Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

Background: Evidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe. 

Aims: Examining the efficacy of NET in a sample of older adults. 

Method: Out-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated. 

Results: Using a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen’s d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress. 

Conclusions: Both NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised. 

Declaration of interest: None.

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J.C.G. Lely, J.W. Knipscheer, M. Moerbeek, F.J.J. ter Heide, J. van den Bout and R.J. Kleber | 2019
In: The British Journal of Psychiatry ; ISSN: 0007-1250 (Print) 1472-1465 (Electronic) 0007-1250 (Linking) | 214 | 6 | 369-377
Elderly, Narrative Exposure Therapy, Posttraumatic Stress Disorder, Present Centered Therapy, PTSD (DSM-IV), PTSD (en), Randomized Clinical Trial