In the current issue of P&P a group of German investigators report on a psychological treatment applied in the setting of post war trauma.
Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. The authors tested a train-the-trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD) randomly assigning widowed or orphaned survivors of the 1994 Rwandan genocide, with a PTSD diagnosis, to narrative exposure therapy (NET) (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 showed that 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 12-month follow-up.
This study showed that a TTT model of PTSD treatment dissemination can be effective in resource-poor post-conflict societies. Even though implementing trauma therapy with brief training, a limited number of treatment sessions, and in the context of the difficult living conditions of genocide survivors can be challenging, evidence-based practice treatment can be disseminated to local mental health workers to confront the great suffering of traumatized people, as found in Rwandan society.
