RESEARCH WEEKLY: Treating Post-Traumatic Stress Disorder in Individuals with Severe Mental Illness
By Elizabeth Sinclair Hancq
People with severe mental illness are especially vulnerable to being victimized. Such victimization can involve theft of clothing or money, violence, sexual assault or emotional abuse. Women who have severe psychiatric disease are especially vulnerable.
Rates of post-traumatic stress disorder (PTSD) are high among people with severe mental illness. New research published in BJPsych Open by researchers from The Netherlands suggests that an evidence-based treatment for PTSD, narrative exposure therapy, is also effective for treating PTSD in people with severe mental illness in an outpatient setting.
Narrative exposure therapy for PTSD
Narrative exposure therapy is a type of treatment for PTSD that is part of a group of trauma-focused treatment options. Narrative exposure therapy is designed for individuals who have experienced repeated traumatic events over their lifetime and has been shown to be especially effective in treating PTSD symptoms in refugee populations and patients with a long history of interpersonal trauma such as victims of child abuse.
Narrative exposure therapy involves building a chronological narrative of an individual’s life with the guidance of a trained therapist. Although this will include the traumatic experiences, it also incorporates positive events to contextualize the memories of a person’s trauma. By expressing one’s life narrative, the therapist works with a patient to fill in details of memories to further refine and understand the trauma. Narrative exposure therapy gives the patient the freedom to reflect on their entire life rather than focusing on one particular traumatic event, while staying present with the therapist who is working with the patient to reprocess the traumatic memories into different meanings.
PTSD treatment in people with serious mental illness
The authors of the study enrolled individuals with serious mental illness into a clinical trial for PTSD using narrative exposure therapy by recruiting individuals who were already participating in assertive community treatment programs at five different locations throughout The Netherlands. Various clinical outcomes were measured both before and after the narrative exposure therapy was administered in order to understand the effect of the treatment on individual’s symptoms and overall wellbeing.
The total number of PTSD symptoms and severity of symptoms of individuals enrolled in the study decreased after participating in narrative exposure therapy. This included intrusion, avoidance, mood symptoms, arousal and reactivity, all symptoms associated with PTSD. The severity of dissociative symptoms also decreased, as did the severity of severe mental illness symptoms. Finally, suicide risk and substance misuse decreased among participants by the end of the study period.
The authors conclude that the results of the study support that narrative exposure therapy is feasible and effective in treating PTSD in individuals with serious mental illness in an outpatient setting. Because of the high prevalence of repeated interpersonal trauma and PTSD in patients with serious mental illness, greater availability of evidence-based trauma-informed treatment options such as narrative exposure therapy is vital to improve outcomes and promote better wellbeing for this already vulnerable population.
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