Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

Abstract

Objective

We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET).

Design

Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach.

Methods

Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery.

Results

NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability.

Conclusions

Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

Acknowledgements

DAISY Foundation Health Equity Award HEG-2022-454. Rush University College of Nursing Dean’s Fund. Imani Dixon, MPH, RN; Andrew Paul Froilan, MSN, RN; Niranjan S. Karnik, MD, PhD; Olimpia Paun, PhD, PMHCNS-BC, FGSA; Natalie Pryzbylo, MSNc; Monique Reed, PhD, MS, RN, FAAN; Barbara Swanson, PhD, RN, RAAN, ACRN.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

DAISY Foundation Health Equity Research Grant HEG-2022-454; Rush University College of Nursing Dean’s Fund.