Table 1.

Table of Studies Examining effects of Narrative Exposure Therapy (NET)

Study	Purpose	Design & comparison group	Sample (N) Setting	Intervention/ Interventionists / Fidelity/ Treatment condition	Main Results (within treatment effect sizes) (Cohen’s d)
Adenauer, H., Catani, C., Gola, H., Keil, J., Ruf, M., Schauer, M., & Neuner, F. (2011). Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli--evidence from a randomized controlled treatment trial. BMC Neuroscience, 12, 127. A3	To examine whether NET causes changes in affective stimulus processing in patients with chronic PTSD	RCT: ET compared to WLC	Sample: N=34 Refugees with PTSD. History of organized violence, persecution & current PTSD diagnosis (ages 16–56) Setting: University of Konstanz, Germany Psychological Research and Outpatient Clinic for Refugees.	Intervention: NET: (standardized manual) 12 therapy sessions, weekly or bi weekly (M=108 min SD 1M7 min) Interventionists: Clinical psychologists with expertise in NET & PTSD. Therapeutic competence & treatment fidelity: Regular supervision. Testimonies were checked for vividness and consistency to ensure proper application- no major deviations noted. Treatment completion: NET: 16/18 (Deportation) WLC 16/18 (Deportation)	In treatment completers, time × treatment interaction revealed difference in decreased PTSD symptoms [(F (1,17)=34.99, p<.001) and decreased depression rating [F (1, 17)=13.2), p<.005) for those in NET group as compared to WLC at 4 months follow-up NET within group effect sizes were d=2.21 for PTSD and d=1.56 for depression. Only in the NET group, parietal and occipital activity towards threatening pictures increased significantly after therapy (NET: t= −3.35, p = .007). (WLC: t = 0.58, p = .58).
Bichescu, D., Neuner, F., Schauer, M., &Elbert, T. (2007). Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behaviour Research and Therapy, 45(9), 2212–2220.	To compare NET with Psychoeducation (PED) effectiveness of decreasing PTSD and depression among political detainees	RCT: NET compared to PED (nature and prevalence of PTSD)	Sample: N=18 political detainees with significant trauma in remote past Setting: Romania at subsidiaries of the Association of Former Political Detainees in Iasi and Brosov and at the University	Intervention: NET: 5 sessions (ca. 120 min per session weekly/biweekly) or PED: 1 session Interventionists: 1 female PhD psychology student from University of Konstanz trained in NET. Therapeutic competence & treatment fidelity: Supervision by documentations by email Treatment completion: NET 9/9 PED 9/9	Time × treatment interaction revealed difference in decreased PTSD symptoms [(F(1, 16)= 20.80, p<.001, n2=.60]and for depression scores [(F(1, 16)= 6.50, p<.05, n2=.35] for those in NET compared to PED. NET effect sizes were d=3.15 for PTSD and d=0.97 for depression (6 months)
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9, 22.	To examine, whether highly affected children with a preliminary diagnosis of PTSD would profit more from KIDNET or from a mediation-relaxation protocol.	RCT: KIDNET compared to mediation-relaxation protocol (MED-RELAX)	Sample: N=31 children (ages 8–14) with PTSD who have experienced recent mass disaster (Tsunami) and also (ca. 120 min per session, weekly/biweekly) civil war Setting: Sir Lanka newly erected refugee camp	Intervention: KIDNET: 5 NET sessions modified for children and adolescents MED-RELAX: 6 sessions. Both treatments 60–90 minutes within 2 weeks Interventionists: 6 female, trained local teachers (master counselors-76 training days (≈10 hours/day) with focus on NET, basic counseling, diagnostic tests, and MED-RELAX. 4 day refresher course. Therapeutic competence & treatment fidelity: Supervision by local trainers. Therapists completed detailed protocol after each session and 2 clinical psychologists (University of Konstanz) & local clinical supervisor carried out random observations of single therapy sessions. Regular supervision meetings were offered to therapist team. No major deviations noted Treatment completion: NET 16/16 MED-RELAX 15/15	Time × treatment interaction revealed no significant differences between NET and MED-RELAX. Both treatment conditions had significant decrease in PTSD symptoms and impairment in function at 1 month after and remained stable. NET effect size d=1.76 (post treatment) and d= 1.96 (6 month follow-up). MED-RELAX effect sizes d=1.83 and d= 2.20.
Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in northern Uganda: A randomized controlled trial. JAMA, 306(5), 503–512.	To assess the efficacy of a community-based intervention targeting symptoms of PTSD in formerly abducted individuals.	RCT: NET (N=29) compared to Academic Catch -up with supportive counseling (N=28) or wait list (N=28)	Sample: N= 85 former Ugandan child soldiers with PTSD (ages 12–25) Setting: 3 study areas in Uganda with varying distances from war exposure, internally displaced persons camps and new settlements. Treatment in patient homes	Intervention: NET: 8 sessions (90–120 minutes), 3 times weekly based on standardized manual and KIDNET. Academic catch-up and supportive counseling: Intensive educational catch-up training (55%) and psychoeducation plus basic counseling. Interventionists: Intensively trained local counselors (7 woman &7 men) Therapeutic competence & treatment fidelity: case discussions in supervision meetings, observation and evaluation of treatment sessions via video recordings, and review of the obligatory treatment process notes for each session. NET testimonies were reviewed to check for trauma focus and data richness. No deviations from protocol noted. Treatment completion: NET: 28/29 Academic/Counseling: 27/28 Wait list: 28/28	Time × treatment interaction revealed a superiority of NET compared with academic catch-up (F1,234.1 = 5.21, P = .02) and wait-listing (F1,228.3 = 5.28, p = .02). NET effect size: d = 1.80 Academic catch-up effect size: d = 0.83 Wait-listing effect size: d = 0.81 (all 12 month)
Hijazi, A. M., Lumley, M. A., Ziadni, M. S., Haddad, L., Rapport, L. J., &Arnetz, B. B. (2014). Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: A preliminary randomized clinical trial. J Trauma Stress, 27(3), 314–322	To test the efficacy of an adapted, culturally sensitive, brief NET in a sample of traumatized Iraqi refugees	RCT: Brief NET vs WLC	Sample: N= 63 Iraqi refugees exposed to violent or traumatic event related to refugee status and they were bothered by it, though repeatedly about it or felt they had not overcome it. Setting: Southeast Michigan community refugee settings with services provided but no intense therapy	Intervention: Brief NET: 3 sessions in Arabic from structured manual Interventionists: 2 doctoral students in clinical psychology. Trained and supervised (weekly) by clinical psychologist with expertise in exposure therapy. Therapeutic competence & treatment fidelity: Trained and weekly supervision by clinical psychologist with expertise in exposure therapy. Treatment completion: NET: 39/41	Time × treatment interactions revealed NET had significantly greater posttraumatic growth (d = 0.83) and well-being (d = 0.54) through 4 months than controls.
Halvorsen, J. O., &Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scand J Psychol, 51(6), 495–502	To examine the effectiveness of NET specifically among tortured refugees residing in a Western country.	Quasi-experimental (no control)	Sample: N=16 adult torture survivors, refugee and asylum seekers with PTSD Setting: Psychiatric outpatient clinics in Mid-Norway health region.	Intervention: NET: 10 sessions based on standardized NET manual (90 minutes). 9 NET sessions had professional interpreter present, 3 professional phone interpreters. Interventionists: 15 Mental health professionals. Experts from the University of Konstanz and the aid organization VIVO trained the mental health professionals during a 5-day workshop plus 2-day workshops twice every 6th month to maintain their skills. Therapeutic competence & treatment fidelity: Therapists received individual supervision after 4, spaced, sessions and self-report measure if used main NET ingredients. No deviations noted Treatment completion: NET: 16/16	Decrease in PTSD scores (F (2,30)=13.72, p =000). Decrease in depressive symptoms [F (2,30)= 6.94), p=0.003) NET effect size = 1.16 for PTSD and 0.84 for depression
Hensel-Dittmann, D., Schauer, M., Ruf, M., Catani, C., Odenwald, M., Elbert, T., &Neuner, F. (2011). Treatment of traumatized victims of war and torture: A randomized controlled comparison of narrative exposure therapy and stress inoculation training. PsychotherPsychosom, 80(6), 345–352	To compare the outcome of 2 active treatments for PTSD as a consequence of war and torture: NET and stress inoculation training (SIT)	RCT: NET compared to stress inoculation training (SIT)	Sample: N=28 Refugees and asylum seekers with PTSD Setting: Research & Outpatient Clinic for Refugees in Konstanz, Germany	Intervention:  NET: 10 sessions based on standardized manual (90 minutes). Ave 9 days before treatments. 17 cases professional interpreter. Interventionists: Trained staff from Research and Outpatient Clinic for Refugees. Therapeutic competence & treatment fidelity: Treatment sessions were videotaped and randomly analyzed. Treatment implementation discussed in team sessions. Treatment completion: NET: 12/15 SIT: 11/13	Time × treatment interactions revealed NET had significantly symptom reduction [F (3,52)= 3.08; p<.05]. NET effect size=1.42 &1.59 for PTSD symptoms (6 months, & 1 year) STI effect size for PTSD symptoms = 0.12–0.19 for (6 months, 1 year) No change for depression or other co-morbid conditions
Morina, N., Maier, T., Bryant, R., Knaevelsrud, C., Wittmann, L., Rufer, M., … Muller, J. (2012). Combining biofeedback and Narrative Exposure Therapy for persistent pain and PTSD in refugees: A pilot study. Eur J, Psychotraumatol, 3.	To present data on a pilot treatment [NET and biofeedback (BF)] study conducted with 15 traumatised refugees with persistent pain and PTSD	Pilot study: NET and biofeedback (no control)	Sample: N=15 Refugees with experience of war/torture persistent pain and PTSD Setting: Outpatient Unit for Victims of Torture and Ware in the Department of Psychiatry and Psychotherapy (University Hospital of Zurich)	Intervention: Combined 10-session BF program followed by 10-session trauma-focused NET protocol Interventionists: 4 postgraduate clinical psychologists who had received special training in NET Therapeutic competence & treatment fidelity: Weekly supervision Treatment completion: BF+ NET 15/18	Objective was to provide information on feasibility, acceptance and safety. Findings indicated intervention to be feasible, well accepted, tolerated & safe. Time × treatment interaction revealed significance in PTSD [F (1.3, 18.39) = 22.01, p < .001] BF +NET Effect sizes: 0.1, 1.43, −.0.01 for PTSD
Neuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(4), 686–694.	To examine whether trained lay counselors can carry out effective treatment of PTSD in a refugee settlement	RCT: NET compared to flexible trauma counseling (TC) and non-treatment group.	Sample: N= 277 Rwandan and Somalian refugees who were diagnosed with PTSD Setting: African refugee settlement in Uganda	Intervention: NET: 6 sessions based on standardized manual. Usually 2 sessions per week, 1–2 hours) Interventionists: Trained local, lay counselors (9 refugees from community with literacy (English & mother tongue, empathy & motivation)- 6 week course, general counseling skills and NET & trauma training) Therapeutic competence & treatment fidelity: Case and personal supervision weekly. Treatment adherence discussed by case in supervision meetings, direct observation of treatment and review of testimonies and treatment protocols. No major deviation noted. Treatment completion: NET: 86/111 TC: 85/111	Time × treatment interaction for NET and non treatment group revealed significance in PTSD [F (1, 112)=8.2, p=.005]. No significant difference between NET and TC NET effect sizes: d= 1.4 and 1.4 in PTSD (post-test & 6 month Follow-up
Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5, 7.	To created and evaluated the efficacy of KIDNET, a child-friendly version of Narrative Exposure Therapy (NET), as a short-term treatment for children	Pilot study: no control	Sample: N=6 Somali refugee children suffering from PTSD aged 12–17 years Setting: Uganda refugee settlement	Intervention: KIDNET: 4–6 sessions of child-friendly version of NET lasting 1–2 hours Interventionists: Expert clinicians experienced with NET Therapeutic competence & treatment fidelity: none indicated Treatment completion: NET: 6/6	Time × treatment effect: F (2,5)= 15.45, p< 0.01. PTSD symptom reduction (post test and 9 month follow-up)
Pabst, A., Schauer, M., Bernhardt, K., Ruf, M., Goder, R., Rosentraeger, R., … Seeck-Hirschner, M. (2012). Treatment of patients with borderline personality disorder and comorbid posttraumatic stress disorder using narrative exposure therapy: a feasibility study. Psychotherapy and Psychosomatics, 81(1), 61–63	To test the feasibility of narrative exposure therapy (NET), a trauma-focused therapy suitable for both in- and outpatient settings which can be taught to clinically experienced therapists in a short-term training program and implemented in a comprehensive treatment for borderline personality disorder (BPD) patients with comorbid PTSD.	Feasibility study	Sample: N= 10 woman (ages 19–45) with BPD and PTSD Setting: Center for Integrative Psychiatry in Kiel, Germany	Intervention:  NET sessions (average 14 based on severity and amount of trauma) standardized manual, 90 minutes, 1–2 times weekly Interventionists: Expert clinicians with 2-day NET training by NET multi-professional team Therapeutic competence & treatment fidelity: Weekly team meetings and biannual supervision to assurance adherence to manual guidelines Treatment completion: NET: 10/10	NET: significant reduction in PTSD symptoms (p< .05) and depression (p<.05) NET effect size (Hedges’g)= 0.92 (PTSD) and .89 (depression) (6 months)
Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children	To examine the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile	RCT: NET compared to WLC	Sample: N=26 refugee children (ages 7–16) traumatized by organized violence and diagnosed with PTSD Setting: Research-Outpatient clinic for Refugees at the University of Konstanz, Germany	Intervention: KIDNET: ≈8 sessions, 90–120 minutes, weekly Interventionists: 8 clinical psychologists (4 PhD students, 2 senior researches at PhD-level and 2 professors of clinical psychology with experience in treatment of war and organized violence survivors). Professional translators in 7 cases Therapeutic competence & treatment fidelity: not indicated Treatment completion: NET; 13/13	Time × treatment [F91,24)= 7.56, p=.01) NET effect size: 1.9, p= .001 (6 month follow-up)
Schaal, S., Elbert, T., &Neuner, F. (2009). Narrative exposure therapy versus interpersonal psychotherapy. A pilot randomized controlled trial with Rwandan genocide orphans. PsychotherPsychosom, 78(5), 298–306.	To evaluate the efficacy of treatment modules for trauma spectrum disorders in a sample of Rwandan genocide orphans	RCT: NET compared to interpersonal therapy (IPT) in group	Sample: N=26 youth (ages 14–28) living in child-headed households or orphanages in Kigali, Rwanda. Setting: Rwanda	Intervention: NET: 3 sessions + I grief session, weekly, 2–2.5 hours. Based on standardized modules IPT; Group (3–4 people), 4 sessions. Both treatments with professional interpreters. Interventionists: 2 female counselors from University of Konstanz with experience in the applied treatment modules Therapeutic competence & treatment fidelity: Weekly supervision meetings Treatment completion: NET 12/12 IPT 14/14	Between group differences: PTSD: F (1,23)=7.68; p<0.01 Depression: F (1,23)= 5.20, p< .05 NET effect sizes 0.39, 0.71 IPT effect size: 0.23, 0.00 (3, 6 month follow-up)
Zang, Y., Hunt, N., & Cox, T. (2013). A randomised controlled pilot study: The effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake. BMC Psychiatry, 13, 41.	To evaluate the efficacy of Narrative Exposure Therapy (NET) as a short-term treatment for PTSD using Chinese earthquake survivors	RCT pilot: NET compared to WLC	Sample: N=22 adults recently diagnosed with PTSD site of Sicuan earthquake in China Setting: Beichaun County, China	Intervention: NET: 4 sessions based on manual, 60–90 minutes over 2 weeks Interventionists: 3 female master level psychologist therapists, native Chines speakers, trained in NET Therapeutic competence & treatment fidelity: Tutored under supervision, case and personal supervision were maintained on weekly basis. Treatment adherence direct observation of treatment, case discussion in supervision meetings, and a review of records and treatment protocols Treatment completion: NET: 11/11	Time × treatment comparison revealed significant differences for 3 subscales of PTSD [F (1,19)= 28.99, 22.20, & 57.30; p<.001] NET effect sizes 1.09, 1.35, 1.30 for 3 subgroups, WLC effect sizes 0.09, 0.35, 0.16.

Key:

RCT= Randomized Control Trial

WLC= Waitlist Control

PTSD: Posttraumatic Stress Disorder