Narrative Exposure Therapy for PTSD in Homeless Women

No longer recruiting at 1 trial location

Overseen By Kirsten A Dickins, PhD

Age: 18+

Sex: Female

Trial Phase: Phase 1

Sponsor: Rush University Medical Center

Disqualifiers: Impaired decisional capacity

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 3 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore the effectiveness of Narrative Exposure Therapy (NET) for treating PTSD in homeless women, particularly those with substance use challenges. The goal is to provide insights into reducing health issues linked to untreated trauma in this group. Participants will begin therapy either immediately or after a short wait. Women who have been homeless within the last year, have experienced trauma, and face substance use challenges might be suitable for this study. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this innovative therapy.

Do I have to stop taking my current medications to join the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that Narrative Exposure Therapy is safe for treating PTSD in homeless women?

Research shows that Narrative Exposure Therapy (NET) is generally safe for people with PTSD (Post-Traumatic Stress Disorder). Studies have found that NET can greatly reduce symptoms of PTSD, depression, and anxiety. This suggests that patients receive the therapy well, and it can improve their mental health.

While specific safety details for this trial might not be available, testing NET in a Phase 1 trial indicates a primary focus on safety. In clinical research, Phase 1 trials mainly assess a treatment's safety for people.

Overall, NET has been used in various settings and has proven effective without causing serious side effects. This suggests it is likely a safe option for those considering joining this trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Narrative Exposure Therapy (NET+) for PTSD in homeless women because it offers a unique approach compared to traditional treatments like cognitive behavioral therapy or medication. Unlike standard therapies that might take weeks to show changes, NET+ is designed to help individuals quickly process traumatic memories by creating a coherent life narrative. This method allows for a more structured and rapid integration of traumatic experiences, which could be especially beneficial for homeless women who often face multiple and complex traumas. Additionally, NET+ focuses on rebuilding personal stories, potentially empowering participants with a renewed sense of identity and control over their lives.

What evidence suggests that Narrative Exposure Therapy could be effective for PTSD?

Research shows that Narrative Exposure Therapy (NET) effectively reduces symptoms of post-traumatic stress disorder (PTSD). Studies found that NET significantly decreased PTSD symptoms both immediately after treatment and over time. Participants also experienced reduced anxiety and depression, which often accompany PTSD. NET has proven successful for groups like refugees and veterans, suggesting it could benefit other vulnerable populations as well. In this trial, some participants will receive Immediate NET+, while others will be on a waitlist before receiving NET+. For women experiencing homelessness with PTSD, NET might be a useful way to manage trauma-related symptoms. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

This trial is for women over 18 who are currently or recently homeless, have problematic substance use, and suffer from trauma-related distress. They must have experienced a traumatic event and show signs of PTSD. Women can't join if they don't meet these specific conditions.

Inclusion Criteria

Positive screen on TAPS-1 (reflecting problematic substance use)

I identify as a woman.

Affected by a traumatic life event and trauma-related distress (+Life Events Checklist for DSM-5 Standard [LEC-5] response ≥1 and PTSD Checklist for DSM-5 [PCL-5] score ≥28)

Exclusion Criteria

I am able to understand and decide to participate in this study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the NET+ intervention immediately or after a waitlist period

3 weeks

Weekly sessions

Follow-up

Participants are monitored for PTSD and trauma-related symptoms, substance use behaviors, and other health outcomes

6 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Immediate Narrative Exposure Therapy (NET)+
• Waitlist + NET+

Trial Overview The study tests Narrative Exposure Therapy (NET+) immediately versus after a waiting period for women with PTSD and substance use disorders. It aims to see how effective NET+ is in reducing the health consequences of untreated trauma among homeless women.

How Is the Trial Designed?

Group I: Immediate NET+ Experimental Treatment 1 Intervention

Receives NET+ immediately

Group II: Waitlist NET+ Active Control 1 Intervention

Receives NET+ after waitlist

Immediate Narrative Exposure Therapy (NET)+ is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Narrative Exposure Therapy for:

• Post-traumatic stress disorder (PTSD)
• Substance use disorders (SUD)

Approved in United States as Narrative Exposure Therapy for:

• PTSD
• SUD
• Co-morbid PTSD and SUD

Approved in Canada as Narrative Exposure Therapy for:

• PTSD
• SUD
• Trauma-related disorders

Who Is Running the Clinical Trial?

Rush University Medical Center

Lead Sponsor

Trials

448

Recruited

247,000+

National Center for Advancing Translational Sciences (NCATS)

Collaborator

Trials

394

Recruited

404,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Published Research Related to This Trial

Narrative exposure therapy (NET) has been shown to be an effective and adaptable treatment for PTSD in children, particularly in refugee populations, and can be applied to various complex cases including those with autism, psychotic symptoms, and histories of trauma.

The therapy's flexibility allows it to be modified for different contexts and needs, making it accessible for health professionals to implement with relatively short training, thus improving care for young people with challenging memories.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Five Applications of Narrative Exposure Therapy for Children and Adolescents Presenting With Post-Traumatic Stress Disorders. Fazel, M., Stratford, HJ., Rowsell, E., et al.[2021]

Narrative exposure therapy (NET) shows moderate effectiveness in reducing PTSD symptoms at midterm and long-term follow-ups, based on a meta-analysis of 24 randomized controlled trials involving various trauma types.

While NET significantly decreased PTSD diagnoses in the short term, this effect was not maintained in the long term, highlighting the need for further research to improve the quality of evidence and understand the therapy's long-term efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base. Raghuraman, S., Stuttard, N., Hunt, N.[2021]

Narrative Exposure Therapy (NET) is feasible and effective for refugees with PTSD, as shown by significant reductions in PTSD symptoms and improvements in global functioning among 76 out of 97 participants who completed the treatment.

28% of participants experienced reliable improvement, with some no longer meeting PTSD criteria, indicating that a supportive living environment may enhance the effectiveness of trauma-focused treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of narrative exposure therapy in an outpatient day treatment programme for refugees: improvement in symptoms and global functioning. de la Rie, SM., Smid, GE., van der Aa, N., et al.[2022]

Narrative Exposure Therapy (NET) has shown large effect sizes in reducing PTSD symptoms in trauma survivors, with a post-treatment effect size of 1.18 and a follow-up effect size of 1.37, based on a meta-analysis of 16 randomized controlled trials involving 947 participants.

NET was found to be more effective than non-active comparators and non-trauma-focused active comparators for PTSD, while also demonstrating medium effect sizes for depression, indicating its potential as a viable treatment option for both conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. Lely, JCG., Smid, GE., Jongedijk, RA., et al.[2020]

The pilot randomized controlled trial successfully recruited 15 out of 22 referred participants who were homeless and had active PTSD symptoms, demonstrating the feasibility of engaging this vulnerable population in trauma-focused therapy.

Once therapy began, retention was high, with 80% of participants completing all six sessions, indicating that the treatment was acceptable and participants were willing to stay engaged in the process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and acceptability of Narrative Exposure Therapy to treat individuals with PTSD who are homeless or vulnerably housed: a pilot randomized controlled trial. Edgar, NE., Bennett, A., Dunn, NS., et al.[2022]

Narrative Exposure Therapy (NET) significantly reduced PTSD symptoms, anxiety, and depression among torture survivors in the MENA region, with the most substantial improvement seen in PTSD symptoms, particularly among women.

The study involved 44 Arabic health professionals and showed that after an average treatment duration of three months, there were notable improvements in self-reported health and physical disabilities, although limitations such as lack of a control group and high dropout rates were noted.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of NET on torture survivors in the MENA region. Viller Hansen, AK., Sloth Hansen-Nord, N., Smeir, I., et al.[2019]

A study involving 30 adult participants with PTSD showed that both Narrative Exposure Therapy (NET) and its revised version (NET-R) significantly reduced PTSD symptoms and related distress compared to a waiting list group.

NET-R was found to be as effective as the original NET in promoting posttraumatic growth and improving coping and social support among Chinese earthquake survivors, indicating its feasibility and cost-effectiveness for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting narrative exposure therapy for Chinese earthquake survivors: a pilot randomised controlled feasibility study. Zang, Y., Hunt, N., Cox, T.[2022]

In a study of 111 COVID-19 patients with post-traumatic stress symptoms, those who received Narrative Exposure Therapy (NET) showed a significant reduction in PTSD symptoms compared to those who only received standard psychological support.

While NET also improved sleep quality, anxiety, and depression, these improvements were not significantly different from the control group, suggesting that NET specifically targets PTSD effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of narrative exposure therapy on COVID-19 patients with post-traumatic stress symptoms: A randomized controlled trial. Fan, Y., Shi, Y., Zhang, J., et al.[2022]

Narrative Exposure Therapy (NET) has been shown to significantly reduce PTSD symptoms in severely traumatized individuals, with a large effect size observed in a meta-analysis of 56 studies involving 1370 participants treated with NET compared to 1055 controls.

Long-term benefits of NET are evident, as the therapy demonstrated large effect sizes for PTSD symptom reduction after 6 months or more, while short-term effects were smaller, indicating that NET may provide sustainable improvements in mental health over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators. Siehl, S., Robjant, K., Crombach, A.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6450467/

The effectiveness of narrative exposure therapy: a review ... Narrative exposure therapy is effective in post-traumatic stress disorder symptom reduction at post-treatment (g = 1.18) and follow-up (g = 1.37).

2. psychiatryinvestigation.org psychiatryinvestigation.org/m/journal/view.php?number=1724

Effects of Narrative Exposure Therapy for Treating ... This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients' negative feelings and aid ...

3. frontiersin.org frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2025.1516144/full

Feasibility and preliminary effectiveness of a highly ... Trauma-focused therapies offered in a highly intensive format have been found to lead to higher adherence and faster symptom reduction, but no ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39210631/

Effectiveness of Narrative Exposure Therapy for Treatment ... Narrative exposure therapy (NET) has shown promising outcomes for treating posttraumatic stress disorder (PTSD) in refugees and veterans. Its effectiveness ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S235201322300100X

The feasibility and preliminary efficacy of narrative ... Post NET intervention, significant reductions in PTSD (t = −10.00, P < 0.001), anxiety (t = −9.46, P < 0.001), and depression (t = −6.00, P < 0.001) scores were ...

6. ptsd.va.gov ptsd.va.gov/professional/articles/article-pdf/id1585394.pdf

Exposure therapy for PTSD: A meta-analysis Findings support the overall efficacy of exposure therapy and highlight that there are a number of efficacious exposure-based therapies ...

7. frontiersin.org frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.765348/full

Narrative Exposure Therapy in Patients With Posttraumatic ... This study shows the value of trauma-focused therapy in patients with BPD and PTSD for recovery in both disorders.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9006570/

The efficacy and acceptability of exposure therapy for ... ET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD.