Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial.
Both STAIR-R combined with NET and SPS plus NET reduced PTSD symptoms in refugees, but no significant differences were found between the two treatments. Tailored approaches may be beneficial for those with high insecurity.
Where it sits
this study against the rest of the 5-amino-1mq corpusSummary and findings
This study evaluated the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) combined with Narrative Exposure Therapy (NET) versus Supportive Problem-Solving (SPS) plus NET in refugees with PTSD. Seventy-one participants were randomly assigned to one of the two treatment groups, with assessments at baseline, post-treatment, and 3-month follow-up. Both groups showed improvements in PTSD symptoms, but no significant differences were found between the groups overall.
Abstract
<b>Background:</b> Responses to evidence-based interventions for posttraumatic stress disorder (PTSD) in refugees vary considerably. Emotion regulation difficulties are associated with greater PTSD severity in refugees and thus represent a potential treatment target.<b>Objective:</b> This study aimed to test the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) and Narrative Exposure Therapy (NET) or Supportive Problem-Solving (SPS) and NET. An exploratory aim was to examine relative efficacy in refugees with high and low levels of visa and family insecurity.<b>Methods:</b> Seventy-one participants were randomly assigned to STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) +NET (7 sessions). Assessments occurred at baseline, post-treatment, and 3-month follow-up, with additional self-report at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5) and secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, difficulties in relationships and environmental quality of life.<b>Results:</b> Intent-to-treat linear mixed models showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both groups demonstrated significant improvements at 3-month follow-up in clinician-assessed (STAIR-R + NET, <i>g = -1.41</i>; SPS + NET, <i>g</i> = -1.54, <i>p</i> < .001) and self-reported (STAIR-R + NET, <i>g</i> = -0.49; SPS + NET, <i>g</i> = -0.44, <i>p</i> = .006) PTSD symptoms. Moderatorg analyses revealed that those with high insecurity (<i>n</i> = 16) obtained greater benefits in STAIR-R + NET from pre-treatment to follow-up on self-reported PTSD (<i>g</i> = 1.35), depression (<i>g</i> = 1.11), emotion regulation difficulties (<i>g</i> = 1.24), relationship difficulties (<i>g</i> = 1.12) and quality of life (<i>g</i> = -1.05).<b>Conclusions:</b> While there were no overall between group-differences, refugees in both conditions showed reduced PTSD symptoms. There is preliminary evidence that those with high insecurity showed a better response to STAIR-R + NET than SPS + NET across several clinical outcomes, although the small sample size necessitates replication of these. These findings highlight the potential importance of tailored intervention approaches for refugees living in different environmental circumstances.
Background
This paper addresses the variability in responses to evidence-based interventions for PTSD in refugees, highlighting the association between emotion regulation difficulties and PTSD severity. Prior research has indicated that tailored interventions may improve treatment outcomes for this population. The study's exploration of the efficacy of STAIR-R combined with NET versus SPS plus NET aims to contribute to understanding effective treatment strategies for refugees.
Methods
The study utilized a pilot randomized controlled trial design with 71 participants assigned to either STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) + NET (7 sessions). Assessments were conducted at baseline, post-treatment, and at a 3-month follow-up, with additional self-report measures at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity measured by CAPS-5, while secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, relationship difficulties, and environmental quality of life.
Results
The primary endpoint showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both treatment groups demonstrated significant improvements in clinician-assessed PTSD symptoms at 3-month follow-up (STAIR-R + NET, g=-1.41; SPS + NET, g=-1.54, p<0.001) and self-reported PTSD symptoms (STAIR-R + NET, g=-0.49; SPS + NET, g=-0.44, p=0.006). Moderator analyses indicated that participants with high insecurity (n=16) experienced greater benefits in STAIR-R + NET across multiple clinical outcomes.
Interpretation
The findings suggest that while both treatment approaches led to improvements in PTSD symptoms, the lack of significant between-group differences indicates that neither intervention was superior overall. The effect sizes observed, particularly in the high insecurity subgroup, may warrant further investigation, although the small sample size raises concerns about the robustness of these results. This study highlights the need for tailored interventions based on individual circumstances in refugee populations.
Key findings
- g=-1.41 for STAIR-R+NET and g=-1.54 for SPS+NET, p<0.001 at 3-month follow-up for clinician-assessed PTSD symptoms.
- g=-0.49 for STAIR-R+NET and g=-0.44 for SPS+NET, p=0.006 at 3-month follow-up for self-reported PTSD symptoms.
- Moderators showed that those with high insecurity (n=16) had a g=1.35 improvement in self-reported PTSD from pre-treatment to follow-up.
- g=1.11 for depression, g=1.24 for emotion regulation difficulties, g=1.12 for relationship difficulties, and g=-1.05 for quality of life in high insecurity group.
- No significant between-group differences at mid-treatment, post-treatment, or follow-up.
Limitations
- small sample size n=71
- no significant between-group differences
- high insecurity subgroup analysis limited to n=16
- short follow-up period of 3 months