The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis

Figures & data

Figure 1. Selection of studies. NET, narrative exposure therapy; RCT, randomized controlled trial; ITT, intention-to-treat.

Table 1. Characteristics of the included studies.

Study name	N NET	Age	Male participants (%)	Treatment dose	Professionals	Outcome	Language	Migration	Dropout NET	Control
Alghamdi et al. 2015	17	28.7	100.00	360	1	SR*	1	0	0.00	WLC*
Al-Hadethe et al. 2015	20	17.5	100.00	300	1	SR	1	0	0.05	EFT*
Bichescu et al. 2007	9	68.9	100.00	600	1	DI*	1	0	0.00	PED*
Ertl et al. 2011	29	18.66	44.8	840	0	DI	1	0	10.34	Catch-up*
Hensel-Dittmann et al. 2011	15	36.4	57.14	900	1	DI	0	1	20.00	SIT*
Hijazi et al. 2014	41	47.6	36.59	225	1	SR	1	1	4.88	WLC
Jacob et al. 2014	38	40.0	10.53	960	0	DI	1	0	2.63	WLC
Morath et al. 2014a	17	27.29	58.82	1080	1	DI	0	1	0,00	WLC
Morath et al. 2014b	19	28.7	67.65	1080	1	DI	0	1	21.05	WLC
Neuner et al. 2004	17	31.9	41.18	420	1	SR	0	0	5.88	SC*
Neuner et al. 2008	111	34.4	49.55	540	1	SR	1	0	3.6	TC*
Neuner et al. 2010	16	31.6	68.75	1055	1	SR	0	1	12.5	TAU
Schaal et al. 2009	12	19.42	38.46	540	1	DI	0	0	0.00	IPT*
Stenmark et al. 2013	51	34.51	66.67	900	1	DI	0	1	25.49	TAU
Zang et al. 2013	11	56.64	22.72	360	1	SR	1	0	0.00	WLC
Zang et al. 2014, NET* 2014	10	53.5	6.67	300	1	SR	1	0	0.00	WLC
Zang et al. 2014, NET-R* 2014	10	56.5	6.67	270	1	SR	1	0	0.00	WLC

^*Catch-up, academic catch-up programme; DI, diagnostic interview; EFT, emotional freedom techniques; IPT, interpersonal psychotherapy; NET, narrative exposure therapy; NET-R, NET – revised; PED, psychoeducation; TC, Trauma Counselling; SC, supportive counselling; SIT, stress inoculation training; SR, self-report; TAU, treatment as usual; WLC, waiting-list conditions.

Table 2. Mean effect sizes of narrative exposure therapy (NET) on post-traumatic stress disorder (PTSD) and depression outcomes, in Hedges’ g.

	Effect sizes					Heterogeneity
	k	Mean	−95% CI*	95% CI	p- value	Q*	df*	p- value
PTSD
Non-controlled effect sizes
Pre- to post-treatment	17	1.18	0.87	1.50	.000	117.41	16	.000
Pre-treatment to last follow-up	15	1.35	0.93	1.77	.000	94.77	14	.000
Controlled effect sizes
All active comparators	9	0.24	−0.10	0.58	.166	25.24	8	.001
Active non-TF comparators	7	0.43	0.09	0.78	.014	11.65	6	.070
Non-active comparators	8	1.37	0.66	2.07	.000	50.96	7	.000
All comparators	17	0.69	0.33	1.06	.000	92.33	16	.000
Depression
Non-controlled effect sizes
Pre- to post-treatment	13	0.47	0.23	0.71	.000	40.63	12	.000
Pre-treatment to last follow-up	11	0.60	0.26	0.94	.001	46.68	10	.000
Controlled effect sizes
All active comparators	7	0.17	−0.31	0.64	.497	22.70	6	.001
Active non-TF comparators	6	0.33	−0.05	0.70	.088	9.84	5	.080
Non-active comparators	6	0.79	0.48	1.09	.000	5.47	5	.361
All comparators	13	0.49	0.15	0.82	.004	35.57	12	.000

^*Note.CI, confidence interval; Q, Cochrane’s heterogeneity statistic; df, degrees of freedom. All active comparators: Trauma focused comparators (Emotional Freedom Techniques and Trauma Counselling) plus active non-TF comparators; Active non trauma focused (non-TF) comparators, Academic Catch-up Programme; Interpersonal Psychotherapy; Psychoeducation; Stress Inoculation Training; Supportive Counselling, and Treatment as Usual. Non-active comparators, waiting list conditions.

Figure 2. Mean effect sizes of narrative exposure therapy (NET) Hedges’ g [95% confidence interval]. Risk of Bias: A, random sequence generation; B, allocation concealment; C, blinding of participants and personnel; D, blinding of outcome assessment; E, incomplete outcome data; F, selective reporting; G, other bias. Ratings: +, low; ?, unclear; -, high.

Table 3. Mean non-controlled effect sizes of the comparators in Hedges’ g (g = 0.02 small; g = 0.05 medium; g = 0.08 large) (Cohen, 1992).

	Effect sizes					Heterogeneity
	k	Mean	−95% CI*	95% CI	p-value	Q*	df*	p-value
All comparators
PTSD* pre–post	17	0.77	0.41	1.12	.000	162.81	16	.000
PTSD pre–FU*	12	1.08	0.55	1.62	.000	95.48	11	.000
Depression pre–post	13	0.34	0.08	0.59	.010	43.18	12	.000
Depression pre–FU	9	0.67	0.26	1.12	.002	37.07	8	.000
Active comparators
PTSD pre–post	8	0.69	0.22	1.16	.004	39.24	7	.000
PTSD pre–FU	5	0.57	−0.17	1.32	.133	32.45	4	.000
Depression pre–post	3	0.31	−0.06	0.67	.100	1.233	5	.030
Depression pre–FU	3	0.47	−0.10	1.04	.108	3.79	2	.150
Active TF* comparators
PTSD pre–post	2	1.79	1.02	2.56	.000	3.37	1	.066
PTSD pre–FU	2	1.50	0.30	2.71	.015	7.20	1	.007
Depression pre–post	1	0.97	0.41	1.54	.001	0.00	0	1.000
Depression pre–FU	1	1.14	0.50	1.79	.001	0.00	0	1.000
Non–active comparators
PTSD pre–post	9	0.19	−0.08	0.47	.163	35.10	8	.000
PTSD pre–FU	7	1.40	0.54	2.26	.001	71.23	6	.000
Depression pre–post	7	0.05	−0.09	0.19	.498	1.32	6	.97
Depression pre–FU	6	0.54	−0.01	1.09	.052	32.00	5	.000

^*PTSD, post-traumatic stress disorder; FU, follow-up; TF, trauma-focused; CI, confidence interval; Q, Cochrane’s heterogeneity statistic; df, degrees of freedom.

Table 4. Meta-regression analyses relating mean age, being female, migration, treatment dose, matching languages, outcome, and therapist’s training to non-controlled effect sizes.

PTSD*
Assessment	Moderator	R^2*	Q* (df = 7)	B*	SE*	B*	p-value
Pre- to post treatment		.34	22.04 (9)				.088
	Mean Age			0.05	0.02	0.75	.043
	Female Gender			−0.01	0.01	−0.39	.145
	Migration			−0.70	0.41	−0.44	.084
	Treatment Dose			0.00	0.00	0.41	.325
	Matching Languages			−0.48	0.60	−0.30	.421
	Outcome			−0.15	0.45	−0.09	.744
	Therapist’s Training			−0.33	0.72	−1.18	.643
Depression
Pre- to post treatment		.97	.82 (5)				.976
	Mean Age			0.3	0.14	0.99	.039
	Female Gender			0.00	0.01	−0.04	.993
	Migration			−0.46	0.19	−0.60	.018
	Treatment Dose			0.00	0.00	−0.22	.793
	Matching Languages			−0.96	0.98	−1.11	.328
	Outcome			−0.22	0.36	−0.26	.548
	Therapist’s Training			0.17	1.18	0.10	.887

PTSD, post-traumatic stress disorder; R², explained variance; Q, Cochrane’s heterogeneity statistic; df, degrees of freedom; B, intercept; SE, standard error; β, regression coefficient.

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