Further thoughts on evaluating interventions for posttraumatic stress disorder in low and middle income countries

While agreeing that there are very few studies on Narrative Exposure Therapy, the author responds to the critique of Mundt et al. (elsewhere in this issue), by arguing that psychological interventions should not only, nor primarily, be evaluated by outcomes immediately after the end of the intervention. This is because psychological interventions, such as Narrative Exposure Therapy, aim to start a process of recovery that may continue long after treatment and eventually result in stronger change.

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Do we really have enough evidence on Narrative Exposure Therapy to scale it up?

This invited commentary reflects on utilising Narrative Exposure Therapy protocols in very different cultural setting than those they were originally developed for, and is a response to Mundt et al. (this issue) and Neuner, Schauer & Elbert (this issue). The author discusses several key issues that should be considered, including: the allegiance effect, demand characteristics, clinical efficacy, and ecological validity.

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Vertical trauma focussed interventions versus broader horizontal psychosocial interventions

Despite an influx of agencies conducting psychiatric and psychosocial interventions worldwide, there is scarce agreement regarding treatment goals and best practice to deal with trauma related mental disorders. A systematic review of posttraumaticc stress disorder treatments concluded that scientific evidence on treatment modalities did not reach the level of certainty that would be desired. This commentary ends by outlining the kind of evidence that would be required.

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On the efficacy of Narrative Exposure Therapy: a reply to Mundt et al.

In their review article, Mundt et al. (2014), ‘Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy’, (Intervention, this issue) evaluated Narrative Exposure Therapy (NET) as an example of a short-term treatment for posttraumatic stress disorder that is applied in low and middle income, post conflict settings. They concluded that it is premature to recommend NET as a treatment approach. In this response, the clinicians and researchers who developed NET argue that the paper by Mundt et al.

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Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy

This article provides a framework for evaluating randomised controlled efficacy trials for the treatment of posttraumatic stress disorder, in low and middle income countries, applied to Narrative Exposure Therapy. A list of methodological and conceptual indicators to evaluate trial data was developed and utilised to assess six trials. The efficacy of this therapy to reduce symptoms is mainly deduced from effects that were measured at long term follow-up points, and that had not been seen at relatively early follow-up points.

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Response to ‘‘Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study’’

Last November, the European Journal of Psychotraumatology
published an interesting paper entitled
‘‘Treatment compliance and effectiveness in
complex PTSD patients with co-morbid personality disorder
undergoing stabilizing cognitive behavioral group
treatment: a preliminary study’’ (Dorrepaal et al., 2013).
This article describes a post hoc analysis on data derived
from an analysis of a sample of complex PTSD patients
previously published in the Journal of Psychosomatics
and Psychotherapy (Dorrepaal et al., 2012). It shows the

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Decision making at the front line

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Changes in the remuneration system for general practitioners: effects on contact type and consultation length

In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients. In 2006, a combined system was introduced for all patients, with elements of capitation as well as FFS. This created a unique opportunity to investigate the effects of the change in the remuneration system on contact type and consultation length.

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Integrating psychosocial support into nutrition programmes in West Africa during the Sahel food crisis

For optimal physical and cognitive development to occur, a child requires adequate nutrition, but this should occur in addition to physical and emotional stimulation from a caregiver. Programmes, in which interventions for nutrition, maternal mental health and psychosocial stimulation are integrated, provide much wider benefits to a child's psychical and cognitive development than stand alone nutritional responses.

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Do humanitarian crises offer opportunities for change? A critical review of the mental health and psychosocial support post emergency in the Republic of the Congo

Violent explosions rocked the city of Brazzaville (the capital of the Republic of the Congo) on 4 March 2012, officially causing more than 280 deaths and leaving approximately 15,000 people displaced. Two months after this event, despite a large number of people suffering from considerable psychological distress, few people had called for, or had received, appropriate mental health care or any external psychosocial support.

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