An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors

Abstract

Introduction: Torture is associated with adverse health consequences, with especially high rates of PTSD, depression and chronic pain. Despite increased awareness of the relationship between pain and posttraumatic symptoms, and the accompanying need for effective treatment strategies, few studies have examined an integrated treatment of comorbid PTSD and pain. Methods: In this study, using an A-B case series design with three and six month follow-up, six refugee torture survivors with comorbid PTSD, depression and chronic pain received 20 sessions of Narrative Exposure Therapy (NET) and 10 sessions of physiotherapy. Outcome variables included symptoms of PTSD and depression, pain intensity, physical functioning and quality of life. Symptoms of PTSD and pain were also rated after each treatment session. Results: Two patients achieved clinically significant reduction in symptoms of PTSD. Only one patient achieved clinically significant change in depressive symptoms, and two experienced clinically significant reduction in pain intensity. Clinical descriptions of the course of treatment for all patients are provided. Discussion and Conclusions: Despite its limitations, the study suggests that some torture survivors who suffer high symptom loads may benefit from a combined treatment of NET and physiotherapy. Appreciating individual differences and how they affect treatment can provide valuable insight and inform clinicians working with torture survivors. Directions for future research regarding the improvement of rehabilitation strategies of torture survivors are discussed, and highlighted through descriptions from the six therapy cases.

The effects of a combined psychotherapy and physiotherapy group treatment program for survivors of torture incarcerated in an adult prison in Kurdistan, Iraq: A pilot study

“…Physiotherapy, which integrates pain neuroscience education and other aspects of the biopsychosocial treatment of pain, has been used to treat persistent pain and functional impairments in the general population, those with mental health problems, and with survivors of torture (Amris & Williams, 2015). Additionally, the effectiveness of an interdisciplinary approach, combining psychotherapy and physiotherapy, for the treatment of pain and mental health problems has been explored (Dibaj et al, 2017;Kurklinsky et al, 2016;Mcgeary, Moore et al, 2011). However, globally, there are no studies examining an interdisciplinary treatment program for survivors of torture who are incarcerated.…”

Trajectories of posttraumatic stress symptoms during and after Narrative Exposure Therapy (NET) in refugees

“…To our knowledge, there are no current studies that have systematically examined symptom trajectories of refugees during treatment. Until now, only one case study depicted the course of symptoms in 6 refugees during a combination of NET and physiotherapy [48]. Otherwise, treatment studies with refugees have concentrated on a few assessment time points of symptoms only [49][50][51].…”

Evaluation of the efficacy of a South African psychosocial model for the rehabilitation of torture survivors

“…However, exceptional experimental studies do exist, with substantial improvements found using the Common Elements Treatment Approach, compared to the less effective Cognitive Processing Therapy (Weiss et al, 2015). Quasiexperimental and outcome research on the rehabilitation of torture survivors provides further support for CBT (Halvorsen & Stenmark, 2010;Neuner et al, 2010) and NET (Dibaj, Overaas Halvorsen, Edward Ottesen Kennair, & Inge Stenmark, 2017;Hansen, Hansen-Nord, Smier, EngelkesHeby, & Modvig, 2017), culturally tailored health promotion intervention (Berkson, Tor, Mollica, Lavelle, & Cosenza, 2014) and educational groups (Phaneth, Panha, Sopheap, Harlacher, & Polatin, 2014). Furthermore, the literature reviewed indicates a strong prevalence of European and North American studies on the rehabilitation of torture survivors, with few outcome studies based in Africa.…”