Investigating the Efficacy and Experiences With Narrative Exposure Therapy in Severe Mentally Ill Patients With Comorbid Post-traumatic Stress Disorder Receiving Flexible Assertive Community Treatment: A Mixed Methods Study

Abstract

BackgroundPatients with severe mental illness with repeated interpersonal trauma and post-traumatic stress disorder (PTSD) have a negative illness progression. Traumas are often not treated because of their vulnerability. Narrative exposure therapy (NET) is an effective trauma therapy. It is unknown whether NET is effective and tolerable in these patients receiving community mental healthcare.ObjectivesThe objectives of this study are (1) to gain insights into patients’ experiences before, during, and after NET concerning changes in PTSD, dissociative and severe mental ill symptoms, care needs (CAN), quality of life, and global functioning; (2) to identify factors that influence diagnostic changes after NET as compared to patients’ experiences. These insights will help to decide whether NET should be incorporated in usual care for these patients.DesignA mixed methods convergent design consists of a grounded theory approach with thematic analysis followed by a merged analysis, comparing quantitative, and qualitative data for each participant and by means of a joint matrix.ParticipantsAdult psychiatric outpatients (age, 21–65) with post-traumatic stress disorder (PTSD) related to repeated interpersonal trauma were indicted for the study.MethodsBaseline demographics and clinical characteristics were assessed. Qualitative data were collected 3 months after NET using individual semi-structured in-depth interviews. The merged analysis compared quantitative and qualitative results for each participant.ResultsTwenty-three outpatients (female, 82%) with a mean age of 49.9 years (SD 9.8) participated in the study. Participants experienced NET as intensive, and most of them tolerated it well. Afterward, eighteen participants perceived less symptoms. Mixed analysis showed substantial congruency between quantitative scores and participants’ perceptions of PTSD, dissociative symptoms, and CAN (Cohen’s kappa > 0.4). Remission of PTSD was associated with sufficient experienced support.ConclusionOutpatients with severe mental illness underwent intensive NET, and most of them tolerate it well. This therapy is clearly efficacious in this group.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NL5608 (NTR5714)].

How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient’s Experience

“…There were N = 33 studies that met inclusion criteria presented in Table 1 [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. Publication years ranged from 2003–2023.…”

“…There were three studies that analyzed Acceptance and Commitment Therapy (ACT) [ 32 , 37 , 39 ] and one with compassionate imagery [ 43 ]. Several additional studies involved a form of trauma therapy, including one study each of eye movement desensitization and reprocessing EMDR [ 41 ], trauma-focused imaginal exposure [ 42 ], prolonged exposure [ 47 ], narrative exposure therapy [ 55 ], and two studies including trauma-integrated psychotherapy for psychosis (TRIPP) [ 61 , 62 ]. In addition, two studies analyzed a technology-enhanced/assisted psychotherapy: Slowmo [ 45 ] and virtual reality therapy for negative symptoms [ 38 ].…”

“…The majority of studies included a cohesive sample of persons with psychosis, schizophrenia, or schizoaffective disorder [ 32 , 33 , 34 , 35 , 36 , 38 , 40 , 43 , 44 , 45 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 60 , 61 , 62 , 63 ]. There were twelve studies which included a broader population of serious mental illness that included additional diagnoses (e.g., depression with psychotic features or post-traumatic stress disorder) along with psychosis [ 31 , 39 , 41 , 42 , 46 , 47 , 55 , 57 , 58 , 59 , 61 , 62 ]. One study included individuals with clinical high risk in addition to the individuals with early psychosis that fit inclusion criteria, thus it was included in the analysis [ 37 ].…”

Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation

“…Many interventions included either a specific trauma-focused therapy (n = 7), such as Eye Movement Desensitization and Reprocessing (EMDR), or a trauma-focused therapy in combination with another intervention (n = 14), including within an intensive trauma program (n = 4). Studies with a single, specific trauma-focused therapy included EMDR (n = 4), [86][87][88]91 Narrative Exposure Therapy (NET) (n = 2), 89,90 Prolonged Exposure (PE) (n = 1), 91 and Hypnotherapeutic Olfactory Conditioning (HOC) (n = 1); 85 all but a group-based bilateral stimulation intervention reported dissociation improvement. This study enrolled participants with severe dissociative symptoms from a specialty trauma and dissociation clinic.…”

“…This study enrolled participants with severe dissociative symptoms from a specialty trauma and dissociation clinic. 88 Other populations studied included PTSD or trauma exposure (n = 5), [85][86][87]89,91 including those with comorbid BPD 90 and severe mental illness with repeated interpersonal trauma. 89 Treatments that combined a trauma-focused modality with another therapy were also common (n = 14 studies); all but two reported improvements in dissociation.…”