Treating children and adolescents with multiple traumas: A randomized clinical trial of narrative exposure therapy
Open accessAbstract
Background and Objective: Millions of children and adolescents worldwide suffer from post-traumatic stress disorder (PTSD) and other problems due to prolonged exposure to traumatizing events. Forms of cognitive-behavioural therapy are the most commonly used treatment for PTSD, but evidence from sophisticated studies in clinical settings among children is limited.Method: This multicentre, parallel, non-blinded, pragmatic randomized controlled trial assessed the effectiveness of narrative exposure therapy (NET) in traumatized children and adolescents. Fifty 9–17-year-old participants, who had experienced prolonged traumatic conditions in the form of refugeedom or family violence and suffered from PTSD symptoms, were randomized into NET (n = 29) and treatment as usual (TAU; n = 21) active control groups. The objective was to determine whether NET can be feasibly implemented within the existing healthcare system of a high-income country and whether it would reduce mental health problems, especially PTSD, and increase resilience, in children and adolescents with multiple traumas more effectively than TAU. We hypothesized that NET would be more effective than TAU in reducing symptoms and increasing resilience.Results: Analysis of variance revealed that PTSD and psychological distress, but not depression symptoms, decreased regardless of treatment group. Resilience increased in both groups. Within-group analyses showed that the decrease in PTSD symptoms was significant in the NET group only. The effect sizes were large in NET but small in TAU. Concerning PTSD symptom cut-off scores, the reduction in the share of participants with clinical-level PTSD was significant in the NET group only. Intention-to-treat analyses using linear mixed models confirmed these results.Conclusions: Despite its shortcomings, this study gives preliminary support for the safety, effectiveness, and usefulness of NET among multiply traumatized children and adolescents in clinical settings. Close attention must be paid to the implementation of the new intervention as an everyday tool in healthcare.
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Narrative exposure therapy (NET) provides long-lasting benefits, reducing PTSD symptoms and psychological distress while enhancing resilience in multiply traumatized youth.
“Researchers in the study [42] find that narrative exposure therapy (NET) provides long-lasting benefits, reducing PTSD symptoms and psychological distress while enhancing resilience in multiply traumatized youth.”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [42]
The Results and Discussion report reduced PTSD symptoms and psychological distress and increased resilience among multiply traumatized youth. However, distress and resilience improved in both NET and treatment-as-usual groups, with no significant treatment-by-time interaction. The Discussion says limited follow-up measurements prevent strong conclusions, so the claim of long-lasting benefits is not supported. (LLM, conf=0.87)
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“Peltonen and Kangaslampi (2019) reported a small effect size advantage in favor of KIDNET compared to TAU in Finland post intervention.”
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“…explored the impact of NET in reducing PTSD symptom severity, with all studies yielding some evidence to suggest that NET is associated with significant reductions in PTSD symptom severity (Catani et al., 2009; Onyut et al., 2005; Peltonen & Kangaslampi, 2019; Ruf et al., 2010; Said & King, 2020).”
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“Our inclusion criteria were as follows: (i) randomized controlled trials (RCTs); (ii) participants were children and adolescents (aged ≤18 years) who met the criteria for PTSD diagnosis: a. for patients with complete PTSD, Conclusion: ET showed superiority in efficacy at post-treatment/follow-up and depressive symptom…”
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“…directly target these child maltreatment experiences, for example using cognitive processing therapy (LoSavio et al., 2021) or narrative exposure therapy (Peltonen & Kangaslampi, 2019) techniques that already showed preliminary efficacy for the treatment of trauma-related symptoms in adolescents.”
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“Two intervention studies that met the criteria for inclusion used NET methodologies and demonstrated mixed results in the reduction in depressive symptoms (Onyut et al., 2005; Peltonen & Kangaslampi, 2019).”
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Unaccompanied minors’ experiences of narrative exposure therapy
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“In published trials of NET for young people with complicated PTSD presentations, including unaccompanied minors, drop-out rates have been noted to be low (Peltonen and Kangaslampi, 2019).”
BackgroundResultInfluentialGrainger, L., Thompson, Z., Morina, N., Hoppen, T., & Meiser‐Stedman, R. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22840 · Cited by 9 · see citing works
Lofthouse, K., Davies, A., Hodgekins, J., & Meiser‐Stedman, R. (2025) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2024.12.014 · Cited by 8 · see citing works
Middle eastern refugee children and adolescents mental health: A systematic review
O'leimat, A. S., Jones, C., & Hayter, M. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13088 · Cited by 10 · see citing works
Cobham, V. E., & McDERMOTT, B. M. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12475 · Cited by 8 · see citing works
Velu, M. E., Martens, I. J. M., Shahab, M. K., de Roos, C., Jongedijk, R. A., Schok, M., & Mooren, T. T. M. (2022) · Trials · doi:10.1186/s13063-022-06178-z · Cited by 9 · see citing works
“Previous studies with refugee children show large between-group effect sizes for PTSD symptom severity for KIDNET vs control group and EMDR vs control group [18, 20, 21, 25].”
BackgroundPhillips, A., Halligan, S. L., Bailey, M., Birkeland, M. S., Lavi, I., Meiser‐Stedman, R., Oram, H., Robinson, S., Sharp, T. H., & Hiller, R. M. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2415267 · Cited by 7 · see citing works
Adapting the protocol for narrative exposure therapy for adults with mild intellectual disabilities
Marlow, K., Schröder, T., Tickle, A., & Renton, J. (2022) · British Journal of Learning Disabilities · doi:10.1111/bld.12479 · Cited by 6 · see citing works
Ryan, G. T. (2023) · Child & Family Social Work · doi:10.1111/cfs.13035 · Cited by 4 · see citing works
Tian, M., Xing, Q., Wang, X., Yuan, X., Cheng, X., Ming, Y., Yin, K., Li, Z., & Wang, P. (2024) · Psychology Research and Behavior Management · doi:10.2147/prbm.s450083 · Cited by 2 · see citing works
“28 Despite their wide usage, linear mixed models have some limitations.”
Powell, K. M. (2024) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2024.2428182 · Cited by 4 · see citing works
“Retelling personal stories of adversity in ways that recall their strength and resilience as survivors can reduce anxiety and PTSD symptoms (Peltonen & Kangaslampi, 2019).”
Rocca, F., Schröder, T., Moghaddam, N. G., & Wilde, S. (2025) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-024-00681-y · Cited by 2 · see citing works
“…results are also consistent with the existing literature on NET face-to-face delivery and use with youth who experienced other types of traumatic events across different cultural contexts (Siehl et al., 2021), including those who experienced both refugeedoom and DV (Peltonen & Kangaslampi, 2019).”
Weber, C., Bazzi, O., Purper‐Ouakil, D., Fongaro, E., & Kerbage, H. (2025) · L Encéphale · doi:10.1016/j.encep.2025.02.006 · Cited by 3 · see citing works
Narrative Exposure Therapy (KIDNET)
Westby, C. E. (2020) · Word of Mouth · doi:10.1177/1048395020949087d · Cited by 2 · see citing works
“NET/KIDNET is proving to be a highly effective short-term therapy for reducing anxiety and PTSD symptoms in children and adults (Park et al., 2020; Peltonen & Kangaslampi, 2019), but children require a certain level of social-emotional and narrative skills to participate optimally.”
BackgroundTimariu, D., Hatton, T., McCook, K., Rohmann, A., & Tobierre, C. (2026) · The British Journal of Social Work · doi:10.1093/bjsw/bcag002 · Cited by 1 · see citing works
Ahmadi, S. J., Musavi, Z., Farhat, M. W., Mehry, S., McAvoy, D., Berzengi, A., Brown, A. D., Dainer‐Best, J., & Jobson, L. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2650894 · Cited by 1 · see citing works
“…al., 2023; King & Said, 2019; Rondung et al., 2022), eye movement desensitization and reprocessing (EMDR; Banoğlu & Korkmazlar, 2022; Kuiper & Uriakhel, 2020), writing for recovery (Kalantari et al., 2012), and narrative exposure therapy (KID-NET; Said et al., 2021; Peltonen & Kangaslampi, 2019).”
Lahtinen, O., Kangaslampi, S., Aalto, S., Soosalu, J., & Peltonen, K. (2024) · BMC Psychology · doi:10.1186/s40359-024-01752-3 · Cited by 1 · see citing works
Peltonen, K., Hakala, V., Laajasalo, T., Stenvall, E., Mielityinen, L., & Ellonen, N. (2024) · Young · doi:10.1177/11033088241282882 · Cited by 4 · see citing works
“Finally, individual traumatic events in war, often involving violence and some-times imprisonment, torture and various forms of abuse, have the potential to trau-matize individuals (Peltonen & Kangaslampi, 2019; Peltonen et al., 2014).”
Ryan, G. T. (2025) · Psychotherapy and Counselling Journal of Australia · doi:10.59158/001c.136978 · Cited by 1 · see citing works
Simmons, C. (2020) · UEA Digital Repository (University of East Anglia)
Li, H., Huang, T., Tan, S., Xie, S., Cheng, Q., Xiang, Y., & Zhou, X. (2021) · Research Square · doi:10.21203/rs.3.rs-745685/v1
Adapting the protocol for narrative exposure therapy for adults with mild intellectual disabilities
Marlow, K., Schroder, T. A., Tickle, A., & Renton, J. (2022) · FPID Bulletin The Bulletin of the Faculty for People with Intellectual Disabilities · doi:10.53841/bpsfpid.2022.20.3.66
EFFECTIVENESS OF USING NARRATIVE THERAPY WITH THE PURPOSE OF INCREASE RESILIENCE OF YOUTH
Miliutina, K. L., & Hudyr, D. V. (2022) · Habitus · doi:10.32782/2663-5208.2022.44.5
Psychological Interventions for Refugee Minors
Emmelkamp, P. M. G. (2023) · Springer eBooks · doi:10.1007/978-3-031-34078-9_8
Reimagining Narrative Approaches Through Comics for Systems-Involved Youth
España, K., Perris, G. E., Ngo, N. T., & Bath, E. P. J. (2023) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2023.11.006
Narrative Exposure Therapy for Children and Adolescents (KIDNET)
Schauer, M., Neuner, F., & Elbert, T. R. (2024) · Springer eBooks · doi:10.1007/978-3-031-77215-3_11
Mtati, C. N., Sorsdahl, K. R., & van der Westhuizen, C. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-104280
“19 23–31 A few studies have been conducted in SSA to evaluate the effectiveness and contextual relevance of adolescent PTSD interventions.”
Lange, B. C. L., Nelson, A. M., Lang, J. M., & Stirman, S. W. (2022) · Figshare · doi:10.6084/m9.figshare.21303044
Lange, B. C. L., Nelson, A. M., Lang, J. M., & Stirman, S. W. (2022) · Figshare · doi:10.6084/m9.figshare.21303050
Lange, B. C. L., Nelson, A. M., Lang, J. M., & Stirman, S. W. (2022) · Figshare · doi:10.6084/m9.figshare.21303047
Gillam, S., & Hyter, Y. (2026) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2025_persp-25-00073
Abreu, L., Beck, J., Hoeffler, A., Rockstroh, B. S., Sill, J., Schauer, M., Kaiser, E., Dohrmann, K., & Koebach, A. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14071-7
“NET was adapted for the special needs of children and adolescents [114, 115], perpetrators [84, 86, 116], communities [85, 117, 118] and online delivery [119, 120], and it is applicable and effective in a wide variety of samples without the need for further adaptation (see Box 1).”
A Narrative Inquiry of the Lived Experiences of Group Home Survivors and Trauma
Brown, T., & Maurya, R. K. (2026) · Qualitative Health Research · doi:10.1177/10497323261436964
(2026) · Wiley eBooks · doi:10.1002/9781394461691.refs
Velu, M. E., de Roos, C., van der Aa, N., Jongedijk, R. A., Lindauer, R., & Mooren, T. T. M. (2026) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-026-01118-0
“While existing studies have demonstrated symptom improvements in refugee children treated with EMDR or KIDNET [16–21, 24– 27 ], significant methodological”
Tawil, N. E., Awad, T., Rouhana, Y., Zalaket, N., & Rahme, E. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08487-y
“A total of 24 articles were included, comprising 7 primary studies [23, 24, 26–29, 37 ] and 17 secondary studies”
InfluentialJi, R., Li, J., He, Q., Yin, J., & Qu, Z. (2026) · Trauma Violence & Abuse · doi:10.1177/15248380261467491
- Authors
- Peltonen, K., & Kangaslampi, S.
- Affiliations
- Tampere University (FI)
- Corresponding author
- Peltonen, Kirsi
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2019-01-17
- Volume
- 10
- Issue
- 1
- Pages
- 1558708-1558708
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC6338259
- OpenAlex
- W2911031990
- Cited by
- 61
- References
- 48
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 13 · 2021: 4 · 2020: 9 · 2019: 4
- FWCI
- 8.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Kulttuurin ja Yhteiskunnan Tutkimuksen Toimikunta (#2501275804)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- narrative exposure therapy, post-traumatic stress disorder, children and adolescents, polytrauma, refugee children, domestic violence, resilience, psychological distress, usual care, feasibility, trauma-focused psychotherapy
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