Narratieve Exposure Therapie voor posttraumatische stressstoornis geassocieerd met herhaald interpersoonlijk geweld bij patiënten met Ernstige Psychische Aandoeningen: een gemengde methoden onderzoek

Rationale: In the Netherlands, SMI patients receive Flexible Assertive Community Treatment (FACT) provided by multidisciplinary community mental health teams. In GGNet, FACT-teams are trained in screening for traumatic experiences and PTSD symptoms to improve the treatment of SMI patients with comorbid PTSD. SMI patients with comorbid PTSD are offered evidence based trauma focused treatment like Eye Movement Desensitization Reprocessing (EMDR) or Prolonged Exposure (PE), according to the international PTSD guidelines. For patients with (comorbid) PTSD associated with repeated interpersonal trauma there is a large amount of evidence for the effectiveness of Narrative Exposure Therapy (NET) within various patient groups. NET has not been specifically studied in SMI patients. Since 2012, our FACT-teams offer NET to SMI patients with PTSD associated with repeated interpersonal trauma. All NET treatments are monitored according to the treatment protocol. This trauma specific monitoring is combined with the routine outcome monitoring (ROM), which is common practice in mental health care and based on Dutch performance indicators for SMI.
Objective: The primary aim of this feasibility study is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma whether: a) the PTSD symptoms changes and b) changes occur in the present SMI symptoms, care needs, quality of life, and care consumption. The second aim is to gain insight in patients’ experiences with the NET and to identify perceived determinants of treatment results in terms of symptom changes, care needs, and quality of life.


Study design: This feasibility cohort study is a mixed methods convergent design. The quantitative method consists of a repeated measures design and the qualitative method consists of a Grounded Theory design with semi-structured in-depth interviews.


Study population: Adult (21 to 65 years) SMI patients (n=25) with comorbid PTSD associated with repeated interpersonal trauma, receiving FACT and referred for NET by their psychiatrist. Participants are independently living outpatients and do not receive involuntary treatment following Mental Health Law.


Intervention (if applicable): the Narrative Exposure Therapy (NET) is offered to the patients of this study population. All patients included will receive the NET according to the guidelines by their psychologist or nurse practitioner.


Main study parameters/endpoints:
Quantitative: There will be eight main study parameters: 1a) existence and 1b) severity of dissociative symptoms (DES); 2a) existence and 2b) severity of PTSD (CAPS-5); 3) care needs (CAN); 4) psychiatric symptoms (HoNOS); 5) Quality of life (MANSA); and 6) care consumption. These outcomes will be analysed using Mixed models to estimate the difference in means between pretest and posttest, taken into account the repeated measures.


Qualitative: Experiences with NET, identified relevant themes and determinants for success or failure.
The integration of the quantitative and qualitative results will be focused on interpreting how the qualitative results enhance the understanding of the quantitative outcomes.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness:
The semi-structured interview takes up to 60 minutes and is conducted three months after NET. At this stage patients are less vulnerable and most of them function better. The interview is not aimed at the traumatic experiences but is focused on the treatment experience and the treatment effect on symptoms and daily life functioning. Moreover, patients are accustomed by the therapy to talk about their experiences in general.

The primary aim of this study is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma whether: a) the PTSD symptoms changes and b) changes occur in the present SMI symptoms, care needs, quality of life, and care consumption. The second aim is to gain insight in patients' experiences with the NET and to identify perceived determinants of treatment results in terms of symptom changes, care needs, and quality of life.

T0 before intervention

T1 one month after finalizing intervention

T2 seven months follow up



Interview: three months after finalizing intervention

Narratieve Exposure Therapy