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| Name | Class |
|---|---|
| Nottinghamshire Healthcare NHS Trust | OTHER_GOV |
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The goal of this interventional study is to evaluate the feasibility of Narrative Exposure Therapy (NET) for people experiencing psychosis. The secondary goal of this study is to evaluate the potential impact of NET in reducing symptoms of psychosis and post-traumatic stress. Participants will be patients accessing local NHS mental health services who are between the age of 18 to 65 years-old who have been diagnosed with a psychotic disorder and have a history of trauma. The main questions the study aims to answer are:
Is NET feasible to deliver to people experiencing psychosis
Can NET impact symptoms of psychosis in people experiencing psychosis?
Can NET impact symptoms posttraumatic stress in people experiencing psychosis?
Can NET impact symptoms of depression, anxiety and stress in people experiencing psychosis?
Participants will be asked to:
Undertake the NET intervention with a trained NET therapist (the number of sessions will be decided based on the need of the participant)
Complete a questionnaire to assess the traumas they have experienced over the course of their life (called the 'Trauma and Life Events' Scale)
Complete a weekly interview to assess their symptoms of psychosis (called the 'Simplified Negative and Positive Symptoms Interview')
Complete weekly measures to assess symptoms of post-traumatic stress (called the 'International Trauma Questionnaire')
Complete weekly measures to assess symptoms of depression, anxiety and stress (using the Depression, Anxiety and Stress 21 item Scale [DASS-21])
Complete a follow-up interview to discuss their personal experience of the NET intervention)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Narrative Exposure Therapy (NET) Arm | Experimental | In Narrative Exposure Therapy (NET), patients construct a detailed narration of their life story with the therapist, focusing on integrating traumatic memories into a coherent whole, including sensory, cognitive, emotional, and physiological aspects. The therapist documents the testimony. After an initial evaluation, including a questionnaire (TALE in this study), patients receive psychoeducation about trauma symptoms, followed by a preparatory introduction. Therapy begins with creating a "lifeline," an autobiographic overview of positive and traumatic events. Patients then undergo "Narrative Exposure," chronologically recounting their life story with in-depth exploration of emotionally charged experiences, particularly trauma, to contextualize and integrate them into reorganized memory. Patients will also be complete assessments pre, during and post the intervention to assess and monitor changes to their symptoms. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Narrative Exposure Therapy (NET) | Other | NET always begins with a face-to-face personal interview between the patient and the therapist to carefully assess life events using checklists, followed by an interview about trauma reactions and a thorough psychoeducation about the findings and suggested procedure of NET. In another session, he arousing and meaningful specific events from birth to present are symbolized in their valence in an autobiographical timeline (or 'lifeline'). The patient is then encouraged to share their life story, focusing on adverse and emotionally charged experiences, which are explored in depth using 'Narrative Exposure', and those are reviewed in the subsequent session. |
| Measure | Description | Time Frame |
|---|---|---|
| Change Interview | A change interview is a semi-structured interview designed to explore participants' experiences of therapy, its feasibility, acceptability, and perceived effects. It covers general wellbeing, views on specific NET components (psychoeducation, lifeline, questionnaires, session length), and reflections on discussing traumatic memories. Participants are asked about any changes they noticed, the importance of these changes, whether they attribute them to therapy or other factors, and what aspects were helpful or unhelpful. The interview also explores challenges, unexpected experiences, and the significance of specific traumas or positive memories (flowers) discussed in therapy, as well as differences observed between initial and later lifeline sessions. | The Change Interview will be conducted at the follow-up phase of study which will occur 4 weeks within the final NET session. |
| Measure | Description | Time Frame |
|---|---|---|
| PANSS-6 | The PANSS-6 is an abbreviated, clinician-rated version of the 30-item Positive and Negative Syndrome Scale, focused on three core positive symptoms (Delusions - P1, Conceptual Disorganization - P2, Hallucinatory Behavior - P3) and three negative symptoms (Blunted Affect - N1, Passive/Apathetic Social Withdrawal - N4, Lack of Spontaneity and Flow of Conversation - N6). It's psychometrically scalable and sensitive to symptom changes, with accuracy comparable to the full PANSS-30 for assessing severity, remission, and treatment response. The PANSS-6 is rated using information collected from the Simplified Negative and Positive Symptoms Interview (SNAPSI) which is a brief semi-structured interview designed to gather information needed to rate the PANSS-6. Clinicians administer the SNAPSI, following its structured probes for each of the six symptom domains, then assign ratings on the 7-point PANSS-6 scale (1 = absent to 7 = extreme) using detailed anchor criteria. |
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Inclusion Criteria: For the purposes of this study the term 'psychosis' covers a range of conditions recognised in standard diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5; APA, 2013) and the International Classification of Diseases - Eleventh Revision (ICD-11; WHO, 2018). Examples include, but are not limited to:
Individuals will be eligible to take part in the study if they meet all of the following:
Exclusion Criteria: People will not be able to take part in the study if any of the following apply
Recent serious mental health crisis -
If the person has experienced a significant adverse event within the last three months, such as:
Currently receiving another structured psychological therapy - For example, Cognitive Behavioural Therapy (CBT) or another regular talking therapy programme. This is to ensure that the results of the study reflect the effects of Narrative Exposure Therapy (NET) alone, without being influenced by another therapy.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lewis Albie MacDonald-Winship, BSc Psychology | Contact | 07399649033 | Lewis.MacDonald-Winship@nottingham.ac.uk |
| Name | Affiliation | Role |
|---|---|---|
| Thomas Schroder, PhD | University of Nottingham | Principal Investigator |
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| ID | Term |
|---|---|
| D011618 | Psychotic Disorders |
| D012559 | Schizophrenia |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
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This is a single group assignment. All participants will get the same intervention, Narrative Exposure Therapy.
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| From baseline to the end of follow up which occurs within 4 weeks of the final NET session. |
| International Trauma Questionnaire (ITQ) | The International Trauma Questionnaire (ITQ) is a brief, self-report tool aligned with ICD-11, designed to assess both PTSD and Complex PTSD (CPTSD) via 18 items-measuring three core PTSD domains (re-experiencing in the present, avoidance, and sense of current threat), three Disturbances in Self-Organization (DSO) domains (affective dysregulation, negative self-concept, interpersonal difficulties), plus functional impairment for each set of symptoms. Respondents first identify "the experience that troubles you the most" and answer items about symptoms and functioning, rating each from 0 ("not at all") to 4 ("extremely"). | From baseline to the end of follow up which occurs within 4 weeks of the final NET session. |
| DASS-21 (Depression, Anxiety, and Stress Scale) | The DASS-21 (Depression Anxiety Stress Scales - 21 items) is a short, self-report questionnaire designed to measure the negative emotional states of depression, anxiety, and stress. It contains 21 items (7 per subscale). Respondents rate how much each statement applied to them over the past week on a 4-point scale (0 = did not apply to me at all, 3 = applied to me very much/most of the time). Scores for each subscale (depression, anxiety, stress) are summed and then multiplied by 2 to make them comparable with the longer DASS-42 version. It is not a diagnostic tool, but it provides an indication of the severity of symptoms in each domain. | From baseline to the end of follow up which occurs within 4 weeks of the final NET session. |