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Purpose A substantial body of research indicates that self-stigma is associated with poorer outcomes related to recovery among people with severe mental illnesses. Narrative Enhancement and Cognitive Therapy (NECT) is a structured, group-based approach which targets the effects of self-stigma. A randomized-controlled trial was conducted to examine the efficacy of NECT. Methods One hundred and seventy persons, recruited from both outpatient and comprehensive treatment settings, meeting criteria for schizophrenia-spectrum disorders and moderate-to-elevated self-stigma, were randomly assigned to NECT or supportive group therapy and assessed at four time points over the course of nearly a year. Participants completed measures of self-stigma, hope, self-esteem, functioning, psychiatric symptoms, coping with symptoms, and narrative insight. Results Analyses indicated that NECT participants in outpatient sites improved significantly more over time in self-stigma compared to supportive group therapy participants in outpatient sites, while NECT participants in comprehensive (including day treatment and psychiatric rehabilitation program) sites improved significantly more in hopelessness and narrative insight than other participants. NECT participants as a group showed decreases in the social withdrawal component of self-stigma, decreased in their use of avoidant coping strategies, and were more engaged in treatment than supportive group therapy participants. There was no evidence for effects of NECT on social functioning or psychiatric symptoms. Conclusions Findings suggest that NECT primarily impacts self-stigma and related outcomes, and that the degree of its effects is partially dependent on the treatment context in which it is offered.

AbstractObjectiveTo determine the effect of a novel brief general practitioner (GP)-led narrative exposure intervention on post-traumatic stress disorder (PTSD) symptoms after intensive care.DesignMulticentre, observer blind, randomised controlled trial (PICTURE).SettingPrimary care in 319 general practices across Germany.Participants319 adults (18-85 years) who have survived critical illness with symptoms of PTSD, discharged from intensive care and randomised to receive the intervention (n=160) or improved usual care (n=159) from a general practitioner.InterventionsIntervention group participants had three narrative exposure consultations with a general practitioner and eight scheduled contacts with a nurse. Control group participants received improved treatment as usual based on the German PTSD guideline.Main outcome measuresThe primary clinical outcome was self-reported PTSD symptoms using the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5, range 0-80, higher scores indicating more severe symptoms) at six months. The minimal clinically important difference was six points. Secondary outcomes included changes in depression, anxiety, patient activation, health related quality of life and disability at six and 12 months.ResultsBetween 21 October 2018 and 18 January 2023, 1283 patients discharged from an intensive care unit were screened for PTSD symptoms. 319 study participants were randomly assigned either to the control group (n=159) or the intervention group (n=160). The mean patient age was 57.7 years (standard deviation (SD) 12.7), and 61% of participants were male. The mean baseline PDS-5 score was 30.6 (SD 13.3) in both groups. 271 (85%) study participants completed follow-up assessment after six months and 247 (77%) after 12 months. The intervention effect showed a mean between-group difference in the PDS-5 score of 4.7 points ((95% confidence interval 1.6 to 7.8); P=0.003, Cohen’s d=0.37)) at six months and 5.4 points ((1.8 to 9.0); P=0.003, Cohen’s d=0.41)) at 12 months. Among secondary outcomes, patients in the intervention group had greater improvements in depression, health related quality of life, and disability.ConclusionsIn adults with symptoms of PTSD after critical illness, a brief narrative exposure intervention was feasible and showed a reduction of symptoms, which was less than the predefined minimal clinically important difference. The effect was found to be sustained at 12 months’ follow-up. These findings support the further evaluation of this intervention in primary care.Trial registrationClinicalTrials.gov, NCT03315390; DRKS-ID DRKS00012589

Evidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults. Out-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated. Using a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress. Both NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

Background: Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. We tested a train-the-trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD). Methods: We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET) treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/NET-2, n = 38). Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at 3- and 12-month follow-ups. Results: At the 3-month follow-up, the NET-1 participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1 were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with an effect size of Cohen's d = 1.37 at the 12-month follow-up. Conclusions: A TTT model of PTSD treatment dissemination can be effective in resource-poor postconflict societies.

Background Children are anxious when hospitalized due to being away from home and undergoing treatment.This anxiety has an effect on their disease process, treatment, growth and development.Children’s anxiety has an effect on parents’ anxiety and can lead to lower level of cooperation among the children and their parents with the treatment team.the present study aimed to compare the effect of play therapy and storytelling on the anxiety of hospitalized children. Methods A randomized controlled trial study with a three-group design (play therapy, storytelling and control) was conducted in 75 children aged 3 to 10 years admitted to Imam Ali Alborz Hospital of Karaj, Iran between 2022–2023.The data before and after the intervention were collected by the Spence children’s anxiety scale and the face tool for anxiety assessment and analyzed by the Mixed effect model statistical method. Results There is a statistically significant difference between the anxiety score of the children for whom storytelling was used and control group. Also, among the two therapies of storytelling and play therapy, only storytelling therapy has a significant effect on reducing children’s anxiety.Regarding the time of measuring the anxiety score(the first, second, third day after the intervention), it was found that as this time increases, the children’s anxiety decreases significantly.morever, the children’s gender, age, and history of hospitalization are influencing factors. Conclusion Play therapy and storytelling play an effective role in controlling the anxiety of hospitalized children, although storytelling had a greater role in reducing the anxiety of hospitalized children than play therapy. It is suggested to provide the necessary conditions and facilities for the implementation of these methods in children’s inpatient departments. Trial registration https://irct.behdasht.gov.ir/ ,IRCT20220704055367N1,13/7 /2022.