Sep 26, 2011


narrative exposure therapy program, aimed at treating refugee children suffering
from post-traumatic stress disorder (PTSD). Using techniques that encourage in
depth descriptions of traumatic experiences, therapists guide children in
building a chronological narrative that includes all of the significant
trauma-related events in their lives. An experimental evaluation of the
treatment program found that there were significant reductions in PTSD, for
those in the treatment group, at post-test and at a 6-month follow-up, which
were sustained through a 12-month follow-up. Significant improvements in
non-verbal cognitive functioning were also found between the 6- and 12-month


Traumatized refugee children and adolescents

The treatment
consists of eight individual therapy sessions, 90 to 120 minutes in length,
conducted weekly by trained clinical psychologists. Focused on refugee children
suffering from post-traumatic stress-disorder (PTSD) primarily related to war
and other types of organized violence, the program is designed around the
therapist helping the child build a chronological narrative of his/her entire
life, with an emphasis on traumatic experiences. When detailing these
experiences, children are asked to describe sensory information, emotions,
physical reactions, and thoughts, which are thoroughly recorded by the
therapist; this written documentation is given to the child at the end of
therapy. While the therapist is meant to be supportive, the therapist also
directs the child in guiding them forward with the narrative. This method seeks
to help children confront their traumatic pasts, while also working to provide
complete details regarding each experience. Techniques utilized by the
therapist include active listening, unconditional positive regard, using empathy
to identify with the child’s experiences, and helping the child match their
feelings and emotions with how they express those emotions.

illustrative and creative tasks are also completed during the treatment program
to aid the child in organizing his/her memories. Prior to constructing the
narrative, children participate in the lifeline exercise, during which they take
different flowers and stones, representing positive and negative events, and
place them along a rope to illustrate each of the most significant events in
their lives. Another exercise is re-enacting body positioning, during which
children show therapists the ways they physically positioned their body during a
traumatic experience (e.g., hiding in a crouched position during a bombing).
Drawings are also used to portray scenes and objects from traumatic
experiences. Each of these latter two exercises is utilized with the purpose of
helping to bring about descriptions and language tied to these events.


Twenty-six refugee children (ages 7 to 16) were selected for the
study. In order to be included, children had to meet the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition
(DSM-IV) criteria for
PTSD, and could not be diagnosed with acute psychotic symptoms. Participants
had experienced an average of four traumatic event types, with the most common
being violent attacks against parents or other family members. Fifty-four
percent of the sample was male; 31 percent originated from Turkey, 31 percent
from the Balkans, 15 percent from Chechnya, 15 percent from Syria, and 8 percent
from Georgia.

Participants were randomly assigned to either the KIDNET therapy (N=13) or to
the wait-list condition (N=13). There were no significant differences between
groups at baseline. Children in the waitlist group were not offered treatment
for the first 6 months after their initial screening interview. After this
waiting period, children were interviewed again and, if they still satisfied the
diagnosis for PTSD, were then offered treatment. To measure the effectiveness
of the therapy program, data was collected on PTSD symptom severity through a
questionnaire administered during diagnostic interviews. For children who did
not speak German, translators trained in PTSD issues provided literal
translations during therapy. Nonverbal cognitive functioning was also
assessed. Data were collected through interviews at baseline, 4 weeks
post-treatment, and at 6- and 12-month follow-ups. Assessors were blind to
whether the children were in the treatment or control group.

Results: At
both the 4-week post-test and the 6-month follow-up, significant reductions in
PTSD symptoms were found for the KIDNET therapy group. Significant reductions
were found for each of the individual symptom levels including intrusion,
avoidance (all types), active avoidance, passive avoidance, hyperarousal, and
functional impairment. At the 12-month follow-up, it was found that these
improvements were sustained, with an effect size of 1.8. Significant
improvements in nonverbal cognitive functioning were also found between the 6-
and 12-month follow-ups.



Ruf, M., Schauer,
M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure
therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized
refugee children. Journal of Traumatic Stress, 23(4), 437-445

Children, Adolescents, Males and Females (Co-Ed), Clinic/Provider-Based,
Counseling/Therapy, Other (Mental Health)

information last updated 9/26/11

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