Empowering narratives: aid to self-help for Ukrainian refugees: a randomized controlled trial of Narrative Exposure Therapy (NET) delivered by supervised Ukrainian health workers in Norway

Abstract

Background: The Russian invasion of Ukraine has resulted in forced displacement, with over six million Ukrainian refugees across Europe, of whom 81,770 are residing in Norway. This displacement and, in many cases, preceding war experiences, has led to increased vulnerability to trauma and mental health challenges. There is to date little knowledge about the extent to which structured mental health interventions can mitigate symptoms in Ukrainian refugees. Narrative Exposure Therapy (NET), a short-term trauma-focused intervention, has demonstrated efficacy in reducing post-traumatic stress disorder (PTSD), depression and dissociation symptoms among individuals exposed to organized violence and war. Aim: The protocol aims to assess the clinical effects of NET on PTSD, dissociation, and depression symptoms among Ukrainian refugees in Norway and to facilitate training and supervised praxis for Ukrainian health professionals in using NET. Methods: This study employs a pretest-posttest randomized controlled experimental design (RCT). Ukrainian health workers in Norway will receive a total of 450 hours of NET training through an online course. As a part of the training, they will, under supervision, administrate NET to Ukrainian refugees. Participants will be screened and assessed at three time points: baseline, immediately after treatment, and at a 6-month follow-up. Validated instruments in Ukrainian and Russian will be used to assess trauma experiences, symptoms, and comorbidities. Exclusion criteria: active psychotic spectrum disorders, neurodevelopmental disorders and concurrent trauma therapy. The study also contains an embedded qualitative sub study that will involve phronetic iterative thematic analysis of anonymized therapy narratives collected during NET sessions, aiming to understand how participants construct meaning from traumatic events, how narrative coherence evolves throughout therapy, and how identity reconstruction occurs post-trauma. Trial registration:ClinicalTrials.gov identifier: NCT07062042.