Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual, Family, Community, and Socio‐Political Contexts

Abstract

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.

Expanding the Traumatic Stress Framework to Incorporate a Socioecological Family Systems Perspective

“…For instance, clinicians may employ the dynamic socioecological framework when working with individual clients, noting how individual PTSD treatments have layered effects across systems. Cooper, Wieling, Pfieffer (2019) provide an example of this approach by underscoring how Narrative Exposure Therapy, while an individual treatment, has systemic implications including interpersonal shifts in parent-child, couple, and peer relationships, as well as impacts at the communal level for communities affected by mass trauma such as war or genocide, as the treatment can be delivered by lay professionals in the community. The dynamic ways in which this intervention can be implemented, with effects across affected systems, allows it to be responsive to varying traumatized systems that differ in severity, timing, and system type.…”

Uitbreiding van het model van traumatische stress met het perspectief van sociaal-ecologische gezinssystemen

“…Cooper et al. ( 2019 b) laten bijvoorbeeld zien hoe Narratieve Exposure Therapie, weliswaar een individuele behandeling, systemische gevolgen heeft zoals interpersoonlijke verschuivingen binnen ouder-kindrelaties, partnerrelaties en relaties met vrienden en collega’s. Op communaal niveau is het gunstig omdat de behandeling voor getroffenen van massale trauma’s zoals oorlog of genocide gegeven kan worden door lekenprofessionals in de gemeenschap.…”

Preliminary support for the use of narrative exposure therapy in a child protection context: Collective case‐study narratives

“…This supports previous research indicating that NET's reduction in trauma symptomology could also contribute to improvements in depression, substance use, interpersonal and family functioning (Bichescu et al, 2007; Pabst et al, 2014). This has led to Cooper et al (2019) presenting a number of case studies identifying the ‘biological implications’ of NET, specifically highlighting its potential impact on improving family outcomes.…”