Lely Jeannette C G, Smid Geert E, Jongedijk Ruud A, W Knipscheer Jeroen, Kleber Rolf J
Foundation Centrum '45, Diemen, The Netherlands.
Arq Psychotrauma Expert Group, Diemen, The Netherlands.
Eur J Psychotraumatol. 2019 Mar 25;10(1):1550344. doi: 10.1080/20008198.2018.1550344. eCollection 2019.
: Narrative exposure therapy (NET) is a short-term psychological treatment for post-traumatic stress disorder (PTSD) that has been investigated in various contexts among traumatized refugees and other trauma survivors. Sustained treatment results have been reported, but the methodological quality of the trials needs a more thorough examination. : To evaluate the effectiveness of NET for survivors of trauma, using a quality assessment, an updated meta-analysis, and a meta-regression analysis. : Following a systematic literature selection, the methodological quality of the included studies was assessed; Non-controlled and controlled effect sizes (Hedges' ) were estimated using a random effects model. Predictor analyses were performed. Non-controlled effect sizes for PTSD and depression included symptom change at post-treatment and follow-up time-points. Controlled effect sizes included post-treatment comparisons of NET with non-active and active comparators: both trauma-focused (TF) and non-trauma-focused (non-TF) interventions. : The selected studies showed high external validity; methodological quality was equivalent to other guideline-supported TF interventions. In 16 randomized controlled trials, involving 947 participants, large non-controlled effect sizes were found for PTSD symptoms, at post-treatment ( = 1.18, 95% confidence interval [0.87; 1.50]) and follow-up ( = 1.37 [0.96; 1.77]). For depression symptoms, medium non-controlled effect sizes were found, at post-treatment ( = 0.47 [0.23; 0.71]) and follow-up ( = 0.60 [0.26; 0.94]). Post-treatment, NET outperformed non-active comparators and non-TF active comparators for PTSD, but not the combined active comparators. For depression, NET only outperformed non-active comparators. Advancing age predicted better treatment results for PTSD and depression symptoms; a history of migration predicted smaller treatment results for depression symptoms. :The findings of this meta-analysis suggest that patients and providers may expect sustained treatment results from NET. Controlled comparisons with other guideline-supported TF interventions are not yet available.
叙述暴露疗法（NET）是一种针对创伤后应激障碍（PTSD）的短期心理治疗方法，已在受创伤的难民和其他创伤幸存者的各种背景下进行了研究。已有持续的治疗结果报告，但试验的方法学质量需要更全面的检查。
为了使用质量评估、更新的荟萃分析和荟萃回归分析来评估NET对创伤幸存者的有效性。
在进行系统的文献筛选后，评估纳入研究的方法学质量；使用随机效应模型估计非对照和对照效应量（Hedges' ）。进行预测分析。PTSD和抑郁症的非对照效应量包括治疗后和随访时间点的症状变化。对照效应量包括NET与非活性和活性对照（均为创伤聚焦（TF）和非创伤聚焦（非TF）干预）的治疗后比较。
所选研究显示出较高的外部效度；方法学质量等同于其他指南支持的TF干预。在16项随机对照试验中，涉及947名参与者，发现PTSD症状在治疗后（ = 1.18，95%置信区间[0.87；1.50]）和随访时（ = 1.37 [0.96；1.77]）有较大的非对照效应量。对于抑郁症状，在治疗后（ = 0.47 [0.23；0.71]）和随访时（ = 0.60 [0.26；0.94]）发现中等非对照效应量。治疗后，NET在PTSD方面优于非活性对照和非TF活性对照，但不优于联合活性对照。对于抑郁症，NET仅优于非活性对照。年龄增长预示着PTSD和抑郁症状的治疗效果更好；移民史预示着抑郁症状的治疗效果较小。
这项荟萃分析的结果表明，患者和提供者可能期望NET能带来持续的治疗效果。目前尚无与其他指南支持的TF干预的对照比较。
