Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda

Jacob N, Neuner F, Maedl A, Schaal S, Elbert T (2014)
Psychotherapy and Psychosomatics 83(6): 354-363.

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Background: Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. We tested a train-the-trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD). Methods: We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET) treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/NET-2, n = 38). Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at 3-and 12-month follow-ups. Results: At the 3-month follow-up, the NET-1 participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1 were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with an effect size of Cohen's d = 1.37 at the 12-month follow-up. Conclusions: A TTT model of PTSD treatment dissemination can be effective in resource-poor postconflict societies. (C) 2014 S. Karger AG, Basel
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Jacob N, Neuner F, Maedl A, Schaal S, Elbert T. Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda. Psychotherapy and Psychosomatics. 2014;83(6):354-363.
Jacob, N., Neuner, F., Maedl, A., Schaal, S., & Elbert, T. (2014). Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda. Psychotherapy and Psychosomatics, 83(6), 354-363.
Jacob, N., Neuner, F., Maedl, A., Schaal, S., and Elbert, T. (2014). Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda. Psychotherapy and Psychosomatics 83, 354-363.
Jacob, N., et al., 2014. Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda. Psychotherapy and Psychosomatics, 83(6), p 354-363.
N. Jacob, et al., “Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda”, Psychotherapy and Psychosomatics, vol. 83, 2014, pp. 354-363.
Jacob, N., Neuner, F., Maedl, A., Schaal, S., Elbert, T.: Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda. Psychotherapy and Psychosomatics. 83, 354-363 (2014).
Jacob, Nadja, Neuner, Frank, Maedl, Anna, Schaal, Susanne, and Elbert, Thomas. “Dissemination of Psychotherapy for Trauma Spectrum Disorders in Postconflict Settings: A Randomized Controlled Trial in Rwanda”. Psychotherapy and Psychosomatics 83.6 (2014): 354-363.
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PMID: 26747683

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