Using narrative exposure therapy to treat women with a history of intimate partner violence for post-traumatic stress: a series of single case studies

Lane, Stephanie (2019) Using narrative exposure therapy to treat women with a history of intimate partner violence for post-traumatic stress: a series of single case studies. DClinPsy thesis, University of Nottingham.

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Background: Intimate Partner Violence (IPV) is said to affect one in four women and is therefore a human rights concern in the UK and internationally. Post-traumatic stress (PTS) is the most prevalent adverse psychological outcome associated with IPV. The impact of IPV can be unique; survivors’ sustained exposure to multiple traumatic events can result in psychological parallels to being taken hostage and subjected to torture. However, interventions often focus on risk management, and few treatments are suited to the chronicity and complexity of trauma endured in IPV. Narrative Exposure Therapy (NET), a treatment specifically designed to alleviate PTS following exposure to multiple trauma, has recently been included in NICE guidelines.

Aims: This study aimed to investigate if NET can reduce levels of PTS in women with a history of IPV. The secondary aims were: (1) to determine if NET impacts on levels of depression, anxiety and general stress within an IPV context; (2) to understand NET’s mechanisms of change within a single case series design; (3) to determine how participants experience NET; (4) to determine if a short term intervention can be beneficial in an IPV context.

Method: A series of single-case studies with a mixed methods sequential-measurement A-B design was conducted with four participants presenting with PTS following IPV. The primary outcome measure was the Impact of Events Scale - Revised (IES-R); the second measure the Depression, Anxiety and Stress Scale (DASS 21). All sessions were video recorded for fidelity assurance and to facilitate observational measures. Simulation Modelling Analysis (SMA) was used to assess temporal relationships between measures. Process was studied in two ways: (1) using a within-session subjective distress measure and (2) using narrative analysis to assess for changes in pre-post NET trauma narratives. Post-treatment change interviews were also completed.

Results: PTS reduced during NET for all participants, which was substantiated by their qualitative accounts. For some there was a reduction in secondary measures. Process measures revealed mixed evidence for NET’s proposed mechanisms of change. Time series data showed varied individual trajectories.

Conclusion: NET is a potential therapeutic resource for IPV survivors; trauma-focused interventions suited to the complexity and chronicity of trauma experienced in IPV may be helpful for this population. Future research should focus on the autobiographical memory component of NET to develop our understanding of its change mechanisms.

Item Type: Thesis (University of Nottingham only) (DClinPsy)
Supervisors: Schröder, Thomas
Sabin-Farrell, Rachel
Regel, Steven
Keywords: Intimate partner violence, Narrative exposure therapy, Post-traumatic stress
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 59197
Depositing User: Lane, Stephanie
Date Deposited: 10 Jan 2020 14:40
Last Modified: 06 May 2020 11:46

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