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Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy

Mundt, Adrian P.; Wünsche, Petra; Heinz, Andreas; Pross, Christian

doi: 10.1097/WTF.0000000000000001
Article

This article provides a framework for evaluating randomised controlled efficacy trials for the treatment of posttraumatic stress disorder, in low and middle income countries, applied to Narrative Exposure Therapy. A list of methodological and conceptual indicators to evaluate trial data was developed and utilised to assess six trials. The efficacy of this therapy to reduce symptoms is mainly deduced from effects that were measured at long term follow-up points, and that had not been seen at relatively early follow-up points. Focused interventions, such as the Narrative Exposure Therapy, may be too short in duration to comprehensively address posttraumatic stress disorder developed as a consequence of serial, long term exposure to trauma with the consequent disruption of social contexts. The Narrative Exposure Therapy approach also does not consider the cultural and political context, nor the effect of traumatic events on communities and appears to be disconnected from more comprehensive care systems. As a result, data for the efficacy of this therapy in post disaster settings are not yet conclusive. Conceptual problems should be addressed in further effectiveness trials.

Adrian P. Mundt, M.D., Ph.D., psychiatrist and psychotherapist trained at the Charité, Universitätsmedizin Berlin, Germany; Traumatherapist; Research fellow at the Unit for Social & Community Psychiatry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, United Kingdom holding a European Union Marie Curie International Outgoing Fellowship at the Department of Psychiatry and Mental Health of the University of Chile. email: a.mundt@qmul.ac.uk

Petra Wünsche, psychologist, Gestalt Therapist, Traumatherapist, Consultant for Medica Mondiale and Doctors Without Borders.

Andreas Heinz, M.D., Ph.D., psychiatrist and psychotherapist, Director and Chair of the Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Universitätsmedizin Berlin, Germany.

Christian Pross, M.D., Ph.D., psychotherapist, founder and former director of the Treatment Centre for Victims of Torture in Berlin, Germany; elected member of the United Nations Subcomittee on Prevention of Torture; Honorary Professor at the Charité Universitätsmedizin, Berlin.

© 2014 War Trauma Foundation, Diemen, The Netherlands