Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy

Figures & data

Figure 1. Adapted CONsolidated Standards of Reporting Trials (CONSORT) flow diagram of data collection. NET, narrative exposure therapy; TAU, treatment as usual.

Table 1. Number of therapists trained, as well as interventions started and completed at different types of treatment units.

Unit	Therapists trained	Interventions started	Interventions completed
Primary healthcare	10	4	4
Specialized healthcare: outpatient clinics	27	30	24
Specialized healthcare: inpatient clinic	4	0	0
Third sector (trauma unit)	7	10	6
Housing unit	3	6	5
Total	51	50	39

Table 2. Number of therapists trained, as well as interventions started and completed, by occupation of therapist.

Occupation	Therapists trained	Interventions started	Interventions completed
Psychiatric nurse	13	16	14
Social worker	4	3	2
Psychologist	29	24	16
Psychiatrist	5	7	7
Total	51	50	39

Table 3. Demographic variables and baseline levels of mental health variables for all randomized participants.

Demographic variables	NET (n = 30) N (%) M (SD)	TAU (n = 20) N (%) M (SD)	Difference
Gender			ns
Girl	12 (40%)	9 (45%)
Boy	18 (60%)	11 (55%)
Age	13.4 (2.7)	13.0 (3.3)	ns
Country of origin			ns
Finland	7 (23%)	6 (30%)
Afghanistan	8 (27%)	6 (30%)
Iraq	8 (27%)	6 (30%)
Other	6 (20%)	3 (10%)
Previous psychiatric treatment (yes)	25 (83%)	17 (85%)	ns
Post-traumatic stress symptoms	38.0 (14.3)	37.0 (13.0)	ns
Depressive symptoms	14.0 (9.0)	12.9 (4.8)	ns
Psychological distress, self-evaluated	14.2 (7.2)	15.8 (5.3)	ns
Psychological distress, guardian-evaluated	17.1 (7.7)	17.4 (6.6)	ns
Resilience	14.1 (4.8)	13.2 (4.5)	ns

NET, narrative exposure therapy; TAU, treatment as usual; ns, no significant difference at p < .05, according to t test. Post-traumatic stress symptoms were measured with the Children’s Revised Impact of Event Scale (theoretical range 0–65). Depressive symptoms were measured by the Depression Self-Rating Scale for Children (theoretical range 0–36). Psychological distress was measured by the Strengths and Difficulties Questionnaire Total Difficulties scale (theoretical range 0–40). Resilience was measured by a custom 10-item measure (theoretical range 0–20).

Table 4. Exposure to different types of traumatic events for children with refugee or family violence backgrounds.

Traumatic event	Refugee (n = 37)	Family violence (n = 13)
Stayed at refugee camp	6 (16%)
Been imprisoned or held in enclosed space against will	13 (35%)
Experienced violence by a stranger	30 (81%)
Family members imprisoned or taken away against their will	17 (46%)
Family members experienced violence or been tortured	27 (73%)
Family members died due to armed conflict	13 (35%)
Family members injured due to armed conflict	9 (24%)
Been separated from family members due to armed conflict	20 (54%)
Family members missing	13 (35%)
Experienced physical abuse by caretakers	21 (57%)	13 (100%)
Experienced psychological abuse by caretakers	20 (54%)	9 (69%)
Experienced sexual abuse by caretakers	7 (19%)	6 (46%)
Neglected	10 (27%)	7 (54%)

Table 5. Levels of primary outcomes at pretreatment and post-treatment for treatment completers, with mean changes and effect sizes.

	Pretreatment				Post-treatment				Change
	NET		TAU		NET		TAU		NET			TAU
Outcome	n	M (SD)	n	M (SD)	n	M (SD)	n	M (SD)	n	M (SD)	gav	n	M (SD)	gav
Post-traumatic stress symptoms	22		16		22		16		21			16
Hyperarousal		13.4 (7.6)		11.0 (6.5)		10.3 (7.1)		9.7 (5.9)		−3.52 (6.45)	0.46		−2.00 (5.24)	0.32
Intrusions		12.1 (4.4)		10.9 (5.2)		7.5 (5.3)		8.8 (6.5)		−4.81 (4.26)	0.97		−2.63 (5.44)	0.43
Avoidance		12.8 (5.0)		13.7 (5.8)		10.5 (6.1)		13.6 (5.7)		−2.00 (5.86)	0.35		+0.31 (5.04)	0.05
Total		38.3 (14.4)		35.6 (12.2)		28.2 (15.2)		32.1 (14.9)		−10.33 (12.70)	0.68		−4.31 (12.1)	0.30
Depressive symptoms	18	13.1 (9.2)	12	12.8 (5.0)	14	13.0 (8.6)	11	12.1 (6.4)	13	−2.08 (6.87)	0.22	11	−0.91 (3.73)	0.14
Resilience	18	14.6 (4.9)	13	13.3 (5.2)	15	15.1 (4.1)	11	15.0 (2.5)	14	+1.57 (3.61)	0.32	11	+2.00 (4.27)	0.43
Psychological distress
Self-evaluated	18	14.6 (7.2)	10	15.4 (5.7)	12	14.7 (5.8)	9	13.4 (5.2)	12	−2.25 (4.69)	0.33	8	−2.50 (4.63)	0.39
Guardian-evaluated	13	18.0 (7.4)	10	17.3 (7.3)	10	15.0 (9.1)	11	15.8 (5.3)	10	−3.10 (5.80)	0.33	9	−3.33 (5.68)	0.50

NET, narrative exposure therapy; TAU, treatment as usual; g_av, effect size as Hedges’ g using average variance.

Table 6. Repeated measures analysis of variance results for changes in post-traumatic stress disorder (PTSD) (n = 39) from pretest to post-test.

	PTSD Total score		Intrusions		Avoidance		Arousal
	F	p	F	p	F	p	F	p
Time	12.93	< .001	21.77	< .001	1.15	.291	8.15	.007
Group	0.00	.949	0.00	.996	1.15	.290	0.51	.478
Time*Group	1.98	.168	1.88	.179	1.30	.262	0.68	.416

df = (1,35). PTSD Total score, Intrusions, Avoidance, and Arousal subscales of the Children’s Revised Impact of Event scale.

Table 7. Repeated measures analysis of variance results for changes in resilience (n = 26), psychological distress reported by the child (n = 21) and guardian (n = 21), and depression (n = 25) from pretest to post-test.

	Resilience		Psychological Distress, Self		Psychological Distress, Guardian		Depression
	F	p	F	p	F	p	F	p
Time	5.14	.033	4.970	.039	5.940	.026	1.66	.212
Group	0.07	.794	0.471	.501	1.15	.290	0.00	.949
Time*Group	0.07	.168	0.150	.908	0.011	.971	0.25	.620

df: Resilience (1,23), Psychological Distress Self-Evaluated (1,18), Psychological Distress, Guardian (1,17), Depression (1,22).

Figure 2. Levels of total post-traumatic stress disorder (PTSD) symptoms, and the Intrusions, Avoidance, and Arousal subscales at pretest (dark grey bars) and post-test (light grey bars). Mean group scores on the Children’s Revised Impact of Event Scale are presented, with 95% confidence intervals. NET, narrative exposure therapy; TAU, treatment as usual. *Significant difference according to t tests at p < .05.