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Effects of Narrative Exposure Therapy for Treating Depressive and Anxious Disorders: A Systematic Review and Meta-Analysis

Geng, Chen, Zhang, Miao, Zhang, Lily, Yin, Hai, Wang, Suyun·2024·Psychiatry Investigation
DOI 10.30773/pi.2023.0281PMC PMC11065527
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Abstract

Objective Narrative exposure therapy (NET) has been used in various contexts for the treatment of the effects of trauma, with promising results in clinical trials. However, its effects on anxiety and depression are still unclear. The present study is a systematic review and meta-analysis of the effects of NET on depression and anxiety.Methods The Embase, Cumulative Index of Nursing and Allied Health Literature, PubMed, Web of Science core collection, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and Wangfang databases were searched from the earliest records to March 2023. Two researchers independently screened the literature, extracted data, evaluated the risk of bias, and cross-checked the data. Meta-analysis was performed using the program RevMan 5.3.Results Eleven randomized controlled trials with a total of 754 participants were included in the study. The results showed that NET reduced both the depression (standard mean difference [SMD]=-0.51, 95% confidence interval [CI] -0.73–-0.29, p<0.00001) and anxiety (SMD=-0.65, 95% CI -1.13–-0.18, p=0.007) scores of the patients. Furthermore, NET was found to alleviate negative emotions associated with guilt (mean difference [MD]=-3.60, 95% CI -5.52–-1.68, p=0.0005) and negative change (MD=-5.80, 95% CI -9.76–-1.83, p=0.004).Conclusion This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients’ negative feelings and aid their overall recovery.

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Figures

Figure 1. PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.
Figure 1. PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.CC BY-NC · PubMed Central
Figure 2. Quality appraisal of the included studies. Two researchers independently classified each quality issue as low, high, or uncertain, using the Cochrane risk-of-bias criteria for the included RCTs. Green indicates low, and yellow indicates uncertain. RCTs, randomized controlled trials.
Figure 2. Quality appraisal of the included studies. Two researchers independently classified each quality issue as low, high, or uncertain, using the Cochrane risk-of-bias criteria for the included RCTs. Green indicates low, and yellow indicates uncertain. RCTs, randomized controlled trials.CC BY-NC · PubMed Central
Figure 3. The influence of NET on depression. Significant differences were found between the NET and control groups (SMD -0.51, 95% CI -0.73–-0.29, I2=50% p<0.0001), with 11 RCTs involving 754 patients reporting improvement in depressive symptoms. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; SMD, standard mean difference; RCTs, randomized controlled trials.
Figure 3. The influence of NET on depression. Significant differences were found between the NET and control groups (SMD -0.51, 95% CI -0.73–-0.29, I2=50% p<0.0001), with 11 RCTs involving 754 patients reporting improvement in depressive symptoms. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; SMD, standard mean difference; RCTs, randomized controlled trials.CC BY-NC · PubMed Central
Figure 4. The influence of NET on depression (subgroup analysis). The data were divided into subgroups based on the length of patient follow-up. Seven RCTs involving 446 patients reported improvement in depressive symptoms at ≤1 month of follow-up; three RCTs involving 198 patients assessed 1–3 months of follow-up; four RCTs involving 301 patients assessed 3‒6 months of follow-up; two RCTs involving 126 patients assessed 6–12 months of follow-up. No significant differences were observed in the improvement in depressive symptoms between the narrative medicine and control groups at 1–6 months follow-up, whereas singificant differences were observed at less than 1 month and 6–12 months of follow-up. The total heterogeneity I2 was reduced to 41%. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCTs, randomized controlled trials.
Figure 4. The influence of NET on depression (subgroup analysis). The data were divided into subgroups based on the length of patient follow-up. Seven RCTs involving 446 patients reported improvement in depressive symptoms at ≤1 month of follow-up; three RCTs involving 198 patients assessed 1–3 months of follow-up; four RCTs involving 301 patients assessed 3‒6 months of follow-up; two RCTs involving 126 patients assessed 6–12 months of follow-up. No significant differences were observed in the improvement in depressive symptoms between the narrative medicine and control groups at 1–6 months follow-up, whereas singificant differences were observed at less than 1 month and 6–12 months of follow-up. The total heterogeneity I2 was reduced to 41%. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCTs, randomized controlled trials.CC BY-NC · PubMed Central
Figure 5. The influence of NET on anxiety. Seven RCTs, including 493 participants, found that those receiving NET had fewer anxiety symptoms than those receiving a control treatment. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCTs, randomized controlled trials.
Figure 5. The influence of NET on anxiety. Seven RCTs, including 493 participants, found that those receiving NET had fewer anxiety symptoms than those receiving a control treatment. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCTs, randomized controlled trials.CC BY-NC · PubMed Central
Figure 6. The influence of NET on anxiety (after removal of 1 RCT). After a sensitivity analysis, the results were stable, with I2 reduced to 38% when one RCT was excluded. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCT, randomized controlled trial.
Figure 6. The influence of NET on anxiety (after removal of 1 RCT). After a sensitivity analysis, the results were stable, with I2 reduced to 38% when one RCT was excluded. SD, standard deviation; CI, confidence interval; NET, narrative exposure therapy; RCT, randomized controlled trial.CC BY-NC · PubMed Central

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Metadata

Authors
Geng, C., Zhang, M., Zhang, L., Yin, H., & Wang, S.
ORCID
Venue
Psychiatry Investigation
Publisher
Korean Neuropsychiatric Association
Published
2024-04-25
Volume
21
Issue
4
Pages
329-339
ISSN
  • 1738-3684
  • 1976-3026
DOI
10.30773/pi.2023.0281
PMC
PMC11065527
Cited by
6
References
7
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (tdm)

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Geng, C., Zhang, M., Zhang, L., Yin, H., & Wang, S. (2024). Effects of Narrative Exposure Therapy for Treating Depressive and Anxious Disorders: A Systematic Review and Meta-Analysis. Psychiatry Investigation. https://doi.org/10.30773/pi.2023.0281