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Chen D, Zhu T, Zhou Y. Constructing and Preliminary Testing a Narrative Therapy Programme for Posttraumatic Growth in Chinese Patients With Inflammatory Bowel Disease-A Pilot Study. Clin Psychol Psychother 2024; 31:e3013. [PMID: 38785414 DOI: 10.1002/cpp.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The research on posttraumatic growth (PTG) promotion programmes, particularly narrative therapy (NT), for patients with inflammatory bowel disease (IBD) remains limited. This pilot study aims to develop an NT programme to promote PTG and evaluate its feasibility, preliminary effectiveness, participants' experiences and improvement suggestions. METHODS The NT programme was initially developed through literature review, interviews with IBD patients and expert panel discussions. A randomized controlled pilot trial was conducted to assess the feasibility and preliminary effectiveness of the programme. Participants in the NT group received five consecutive weekly sessions of the programme, while the control group received standard care. Outcomes including PTG, anxiety, depression and quality of life were measured. Qualitative interviews were conducted to explore participants' experiences and suggestions for programme modifications. RESULTS The NT programme was developed with scientific rigour. The recruitment rate and retention rate were 62.5% and 96.7%, respectively. A significant reduction in anxiety levels was observed, and manifestations of PTG were reported in the NT group. Suggestions for improvement of the NT programme were received from the participants. CONCLUSION The NT programme was constructed to promote PTG in IBD patients in this study, further offering preliminary evidence for its feasibility and potential positive psychological change. However, large-scale research is needed to validate its effectiveness for broader applications.
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Affiliation(s)
- Dandan Chen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tianrong Zhu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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Estrada Gonzalez V, Meletaki V, Walker M, Payano Sosa J, Stamper A, Srikanchana R, King JL, Scott K, Cardillo ER, Rhodes CS, Christensen AP, Darda KM, Workman CI, Chatterjee A. Art therapy masks reflect emotional changes in military personnel with PTSS. Sci Rep 2024; 14:7192. [PMID: 38531999 DOI: 10.1038/s41598-024-57128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Among disabling post-traumatic stress symptoms (PTSS) are irritability, aggressive behavior, distressing memories and general impaired cognition and negative mood. Art therapy interventions, including mask-making, can potentially alleviate these symptoms. We tested the hypothesis that art conveys emotions and predicted that blinded viewers would be able to perceive changes in theoretically derived emotional profiles expressed in art made by military personnel with PTSS from the onset to the end of therapy. Five service members and veterans exhibiting PTSS were enrolled in an 8-session art therapy protocol, during which they artistically transformed papier-mâché masks at the beginning and end of the protocol. We found that blinded viewers without knowledge of the masks' creation stage (onset or end of therapy) read initial masks as conveying more negative emotions (e.g., angry, upset, and challenged) and later masks as conveying more positive emotions (calm and pleasure). Based on the assessments from the blinded evaluators, we infer the emotional transition experienced by the participants was expressed in the masks. In an exploratory arm of the study, we also found that viewers were better able to empathize with the negative emotions experienced by participants with PTSS when asked to explicitly take their perspective.
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Affiliation(s)
- V Estrada Gonzalez
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - V Meletaki
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Walker
- National Intrepid Center of Excellence, Bethesda, USA
| | - J Payano Sosa
- National Intrepid Center of Excellence, Bethesda, USA
- National Endowment for the Arts, Washington, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, USA
| | - A Stamper
- National Intrepid Center of Excellence, Bethesda, USA
- National Endowment for the Arts, Washington, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, USA
| | - R Srikanchana
- National Intrepid Center of Excellence, Bethesda, USA
| | - J L King
- Department of Art Therapy, George Washington University, Washington, USA
| | - K Scott
- National Intrepid Center of Excellence, Bethesda, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, USA
| | - E R Cardillo
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - A P Christensen
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, USA
| | - K M Darda
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Advancement and Research in the Sciences and Arts (ARISA) Foundation, Pune, MH, India
| | - C I Workman
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Psychological and Brain Sciences, University of Delaware, Newark, USA
| | - A Chatterjee
- Penn Center for Neuroaesthetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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The treatment of PTSD in refugees and asylum seekers using imagery rescripting within an NHS setting. Behav Cogn Psychother 2023; 51:119-132. [PMID: 36537014 DOI: 10.1017/s1352465822000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service. AIMS To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers. METHOD Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression. RESULTS Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors. CONCLUSIONS Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.
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Trauma-informed interventions for counselling sex trafficking survivors. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-022-09465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tappenden PC, Shiner RL, Mo F. Narrating life in the military: Links between veterans' narrative processing of service experiences and their posttraumatic stress symptoms and well-being. J Trauma Stress 2022; 35:288-301. [PMID: 34655109 DOI: 10.1002/jts.22738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/10/2021] [Accepted: 07/14/2021] [Indexed: 11/10/2022]
Abstract
Military veterans frequently experience traumatic, highly stressful events; thus, it is especially important for them to find positive ways of making meaning from these experiences. The present study used the methods of narrative personality psychology to investigate the associations between veterans' narrative processing of highly stressful and significant events from their military service and postdischarge functioning, including posttraumatic stress symptoms (PTSS). United States military veterans (N = 154; M age = 64.28 years, 86.4% men, 57.8% deployed) completed an online survey in which they wrote narratives about one "highly stressful" and one "key scene" military service memory and completed questionnaires to assess PTSS, symptoms of depression and anxiety, functional impairment, and well-being. Narratives were coded for personal growth from the experience, themes of agency and interpersonal communion, affective tone, and coherence. In the highly stressful narratives, small-to-moderate negative associations emerged between both growth and agency and PTSS, depression and anxiety, and functional impairment; growth was also modestly positively associated with well-being. In contrast, affective tone and communion were each only associated modestly with one outcome, and coherence with none, and narrative processing of the key scene narrative was not linked with any mental health outcomes. These findings suggest that (1) the theory and methods of narrative identity research are relevant for studying trauma narratives, and (2) veterans who narrate themselves as growing from and exerting control over their most stressful service experiences may achieve better mental health and day-to-day functioning.
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Affiliation(s)
- Peter C Tappenden
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, New York, USA.,Traumatic Stress Studies Division, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Rebecca L Shiner
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, New York, USA
| | - Fanyi Mo
- Department of Psychological and Brain Sciences, Colgate University, Hamilton, New York, USA
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Mauritz M, Goossens P, Jongedijk R, Vermeulen H, van Gaal B. Investigating the Efficacy and Experiences With Narrative Exposure Therapy in Severe Mentally Ill Patients With Comorbid Post-traumatic Stress Disorder Receiving Flexible Assertive Community Treatment: A Mixed Methods Study. Front Psychiatry 2022; 13:804491. [PMID: 35573345 PMCID: PMC9095974 DOI: 10.3389/fpsyt.2022.804491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with severe mental illness with repeated interpersonal trauma and post-traumatic stress disorder (PTSD) have a negative illness progression. Traumas are often not treated because of their vulnerability. Narrative exposure therapy (NET) is an effective trauma therapy. It is unknown whether NET is effective and tolerable in these patients receiving community mental healthcare. OBJECTIVES The objectives of this study are (1) to gain insights into patients' experiences before, during, and after NET concerning changes in PTSD, dissociative and severe mental ill symptoms, care needs (CAN), quality of life, and global functioning; (2) to identify factors that influence diagnostic changes after NET as compared to patients' experiences. These insights will help to decide whether NET should be incorporated in usual care for these patients. DESIGN A mixed methods convergent design consists of a grounded theory approach with thematic analysis followed by a merged analysis, comparing quantitative, and qualitative data for each participant and by means of a joint matrix. PARTICIPANTS Adult psychiatric outpatients (age, 21-65) with post-traumatic stress disorder (PTSD) related to repeated interpersonal trauma were indicted for the study. METHODS Baseline demographics and clinical characteristics were assessed. Qualitative data were collected 3 months after NET using individual semi-structured in-depth interviews. The merged analysis compared quantitative and qualitative results for each participant. RESULTS Twenty-three outpatients (female, 82%) with a mean age of 49.9 years (SD 9.8) participated in the study. Participants experienced NET as intensive, and most of them tolerated it well. Afterward, eighteen participants perceived less symptoms. Mixed analysis showed substantial congruency between quantitative scores and participants' perceptions of PTSD, dissociative symptoms, and CAN (Cohen's kappa > 0.4). Remission of PTSD was associated with sufficient experienced support. CONCLUSION Outpatients with severe mental illness underwent intensive NET, and most of them tolerate it well. This therapy is clearly efficacious in this group. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NL5608 (NTR5714)].
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Affiliation(s)
- Maria Mauritz
- GGNet Center for Mental Health Care, Warnsveld, Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Peter Goossens
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ruud Jongedijk
- ARQ Centrum'45, Oegstgeest, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Betsie van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
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Opaas M, Hartmann EJ. Traumatized Refugees in Psychotherapy: Long-Term Changes in Personality, Mental Health, Well-Being, and Exile Life Functioning. J Nerv Ment Dis 2021; 209:859-871. [PMID: 34417421 PMCID: PMC8614541 DOI: 10.1097/nmd.0000000000001396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This pre- and posttreatment study of 22 severely traumatized adult refugees spanned a mean of 6.5 years. Changes in personality functioning, mental health, and well-being were examined using the Rorschach Performance Assessment System, Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the World Health Organization's Quality of Life-BREF questionnaire. A paired samples t-test revealed significant improvement after psychotherapy in traumatic ideation and initial severe disruptions in thought processes, reality testing, perception, self and other representations, and relational capacity (Cohen's d = 0.46-0.59). Symptoms of anxiety, depression, and posttraumatic stress were significantly reduced (d = 0.54-0.84), quality of life in the physical health and psychological health domains increased significantly (d = 0.87 and 0.97), and percentage of participants with exile language proficiency and work/study status increased significantly. The findings demonstrate the potential of psychotherapy to contribute to normalizing perceptual, cognitive, and relational capacities in severely traumatized refugees, paramount to well-being and functioning in exile.
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Affiliation(s)
- Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies
| | - Ellen J. Hartmann
- Professor Emeritus, Department of Psychology, University of Oslo, Oslo, Norway
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Siehl S, Wilhelms L, Crombach A. Commentary on Raghuraman et al. (2021). On the Long-Term Efficacy and Effectiveness of Narrative Exposure Therapy. Front Psychol 2021; 12:771958. [PMID: 34819901 PMCID: PMC8606553 DOI: 10.3389/fpsyg.2021.771958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/08/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.,Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.,Non-governmental Organization vivo International e.V., Konstanz, Germany
| | - Laura Wilhelms
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Anselm Crombach
- Non-governmental Organization vivo International e.V., Konstanz, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents at the University of Saarland, Saarbrücken, Germany.,Department of Psychology at the University of Konstanz, Clinical Psychology, Kosntanz, Germany.,Non-governmental Organization Psychologues Sans Frontières, Bujumbura, Burundi.,Department of Clinical Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
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