Role of baseline emotion dysregulation and perceived daily stress in adherence to and completion of narrative exposure therapy among forced migrants

Abstract

Background: Forced migrants are at risk of developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an empirically supported treatment for forced migrants with PTSD. However, multiple barriers can make it difficult for them to consistently engage in and complete mental health treatment. Identifying factors contributing to the feasibility of NET could enhance its treatment outcomes. Objectives: The first aim was to examine whether baseline levels of perceived daily stress and emotion dysregulation were associated with NET completion. The second aim was to test whether these baseline measures were associated with NET adherence, while considering pretreatment PTSD symptom severity. In this study, completion was defined as having completed the full treatment protocol, while adherence was defined as the total number of attended treatment sessions relative to the total number of planned sessions. Method: An uncontrolled observational study was conducted at an outpatient mental health clinic. Treatment-seeking forced migrants (N = 86, 59% identifying as women, age range 19–63 years) with PTSD were monitored while engaging in NET. Pretreatment measures were considered as indicators: a perceived stress scale, difficulties in emotion regulation scale, and a PTSD checklist. Information on NET session attendance, treatment protocol adherence, and completion was derived from medical records. Analyses were carried out using logistical and hierarchical regression analysis. Results: First, baseline levels of perceived daily stress and emotion dysregulation were not found to be associated with NET completion rates. Secondly, baseline perceived daily stress scores were significantly associated with treatment adherence, although not when controlling for baseline PTSD symptom severity. Overall, NET adherence could not be attributed to baseline measures. Conclusions: The lack of significant findings could be due to the limited sample size or methodological choices. Alternative factors impacting NET treatment completion and session adherence could be considered for future research.