A study of refugee and asylum-seeker experiences of NET for PTSD
Research type
Research Study
Full title
An interpretative Phenomenological Analysis of Refugee and Asylum-seeker Experiences of Narrative Exposure Therapy in the Treatment of Post-Traumatic Stress Disorder in PTSD Services.
IRAS ID
189071
Contact name
Najat Elwakili
Contact email
Sponsor organisation
City University London
Duration of Study in the UK
1 years, 9 months, 13 days
Research summary
In recent years, the issue of refugees and asylum-seekers has been a contentious topic in the media. This growing population now make up a significant proportion of those accessing trauma services, and thus research into the experience of trauma-based treatment for this population remains pertinent.
Lab, Santos & De Zulueta (2008) report that the existing therapy models advocated by the National Institute for Clinical Excellence (NICE, 2005) for the treatment of Post-Traumatic Stress Disorder (PTSD) are insufficient for those presenting with multiple traumas, such as refugees and asylum-seekers. NICE recommends Trauma-focused Cognitive Behavioural Therapy (TFCBT) and Eye Movement Desensitisation Reprocessing (EMDR) for PTSD. Lab et al. (2008) highlight that only one of the 30 studies focused on treating refugees (Paunovic & Ost, 2001). In the NICE (2013) PTSD evidence update, the appraisal of further randomised control trials (RCTs) did not result in changes in treatment guidance for PTSD for this group.
In the Cochrane Review for the Psychological Health and Well-Being of Torture Survivors (2014), Narrative Exposure Therapy (NET) and TFCBT were reported to have moderate effects in reducing PTSD symptoms in the medium-term. TFCBT was reported to have been experienced by asylum-seekers as ‘exceedingly difficult’, ‘untrustworthy’ and ‘time-consuming’ (Vincent, Jenkins, Larkin & Clohessy, 2012). However, NET has not yet been recommended by the NICE guidelines, despite being a treatment of choice for this population in trauma services.
NET was developed (Schauer, Neuner & Elbert, 2005) to treat survivors of mass violence and torture with PTSD in low income countries, and has since been used to treat such groups in high income countries. It incorporates exposure elements from existing models: prolonged exposure (Foa & Kozac, 1986), TFCBT (Ehlers & Clark, 2000), and Testimony therapy, which places the trauma within a socio-political context (Cienfuegos & Monelli, 1983). A chronological narrative of the life of the patient is constructed, with a focus on processing their traumatic experiences. The elements (affective, sensory and cognitive) of the trauma memories are elaborated and contextualised. This is narrated back by the therapist to the patient at the end of treatment and given to the patient as a written record (Schauer et al. 2011).
Patient-reported experiences further inform us beyond RCTs about the acceptability and credibility of trauma treatments (d’Ardenne & Heke, 2014).
To date, there are no studies investigating this population’s treatment experience of NET. Psychologists have a duty to provide acceptable trauma therapy beyond that we can infer from RCTs.
The clinical implications of this research study are threefold; to capture how this population experience NET as a treatment of choice by trauma services; to inform therapists and policy-makers; and to be available for service-users considering such treatment.
Semi-structured interviews of 6 to 8 refugees/ asylum-seekers coming to the end of the treatment of their NET treatment will be recruited from East London NHS Trust Mental Health Service. Interpretative Phenomenological Analysis (Smith, 2004) will be used to analyse the transcripts and identify themes and master themes giving rise to a richer understanding of how this group experience NET for the treatment of their PTSD.
REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
16/LO/0320
Date of REC Opinion
7 Apr 2016
REC opinion
Further Information Favourable Opinion