Effective Treatment for PTSD in Survivors of War, Terror and Torture? A Review

Background: This review examines available experimental outcome studies that evaluate the effectiveness of narrative exposure therapy (NET), a short-term intervention developed to counteract posttraumatic stress disorder (PTSD) in survivors of war, terror and torture. Survivors of war, terror and torture are a specialized group among trauma survivors due to the often multiple events and extended temporal nature of the trauma they have endured. Additionally, many have fled their homes and become internally displaced persons, refugees, or asylum seekers. Beyond its therapeutic value to individuals, NET is designed to create documentary evidence of human rights abuses, thereby assisting communities and nations.

Methods: This review will report and synthesize the results of randomized controlled studies that examine the effectiveness of NET on PTSD among survivors or war, terror and torture. Multiple database and hand searches were performed for key works including “refugee,” “trauma,” “outcome,” “intervention,” and “narrative exposure therapy.” Studies were eligible for review if they met the inclusion criteria: 1) randomized control trial study design; 2) use of PTSD symptomatology as an outcome variable; 3) published in a peer-reviewed journal; 4) published in the English language; and 5) published since 2000. Participants: The eight studies reviewed here report results from NET trials with heterogeneous populations, including Sri Lankan children, Rwandan orphans, Romanian former prisoners, and African refugees. Participants range in from age from 7 to over 70.

Results: Participants who received NET in the reviewed studies show an overall decrease in PTSD symptomatology when compared to participants who received other treatments, waitlist or treatment as usual. Though the studies are very diverse in design (e.g., participant population, length of treatment, provider of treatment, use of translators, comparison treatment, etc.), the studies' strengths include a concern for NET treatment fidelity, the use of standard PTSD diagnostic instruments, and adherence to experimental study design.

Conclusions & Implications: There is preliminary evidence to support the effectiveness of NET for the treatment of PTSD in diverse populations. The evidence would be strengthened with larger trials and further attention to blinding of subjects and evaluators. Additionally, the research teams who conducted the current studies share team members; NET needs to be evaluated by independent researchers in new populations. Future Implications: Our world is home to millions of survivors of war, terror and torture. As a potentially effective treatment for PTSD in these survivors, NET should be further evaluated; if found effective, social workers and others who work with refugee populations should be trained in its use. Also, the studies evaluated in this review did not evaluate NET's human-rights impact. Further studies should evaluate NET's potential as a human-rights intervention.