Zang, Yinyin
(2013)
Developing effective narrative interventions for earthquake survivors.
PhD thesis, University of Nottingham.
Abstract
Disasters are events that challenge both the social and individual ability to adapt, carrying the risk of adverse mental health outcomes. High prevalence rates of Post Traumatic Stress Disorder (PTSD), anxiety, and depression have been found after disasters among affected adults and children, and PTSD is the most distinct and common disorder. However, the challenge of providing sufficient numbers of mental health professionals is the most critical issue facing health-care systems throughout the world, and especially in developing countries. The 2008 Sichuan earthquake in China had enormous destructive power and affected millions of people. Given the large number of people involved – and the shortage of resources in any major disaster – brief, pragmatic, and easily trainable interventions are needed for both adult and child survivors.
In the context of the Sichuan earthquake, this thesis describes a research work aimed at: (1) investigating the extent and nature of earthquake-related distress and positive change experienced by the targeted survivor population, and exploring the factors that predict these distresses and changes, (2) examining the effectiveness of narrative exposure therapy (NET) in adult survivors, and (3) examining the effectiveness of written narrative strategies for child survivors in the school setting.
To achieve these aims, a cross-sectional survey (N=120) was conducted to explore the psychological morbidities, risk, and protective factors as well as predictive models of PTSD and positive change at 1.5 years after the Sichuan earthquake. It highlights the mental health problems after the earthquake, and provides the background information for the subsequent intervention studies. Sequentially, effectiveness of the narrative exposure therapy was assessed within Chinese adult survivors and modified appropriately via two RCT studies using waiting list control. In the NET-1 study, 22 survivors with diagnosed PTSD were recruited and received the NET treatment. The results supported the effectiveness of NET for treating Chinese earthquake survivors. In the NET-2 study, NET was adapted according to the feedback and practical implications from the NET-1 study. Thirty participants with newly diagnosed PTSD were recruited. Twenty of them were treated by the NET-R, and the other 10 participants were treated by the original NET. The revised NET showed a similar intervention effect to the original NET in reducing PTSD symptoms anxiety, depression, general distress, and negative change, and promoting positive change following adversity.
In the child intervention studies, a short, inexpensive and easily applied written narrative intervention called Guided Narrative Techniques (GNT) was developed and evaluated with traumatised children in the school setting through two studies. The first study was conducted with 108 sixth grade children (11-12-years old) from three classes in a single primary school, in the earthquake area. Two classes were randomly assigned to the GNT group, and one class was assigned to the expressive writing group that was given simple verbal instruction. The results indicated that if the writing instructions of the programme were fully followed through by the children, GNT might function better on reducing the posttraumatic symptoms than the expressive writing in a short time. However, a low level of writing adherence was reported, indicating that written narrative strategies may not be suitable for traumatised early adolescents.
In the second child study, the GNT protocol was improved to enhance the writing adherence of children. Eighty-two Chinese fourth grade children (9-10-years-old) from three classes were recruited as participants in the writing programme. One class was randomly assigned to the GNT group; one class was assigned to the GNT condition with encouragement (GNTE group); and one class was assigned to the control group with mixed expressive writing and painting (MEWP) without specific guidelines. The results indicated that all three written narrative strategies appeared to be efficient concerning post-disaster resilience for Chinese school children. The GNTE showed most rapid, stable and extensive effects, indicating its advantages over the other two conditions.
The research provides evidence for the applicability and effectiveness of narrative interventions in the Chinese earthquake survivor population. It attempted to facilitate the wider dissemination of psychological interventions to promote recovery from traumatic stress after major disasters. The findings help advance current knowledge in the management of PTSD after natural disasters in developing areas, contribute to the validation of PTSD theories, and inform future research.
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