Efficacy and cultural adaptions of narrative exposure therapy for trauma-related outcomes in refugees/asylum-seekers: A systematic review and meta-analysis

Refugees/asylum-seekers are more likely to have experienced traumatic events than the general population in high-income countries. Narrative Exposure Therapy (NET) was developed to treat trauma within this population. This review aimed to determine (1) the efficacy of NET and (2) if the interventions have been successfully culturally adapted. Databases were searched from January 2002 to September 2020, for peer-reviewed randomised controlled trials (RCT) of NET published in English, involving adult refugees/asylum-seekers with any trauma disorder, resettled in high-income countries. Data were extracted and risk of bias assessed using the Cochrane data collection forms, and meta-analyses were conducted for depression and trauma symptom change. Cultural adaptations were assessed using a structured framework. Six RCTs (total  n=   272) met eligibility criteria. All reported significant reductions in trauma symptoms in the NET group but only two studies found a significant reduction in depression symptoms. Meta-analyses showed medium-large between-groups effect sizes in favour of NET (depression −0.59 [−1.07, −0.11]; trauma −0.75 [−1.19, −0.31]), with substantial heterogeneity. The most common cultural adaptations were in language and context. NET was shown to be a potentially beneficial intervention for treating trauma-related outcomes. However, studies should be more transparent regarding any attempts to make interventions more culturally appropriate.