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Wagner AM, Richards A, Chiros C, Thuras P, Parsons EC, Oien AD, Schenck CH, Irfan M. A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans. Sleep Sci 2023; 16:e439-e445. [PMID: 38197021 PMCID: PMC10773522 DOI: 10.1055/s-0043-1776796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/14/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p = 0.04) and intensity of nightmares ( p = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.
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Affiliation(s)
- Ann Marie Wagner
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Anne Richards
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America
- Mental Health Services, San Francisco Veteran's Affairs (VA) Health Care System, San Francisco, CA, United States of America
| | - Christine Chiros
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Paul Thuras
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Elizabeth C. Parsons
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Angela D. Oien
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
| | - Carlos H. Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, United States of America
| | - Muna Irfan
- Pulmonary, Allergy, Critical Care and Sleep, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States of America
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Zhou DHR, Chiu YLM, Lo TLW, Lo WFA, Wong SS, Leung CHT, Yu CK, Chang YSG, Luk KL. An unexpected visitor and a sword play: a randomized controlled trial of collective narrative therapy groups for primary carers of people with schizophrenia. J Ment Health 2023; 32:351-362. [PMID: 32667240 DOI: 10.1080/09638237.2020.1793123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most family carer support programs focus on supporting carers with caregiving-related knowledge and skills to help their family members who suffer from schizophrenia in their recovery process while carers' inner resources and preferred identities are less emphasized in the existing studies. AIMS The present study uses collective narrative therapy groups (CNTG) to promote the inner strengths and agency of family carers and help them to explore their preferred identities while caring for family members with schizophrenia. METHOD To ensure an evidence-based intervention, 89 Chinese family carers of people with schizophrenia took part in this three-wave longitudinal program evaluation study using a randomized controlled trial design. RESULTS Compared with the control group, family carers in CNTG reported better family relationships, a lesser caregiving burden, and more perceived inner resources. Repeated one-way ANOVA revealed that CNTG improved family relationships, the caregiving burden, the level of hope and inner resources in the posttest, and a statistically significantly better mental health condition in the follow-up. CONCLUSION This study shows that collective narrative psychotherapy is effective in supporting family carers of people with schizophrenia in Hong Kong. Based on the research findings, we discuss the strengths of the program and its implications for practitioners.
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Affiliation(s)
- De-Hui Ruth Zhou
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, Hong Kong
| | - Yu-Lung Marcus Chiu
- Department of Applied Social Science, City University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Siu-Sing Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, Hong Kong
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Conti J, Heywood L, Hay P, Shrestha RM, Perich T. Paper 2: a systematic review of narrative therapy treatment outcomes for eating disorders-bridging the divide between practice-based evidence and evidence-based practice. J Eat Disord 2022; 10:138. [PMID: 36096908 PMCID: PMC9469550 DOI: 10.1186/s40337-022-00636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Narrative therapy has been proposed to have practice-based evidence however little is known about its research evidence-base in the treatment of eating disorders. The aim of this study was to conduct a systematic review of the outcome literature of narrative therapy for eating disorders. METHOD Treatment outcome data were extracted from 33 eligible included studies following systematic search of five data bases. The study is reported according to Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Of the identified 33 studies, 3 reported positive outcomes using psychometric instruments, albeit some were outdated. Otherwise, reported outcomes were based on therapy transcript material and therapist reports. The most commonly reported treatment outcome was in relation to shifts in identity narratives and improved personal agency with a trend towards under-reporting shifts in ED symptoms. Some improvements were reported in interpersonal and occupational engagement, reduced ED symptoms, and improved quality of life, however, there was an absence of standardized measures to support these reports. CONCLUSIONS This systematic review found limited support for narrative therapy in the treatment of eating disorders through practice-based evidence in clinician reports and transcripts of therapy sessions. Less is known about systematic treatment outcomes of narrative therapy. There is a need to fill this gap to understand the effectiveness of narrative therapy in the treatment of EDs through systematic (1) Deliveries of this intervention; and (2) Reporting of outcomes. In doing so, the research arm of narrative therapy evidence base will become more comprehensively known.
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Affiliation(s)
- Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Tania Perich
- School of Psychology, Western Sydney University, Sydney, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Zhou DHR, Chiu YLM, Lo TLW, Lo WFA, Wong SS, Luk KL, Leung CHT, Yu CK, Chang YSG. Outside-in or Inside-out? A Randomized Controlled Trial of Two Empowerment Approaches for Family Caregivers of People with Schizophrenia. Issues Ment Health Nurs 2020; 41:761-772. [PMID: 32497453 DOI: 10.1080/01612840.2020.1734992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Training-based intervention such as psychoeducational groups has become increasingly popular to empower family caregivers of people with schizophrenia, yet existing supportive programs for caregivers tend to focus more on the needs of the patients rather than the development of the caregivers. This study aimed to compare the outcomes of a skill-based empowerment psychoeducational group and an inner-resource enhancing empowerment narrative therapy group for family caregivers of people with schizophrenia. We conducted a randomized controlled trial with a longitudinal design. The sample consisted of 132 family caregivers who were randomly assigned to eight sessions of the two groups (i.e. a narrative-based group, or a psychoeducational group), or a control group with delayed treatment. Psychometric scales were administrated throughout the project. Both the psychoeducational group and the narrative group showed significant improvements in family relationships, caregiving burden, and coping skills compared with the control group across the three time points (pretest, posttest, and 2-month follow-up). A statistically significant advancement in coping skills was found in the psychoeducational group. The narrative group outperformed the psychoeducational group and the control group in the enhancement of inner resources, perceived control, and level of hope. The findings call for the need of an integrative empowerment approach that both values the inner strength and unique experiences of the caregivers and at the same time provides them with necessary skills and knowledge in taking care of their family members with schizophrenia.
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Affiliation(s)
- De-Hui Ruth Zhou
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Yu-Lung Marcus Chiu
- Department of Applied Social Science, City University of Hong Kong, Kowloon, Hong Kong
| | | | | | - Siu-Sing Wong
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Kwok-Leung Luk
- Department Operations Manager, Kwai Chung Hospital, Kowloon, Hong Kong
| | - Chi-Hoi Tom Leung
- East Kowloon Psychistric Center, Kwai Chung Hospital, Kowloon, Hong Kong
| | - Chui-Kam Yu
- East Kowloon Psychistric Center, Kwai Chung Hospital, Kowloon, Hong Kong
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Ali A, Wolfert S, McGovern JE, Nguyen J, Aharoni A. A trauma-informed analysis of monologues constructed by military veterans in a theater-based treatment program. QUALITATIVE RESEARCH IN PSYCHOLOGY 2020. [DOI: 10.1080/14780887.2018.1442704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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MacLeod R, Moldovan R, Stopford C, Ferrer-Duch M. Genetic Counselling and Narrative Practices: A Model of Support following a "Negative" Predictive Test for Huntington's Disease. J Huntingtons Dis 2019; 7:175-183. [PMID: 29562548 DOI: 10.3233/jhd-170276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Predictive testing for Huntington's disease (HD) has been available for individuals at risk of HD by direct mutation analysis since 1993. International Predictive test guidelines recommend that support is offered following the result regardless of test outcome. However, there is lack of an evidence base regarding what this support should look like and how it might work in practice. OBJECTIVE A service improvement initiative looked at the feasibility of offering a narrative group session co-facilitated by a genetic counsellor and clinical psychologist, to individuals who had tested mutation negative for HD. The narrative session was evaluated from the perspective of group participants. METHODS Individuals who tested mutation negative at a genetic centre in the North of England over a 5-year period were invited to attend a narrative group session. 52 people were contacted and 9 people agreed to participate. Participants completed standardised questionnaires (PHQ-9 and GAD-7) before and after the session and a detailed written evaluation. Participants' comments were analysed thematically. RESULTS Participants were overwhelmingly positive about the narrative session finding it a safe and enjoyable way to explore difficult life experiences. Reported benefits included feeling less isolated, being inspired by other people's stories and connecting as a group. All 9 participants said they would recommend the narrative session to anyone impacted by HD. CONCLUSIONS The narrative group session was considered an interesting and useful approach to facilitating adaptation following a negative predictive test result for HD.
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Affiliation(s)
- Rhona MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Cheryl Stopford
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
| | - Mariangels Ferrer-Duch
- Leeds Family Therapy and Research Centre, Leeds Institute of Health Sciences, Leeds University School of Medicine, University of Leeds, Leeds, UK
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Wark J, Vis JA. Effects of Child Sexual Abuse on the Parenting of Male Survivors. TRAUMA, VIOLENCE & ABUSE 2018; 19:499-511. [PMID: 27770031 DOI: 10.1177/1524838016673600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research shows that child sexual abuse (CSA) can have detrimental effects on adult functioning. While much research regarding the effects of CSA on parenting of mothers is available, there is a dearth of information on how CSA impacts fatherhood. This literature review finds that the parenting experiences of male survivors are characterized by self-perceptions as adequate parents, deficient parenting as measured by standardized instruments, conceptualization of parenting as an intergenerational legacy and potential healing experience, fear of becoming an abuser, and physical and emotional distance from their children. These themes are strongly related to social discourses on intergenerational cycle of violence theories. Fatherhood is not exclusively problematic for male survivors and can be a healing experience and a source of strength for some survivors. Based on literature concerning male survivors who are parents, narrative therapy is recommended as a therapeutic model to explore how fathers who are survivors challenge dominant discourses around legacies of family violence, intergenerational parenting deficiencies, and victimization. Restorying fatherhood as a healing opportunity is essential when working with fathers who are male survivors and their families.
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Affiliation(s)
- Joe Wark
- 1 Kairos Community Resource Centre, Thunder Bay, Ontario, Canada
| | - Jo-Ann Vis
- 2 School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada
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Jørring NT, Gjessing Jensen K. Treatment efficacy of narrative family therapy for children and adolescents with diverse psychiatric symptomatology. Scand J Child Adolesc Psychiatr Psychol 2018; 6:107-114. [PMID: 33520758 PMCID: PMC7703837 DOI: 10.21307/sjcapp-2018-012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Little research has been undertaken on children and adolescents with psychiatric co-morbidity and this group is seldom subject to evidence-based treatment. Equally, there has been little research on creating an evidence base for Narrative Therapy, which means that narrative family therapy (NFT) is seldom available to children and adolescents with a psychiatric disorder. Objective: A single group clinical design was used to examine the efficacy of NFT for children and adolescents with different diagnoses. Method: Families receiving NFT from the Family Therapy Team (FTT) at the Child and Adolescent Mental Health Services (CAMHS) of the Capital Region of Denmark filled out psychometric measurements before and after treatment. Patients evaluated the burden of symptoms using Beck’s Youth Inventory (BYI), and parents evaluated their personal agency in relationship to their child’s psychiatric disorder using Parent Activation Measurement (PAM). Results: We analyzed data from 48 patients and found a significant increase in median BYI measures of Self-Concept (40.5 to 46.0, p = 0.002) with an effect size of 0.60, decreases in BYI Depression Index (58.0 to 54.0, p = 0.030) with an effect size of –0.41, decreases in BYI Disruptive Behaviour Index (48.0 to 43.0, p = 0.030) with an effect size of –0.38, and a significant increase in PAM from 56.4 to 68.5, p = 0.001 with an effect size of 0.61. Conclusion: Results from this study suggest that NFT has a direct positive effect on patients’ own evaluation of the burden of symptoms, and parents’ perceived personal agency regarding their child’s distress.
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Affiliation(s)
- Nina Tejs Jørring
- Unit for Psychotherapy, Child and Adolescent Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
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Theatre as a treatment for posttraumatic stress in military veterans: Exploring the psychotherapeutic potential of mimetic induction. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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