Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET)

Abstract

Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn

Are Mindfulness‐Based Interventions as Effective as Cognitive Behavioral Therapy in Reducing Symptoms of Complicated Perinatal Grief? A Systematic Review

“…56 In recent studies that analyzed a positive reappraisal coping intervention and narrative exposure therapy, these particular components of CBT have also shown to be effective for women who experienced a perinatal loss. 72,73 Subsequently, it can be argued these elements of CBT can be the most effective for this population.…”

“…Despite the differences in delivery and duration of the CBT interventions, all studies reported reductions of perinatal complicated grief symptoms 51,53,56–58 with improvements observed when participants engaged in cognitive reappraisal skills and emotion exposure exercises 56 . In recent studies that analyzed a positive reappraisal coping intervention and narrative exposure therapy, these particular components of CBT have also shown to be effective for women who experienced a perinatal loss 72,73 . Subsequently, it can be argued these elements of CBT can be the most effective for this population.…”

Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy

“…Recently, prolonged exposure for primary care (PE-PC), a four 30-min session treatment, has been piloted in both military and civilian samples and shown to be effective at reducing PTSD, depression, and related mental health symptoms ( 38 , 39 ). Similarly, a small recent study of a four-session narrative exposure based treatment for prenatal PTSD suggested acceptability to patients and clinically meaningful change on PTSD symptoms ( 40 ). These findings suggest that short term and brief treatments may be warranted in order to be acceptable to non-treatment seeking individuals, or those experiencing less severe symptoms.…”

“…These findings suggest that short term and brief treatments may be warranted in order to be acceptable to non-treatment seeking individuals, or those experiencing less severe symptoms. In addition, the evidence base for specifically treating pPTSD, including during pregnancy, is only now in development ( 40 ). Brief and shorter-term treatments for PTSD and pPTSD focused on arousal symptoms may be especially important in pregnant populations given the potential for adverse pregnancy outcomes due to untreated illness, and concerns for intergenerational transmission of trauma ( 27 , 41 ).…”

Survivor narratives of the Oklahoma City bombing: The story over time

“…Narrative analysis has demonstrated utility in clinical settings. For example, application of narratives in psychotherapy has been found to reduce anxiety, depression, and PTSD (Graf et al., 2008; Morkved et al., 2014; Stevens et al., 2020) and improves health outcomes through enhanced insight and medical decision‐making (Cepeda et al., 2008).…”