Feasibility and acceptability of Narrative Exposure Therapy to treat individuals with PTSD who are homeless or vulnerably housed: A pilot randomized controlled trial
By Nicole E. Edgar, Alexandria Bennett, Nicole Santos Dunn, Sarah E. MacLean & Simon Hatcher
Previous studies have shown that rates of PTSD in people who are homeless and vulnerably housed are between 21% and 53% (much higher than the general population). One promising treatment for PTSD is Narrative Exposure Therapy (NET), a type of psychotherapy that helps patients place their experience of trauma within a larger narrative of their life. There is also evidence that implies that tracing your family history helps people to deepen their roots so they are not blown over by life’s storms.
This study had two goals. Since this treatment has never been used in homeless or vulnerably housed populations before, our first goal was to determine whether it was possible to recruit patients from this under-represented population to participate in a clinical trial that focused on trauma. Our second goal was to learn if both NET and completing a family history was acceptable to the patients enrolled in the study.
To achieve these goals, we conducted a clinical trial where half of the participants received NET only and half received NET + the option to complete a family history with a genealogist. We collected information about how many participants agreed to participate in the study and how long they stayed in the study as well as their personal characteristics and housing status, PTSD symptoms, and drug use over the course of the study. We also interviewed service providers from community organizations to figure out how to best deliver the NET treatment in a larger clinical trial.
14 participants were included in the study (7 in each group). Some participants dropped out of the study but this mostly happened before starting therapy. Once participants started the therapy sessions, 80% went to all of their therapy sessions and 70% completed all of the study questionnaires. The service providers we interviewed pointed out that the treatment we offered is badly needed because homeless and vulnerably housed patients have so few options. They also explained that in a future study, they would like to know more about NET and would like more effective communication with the study team.
While we didn’t quite recruit the number of participants we wanted to, this study still showed that it is possible to recruit homeless and vulnerably housed patients to take part in a clinical trial that focuses on trauma. We also found that even though a high number of participants did drop out of the study, this was greatly reduced once participants started therapy. We will use the results of this study to help us design a larger clinical trial that tests the effects of this treatment in people who are homeless and/or vulnerably housed .