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

Abstract

Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET).

Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short- (< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression.

Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term.

Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.

Keywords:

• Narrative Exposure Therapy
• PTSD
• systematic review’ therapy
• meta-analysis

Acknowledgement

We would like to thank Thomas Elbert, Svenja Geißler, Yannick Janvier, Eylül Karabiber, Kaan Karan, Michaela Potts, Natalie Talalaev and Laura Wilhelms for their valuable input and help in conducting this study. We are further grateful to the study authors providing invaluable information regarding the included studies. All three authors designed the study and wrote the preregistration. Authors S. Siehl and A. Crombach conducted the systematic literature searches with the help of two psychology students, provided the overview tables and coded the studies for analyses. The risk of bias ratings were carried out by a student and A. Crombach. The statistical analysis was carried out by S. Siehl, who also wrote the first draft of the manuscript to which all three authors contributed to. All authors have approved the final manuscript.

Conflict of Interest

All authors report no financial relationships with commercial interests.

Role of Funding Sources

All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Data Transparency Statement:

The data reported in this manuscript were obtained from publicly available data. The data was extracted by the authors of this manuscript from the original publications reviewed in this manuscript. To the best of our knowledge, there is currently no journal articles, working papers, conference presentations, and dissertations using the dataset of this study. The variables and relationships examined in the present article have not been examined in any previous or current articles, or to the best of our knowledge in any papers that will be under review soon. The data and R scripts are online and can be retracted from the Open Science Framework under the title of the study.

Supplemental data

Supplemental data for this article can be accessed doi:10.1080/10503307.2020.1847345.