Citation

Mauritz M, Goossens P, Jongedijk R, Vermeulen H, van Gaal B. Front. Psychiatry 2022; 13.

Copyright

(Copyright © 2022, Frontiers Media)

DOI

10.3389/fpsyt.2022.804491

PMID

unavailable

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)]. Copyright © 2022 Mauritz, Goossens, Jongedijk, Vermeulen and van Gaal.

Language: en

Keywords

adult; human; female; male; PTSD; quality of life; decision making; bipolar disorder; insomnia; prevalence; anger; schizophrenia; suicide risk; anxiety; randomized controlled trial; qualitative study; suicide attempt; interview; comorbidity; experience; posttraumatic stress disorder; pain; polypharmacy; nurse; nurse practitioner; substance abuse; fatigue; mental disease; controlled study; mental health care; clinical article; avoidance behavior; middle aged; intervention study; reproducibility; demography; nightmare; qualitative analysis; DSM-IV; heart palpitation; Article; crying; quantitative study; young adult; Global Assessment of Functioning; therapist; global functioning; pretest posttest design; mixed methods; reflexivity; certificate of need; Clinical Administered Post traumatic Stress Disorder Scale for DSM 5; community mental healthcare; dissociative symptom; efficacy parameters; Flexible Assertive Community Treatment; flexible assertive community treatment (FACT); grounded theory approach; merged analysis; mixed methods study; narrative exposure therapy; narrative exposure therapy (NET); semi structured in depth interview; severe mental disorder; substantial congruency