Impact and cultural acceptance of the Narrative Exposure Therapy in the aftermath of a natural disaster in Burundi

Background: In the aftermath of natural disasters, affected populations are at risk of suffering from trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) or depression. Particularly in poor post-conflict regions, these mental disorders have the potential to impair the ability of individuals to move on with their lives. We aimed to evaluate the feasibility, cultural acceptance, and effect of a trauma-focused psychotherapy, Narrative Exposure Therapy (NET), in the aftermath of a flood disaster in Burundi. Methods: Fifty-one individuals who were living in emergency camps overseen by the Burundian Red Cross in the aftermath of a flood disaster, and who had lost homes and close relatives, were invited to participate in semi-structured diagnostic interviews. Trained Burundian psychology students conducted these interviews, and six sessions of NET were offered to the 15 individuals most affected by trauma-related symptoms. An additional group of psychology students, blind to the treatment conditions, conducted three and 9 months follow-ups with them including also 25 participants who had reported significant but less severe trauma-related symptoms, assessing mental health symptoms, acceptance of NET, stigmatization due to trauma symptoms, and participants’ economic well-being. Results: Between baseline and 9-months post-intervention assessment, symptoms of PTSD (Hedges’ g = 3.44) and depression (Hedges’ g = 1.88) improved significantly within participants who received NET and within those who received no treatment (Hedges’ gPTSD = 2.55; Hedges’ gdepression = 0.72). Furthermore, those who received NET felt less stigmatized by their participation in the intervention than by the trauma-related mental health symptoms they experienced. Overall, participants reported that they would be willing to forego as much as 1 month’s worth of income in exchange for receiving trauma-focused interventions in the months following the disaster. Conclusions: Individuals severely affected by trauma-related mental health symptoms might benefit significantly from NET in the aftermath of natural disasters, while less affected individuals seem to recover spontaneously. Despite significant challenges conducting NET in emergency camps in the aftermath of natural disaster in a post-conflict country, such interventions are feasible, appreciated and might have long-lasting impacts on the lives of survivors if conducted with due respect to participants’ privacy. Trial registration: UKCR2014 , the 19.06.2014, retrospectively registered

Commentary on Raghuraman et al. (2021). On the Long-Term Efficacy and Effectiveness of Narrative Exposure Therapy

In the past years, several systematic reviews and meta-analyses have been published assessing the effectiveness of narrative exposure therapy [NET; (Lely et al., 2019; Raghuraman et al., 2021; Siehl et al., 2021; Wei and Chen, 2021)]. The meta-analyses had different aims and came to different conclusions about the effectiveness of NET. Lely et al. (2019) and Wei and Chen (2021) focused on between-treatment effects, post intervention, comparing NET with active and non-active control- treatment-conditions. In addition to comparing between-treatment effects Raghuraman et al. (2021) and Siehl et al. (2021) assessed also the temporal stability of the effects. The latter two studies investigated the reduction of symptom severity of posttraumatic stress disorder (PTSD) and the percentage of PTSD diagnoses over several follow-up periods. Raghuraman et al. (2021) indicated a medium standardized mean difference (SMD) in favor of NET in comparison to active and inactive control groups in the long-term and no benefit regarding PTSD diagnoses. The authors cautioned against using the existing evidence to inform policies and guidelines. In contrast, Siehl et al. (2021) found a large SMD in favor of NET compared to active or inactive control groups in the long-term. They reported an improvement of effectiveness over time when analyzing active control groups and concluded that NET is an effective treatment approach in post-conflict settings and refugee populations, highlighting the high external validity of the trials. Acknowledging the significant efforts of both author groups to select, code, and analyze the existing evidence, we aim to clarify potential underlying reasons for the differences between the two meta-analyses. The purpose of this commentary is two-fold: (a) discuss more generally ways to assess the quality of a treatment, such as NET, that is used in a broad range of contexts and (b) more specific differences between the two meta-analyses in (1) selecting and analyzing strategies, and (2) potential coding errors

Pfadabhängigkeit und Privatisierung in Osteuropa: die institutionenökonomische Perspektiv

Die gesellschaftlichen Veränderungsprozesse werden wesentlich durch den Aspekt der Finanzierbarkeit geregelt. Verfügungsrechte (prosperty rights), die den Zugang zur Nutzung von Ressourcen regeln, entscheiden über den Einfluss von Personen und Personengruppen: Wohlstand ermöglicht Macht. Aus diesem Grund wurde "Eigentum" zu einem wichtigen Begriff für den Forschungsbericht. Die Möglichkeiten, im Rahmen der Privatisierung Besitz erwerben zu können, sind direkt betroffen. Die Mangelsituation in den osteuropäischen Wirtschaften bewirken hohe Transaktionskosten. Privatisierungsprogramme sind Arbeitsergebnisse politischer Koalitionen und stellen Kompromisse dar. Die Neuordnung der Verfügungsrechte ist Resultat von Interessenkämpfen. Privatisierungsprogramme garantieren nicht notwendigerweise die Effizienz bei Anwendung. (pri

Structural and functional neuroplasticity in posttraumatic stress disorder: fear learning and context processing

In this thesis, structural and functional brain differences are investigated in three studies between patients with posttraumatic stress disorder (PTSD) and healthy trauma (TC) or non-trauma exposed (HC) control subjects and results are discussed within a common psychobiological model of PTSD. In this work, we provide a meta-analysis including 30 studies with 1,700 participants on structural white matter differences, investigate white and gray matter alterations in PTSD (154 subjects) and examine behavioral and psychophysiological alterations during contextual fear processing using virtual reality in a functional magnetic resonance imaging study (63 subjects). In summary, this work suggests that patients with PTSD show alterations in structural and functional brain activity that can both be associated to fear learning and context processing. Our work proposes above all that lower volume and activity within the prefrontal cortex in combination with functional alterations in the hippocampi can be associated with deficient contextual fear processing