According to a study of JAMA, (August 3 theme issue on violence and human rights) former child soldiers from Northern Uganda who underwent a short-term trauma-focused intervention showed a greater reduction of symptoms of post-traumatic stress disorder than soldiers who received other therapy.

Current estimates state that approximately 250,000 children under the age of 18 are currently active as child soldiers in hostilities in 14 countries or territories worldwide. The Northern Uganda civil war lasted over 2 decades and has virtually affected the entire population.

According to background information in the article:

"The Northern Ugandan communities have been confronted with large numbers of formerly abducted children, adolescents, and young adults returning after their rescue, flight, or release throughout the war and thereafter. The successful reintegration of these former child soldiers continues to be a major challenge. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers."

Verena Ertl, Ph.D., of Bielefeld University, Bielefeld, Germany, and her fellow researchers conducted a randomized controlled trial testing the feasibility and effectiveness of narrative exposure therapy for treating former child soldiers with posttraumatic stress disorder (PTSD).

Narrative exposure therapy (NET) is a short-term treatment for trauma victims developed for use in low-resource countries affected by crisis and war. NET enables participants to recollect details of their traumatic and often fragmented experiences in cooperation with a therapist who reconstructs their memories of traumatic events to achieve habituation. The trial consisted of 85 former child soldiers between the ages of 12 to 25 with PTSD from a population-based survey of 1,113 Northern Ugandans and was conducted in internal displacement camps between November 2007 and October 2009.

Participants were randomly split into 1 of 3 groups consisting of narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28) with treatments carried out in 8 sessions by trained local lay therapists in their respective communities.

The symptoms of PTSD, depression, and related impairment were evaluated before treatment commenced and at 3 months, 6 months, and 12 months post-intervention using various analytic tools. Researchers discovered that the severity of PTSD symptoms improved significantly more in the NET group compared to the academic catch-up and waiting-list groups.

During one measure of clinically significant change, 80% (20 of 25 participants) in the NET group had reduced the severity of their PTSD.

The authors wrote:

"In the academic catch-up and waiting-list conditions, 11 of 23 (47.8%) and 14 of 28 (50%), respectively, showed clinically relevant improvement. Subgroup comparisons revealed that improvement was significantly greater in the narrative exposure therapy group vs. the academic catch-up group and the narrative exposure therapy vs. the waiting-list groups."

After 12 months of trial, 68% of NET participants, 52.2% of academic catch-up participants, and 53.6% of waiting-list participants no longer fulfilled criteria for PTSD. The 12-month follow up revealed that NET participants experienced a larger within-treatment effect of 51.6% of reducing the severity of PTSD compared to 30.9% of the academic catch-up group and 30.4% of the waiting list group.

The Researchers stated:

"Moreover, results indicated that there were additional positive effects of treatment on associated problems not primarily targeted, such as depression, suicidal ideation, feelings of guilt, and important indicators of readjustment such as stigmatization and functioning."

The author concludes that the results of this study indicate that community-based lay therapists without a mental health or medical background can apply narrative exposure therapy successfully.

Grace Rattue