Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD). This includes the treatment of trauma-related suffering in refugee populations. However, there is a lack of knowledge about symptom trajectories in refugees living in volatile conditions. This has led to fear of “retraumatisation” and general skepticism in clinicians concerning the use of exposure therapy. To test the relevance of this concern, we investigated PTSD symptom trajectories and potentially influencing factors during the course of Narrative Exposure Therapy (NET) in a refugee sample living in Germany. Refugees filled out the PTSD Checklist prior to each treatment session and also during follow-up interviews. Therapists continuously documented positive and negative life events as well as the content of the treatment sessions. Additionally, structured clinical interviews were conducted pre-treatment and at follow-up time points. On average, clients presented with substantial decreases in PTSD symptoms already during and after NET. However, symptom trajectories differed and ranged from fast responders to slow responders to no immediate response during treatment. Importantly, a persistent worsening of symptoms was not observed, also not after exposure to the most distressing events. In contrast, stressful life experiences seemed to aggravate PTSD symptoms. Consistent with earlier studies, NET leads to clinically and behaviorally relevant reductions in PTSD symptoms both throughout and following treatment in refugees living in volatile conditions. Concerns about imaginal exposure in refugees were not substantiated. While stressful life events contributed to transient symptom increases, they weren’t found to prevent the overall effectiveness of NET. NCT02852616.

中文翻译：

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难民叙事性暴露疗法（NET）期间和之后的创伤后应激症状的轨迹。

建议以创伤为重点的治疗方法作为创伤后应激障碍（PTSD）的治疗方法。这包括治疗难民中与创伤有关的痛苦。但是，对生活在动荡环境中的难民的症状轨迹缺乏了解。这导致了对临床医生关于使用暴露疗法的“再彻底化”和普遍怀疑的恐惧。为了检验这种关注的相关性，我们在叙事暴露疗法（NET）的过程中，对居住在德国的一个难民样本进行了调查，探讨了PTSD的症状轨迹和可能的影响因素。在每次治疗前以及随访期间，难民都填写了PTSD检查表。治疗师不断记录积极和消极的生活事件以及治疗内容。另外，在治疗前和随访时间点进行了结构化的临床访谈。平均而言，在NET期间和之后，客户的PTSD症状已大大降低。但是，症状轨迹有所不同，范围从快速反应者到缓慢反应者到治疗期间没有立即反应。重要的是，在暴露于最令人痛苦的事件之后，也没有观察到症状持续恶化。相反，紧张的生活经历似乎加剧了PTSD症状。NET与早期研究一致，在生活在动荡环境中的难民的整个治疗过程中和治疗后，PTSD症状均在临床和行为上有所减轻。关于难民虚构接触的担忧没有得到证实。虽然压力大的生活事件会导致短暂的症状增加，但并未发现它们会阻止NET的整体有效性。NCT02852616。