Brief Narrative Exposure Therapy for Posttraumatic Stress in Iraqi Refugees: A Preliminary Randomized Clinical Trial

Abstract

Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally-sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the U.S. reporting elevated posttraumatic stress (N=63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well-being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2- and 4-month follow-ups. Treatment participation (95.1% completion) and study retention (98.4% provided follow-up data) were very high. Significant condition by time interactions showed that brief NET led to greater posttraumatic growth (Effect size; ES=0.83) and well-being (ES=0.54) through 4 months than the control. Brief NET reduced symptoms of posttraumatic stress (ES=-0.48) and depression (ES=-0.46) compared to control, but only at 2 months; symptoms of controls decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of NET increased growth and well-being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Middle Eastern refugees.

Narrative Exposure Therapy

“…3 However, one modification made by researchers has been to decrease the session numbers (3–6 sessions). 7,86,88,90,91 The shortened sessions has been supported by the documentation of Initial relief has been documented within 3 sessions of NET 3 and effectiveness in shortened studies. For example, a study examining a brief modification of NET (3 sessions) determined increase of well-being and symptoms reduction in a sample of Iraqi refugees.…”

“…For example, a study examining a brief modification of NET (3 sessions) determined increase of well-being and symptoms reduction in a sample of Iraqi refugees. 90 Notably, the authors attributed the therapy’s modest effect as compared to other studies to the short-term therapy. However in the original NET, the therapist determines the number of sessions based on the severity and number of traumatic events.…”

“…6,83,84,87,88 Other studies indicated doctoral or psychology students delivered the intervention 6,90,91 or expert clinicians or mental health professionals 5,7,85,87,89 but did not detail level of education or training. However, to improve access to transient populations, implementation studies have been conducted with NET using trained lay counselors.…”

“…However, one study had a sample size of 277. 86 Trauma affected all participants, which included refugees and asylum seekers, 6,83,84,86,89,90 political detainees and torture and genocide survivors, 85,89,91 survivors of mass disasters and war, 4,5,7,85,88 and child soldiers. 8 All participants met criteria for PTSD.…”

“…4,5,7,8,86,88 Only one study was set in the United States. 90 Hijazi and colleagues (2014) recruited at community agencies providing comprehensive services for refugees. However, intensive therapy was not included in such services.…”