Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

Abstract

BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

“…All four PTSD clusters showed significant reduction of symptoms, whereas intrusions, arousal and reactivity decreased more slowly than symptoms of avoidance, cognition and mood. These results are in line with other controlled NET studies in vulnerable patients, such as children and adolescents, 52 patients with borderline personality, 17 the elderly, 53 refugees 15 and asylum-seeking refugees with PTSD and depressive disorder. 54 Of the 23 participants, 11 (48%) were in remission for PTSD at follow-up.…”

“…Until now, most NET studies excluded patients with psychosis, bipolar disorder, substance misuse and suicidal ideations. 17,[52][53][54] One case study reported positive results of NET in a refugee with PTSD and psychotic features. 57 Mørkved et al 55 compared NET and prolonged exposure therapy for PTSD and argued that NET and prolonged exposure have several commonalities when it comes to the principles of exposure.…”

Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators

“…In two thirds of studies the risk of bias was medium to low (Table 5; Ertl et al, 2011;Hijazi et al, 2014;Lely et al, 2019a;Morath et al, 2014a;Morath et al, 2014;Neuner et al, 2008;Neuner et al, 2004b;Orang et al, 2018;Stenmark et al, 2013;Zang et al, 2014Zang et al, , 2013, while in a third of studies the risk of bias was found to be unclear or medium to high (Adenauer et al, 2011(Adenauer et al, , 2015Bichescu et al, 2007;Crombach & Siehl, 2018;Hensel-Dittmann et al, 2011;Neuner et al, 2010;Pabst et al, 2014;Schaal et al, 2009). The complete ratings can be found in Suppl.…”

Effectiveness of a Multimodal, Day Clinic Group-Based Treatment Program for Trauma-Related Disorders: Differential Therapy Outcome for Complex PTSD vs. Non-Complex Trauma-Related Disorders

“…Hence, “stabilization” not only included training in affect regulation and self-calming abilities but also focused on trauma-related contents and clearing of associations between traumatic experiences and present symptomatology or difficulties in everyday life. The present-centered therapy approach introduced by Schnurr et al (60) includes similar contents and was shown to be an efficacious and safe treatment for trauma-related disorders (64, 65). Skipping the presented aspects and starting directly with confrontational methods, e.g.…”