Rocca, Fiammetta and UNSPECIFIED
(2023)
Video Narrative Exposure Therapy (NET) with children and young people who witnessed domestic violence: A naturalistic single case study series.
DClinPsy thesis, University of Nottingham.
Abstract
Introduction
Children and young people (CYP) who witnessed domestic violence (DV) can develop posttraumatic stress symptoms (PTSS) and other negative mental health outcomes. Narrative Exposure Therapy (NET) is a treatment for survivors of repeated or prolonged trauma which has been adapted for use with CYP and videoconferencing delivery. Despite the growing evidence for the use of NET with adults, fewer studies have been conducted using its child-friendly protocol. As a brief, NICE-recommended treatment that was specifically designed to address multiple traumas and appears to be tolerable, NET may be a good candidate for use with CYP experiencing trauma-related difficulties following DV-exposure.
Aims
The primary study aim was evaluate whether video NET can reduce PTSS in CYP who witnessed DV. Secondary aims were to: (a) determine whether video NET can also impact on general psychological distress, including depression symptoms, anxiety symptoms, risk to self, and functioning problems; (b) examine the putative mechanisms of change within NET, i.e., habituation and integration of trauma memories; and (c) explore whether video NET is feasible and acceptable.
Methods
A naturalistic, mixed-method, AB, interventional single case design was used in this study. Participants were recruited from the waiting lists of a Child and Adolescent Mental Health Service. They completed questionnaires to assess symptom change and trauma memory quality and wore a heart rate (HR) monitor device to assess habituation. Participants could also opt to complete a Change Interview at one-month follow-up. Analyses included visual inspection of outcome and process data, reliable and clinically significant change indices, effect size estimate calculations (TAU-U A vs B), and content analysis of qualitative data.
Results
Five female adolescents aged 13-17 years joined the study and completed 4-10 video-sessions of the child-friendly NET protocol. At post-intervention, three participants showed reliable improvement in PTSS, but only one showed clinically significant change. One participant also demonstrated reliable improvement in general psychological distress. Effect size point estimates ranged from moderate to very large and indicated change in the desired direction for all but one participant; TAU-U values for general psychological distress were more modest. Three participants showed reductions in trauma memory quality, indicating increased integration. Within-session habituation was observed for all participants with available HR data; between-session habituation was also recorded for two of them. Completing the lifeline was mentioned as a helpful aspect of NET, the video delivery was considered both a barrier and a facilitator to engagement, and positive or mixed changes were reported by the two participants who completed Change Interviews.
Conclusions
The findings provided preliminary evidence for the effectiveness of video NET in reducing PTSS in young people who witnessed DV. The study also offered some support for reduction in trauma memory quality and between-session habituation as key mechanisms of change. Video NET appeared feasible and acceptable, although not all participants’ views were represented. Future research with more control and larger samples is needed to answer questions on generality of findings and impact of online delivery; future studies may also include longer follow-up periods and investigate other outcomes.
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