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Randomised Controlled Study Comparing Two Psychological Therapies for Posttraumatic Stress Disorder (PTSD): Emotional Freedom Techniques (EFT) Vs. Narrative Exposure Therapy (NET)

Citation: Al-Hadethe, A., Hunt, N., Ghaffar, A., Thomas, S. Randomised Controlled Study Comparing Two Psychological Therapies for Posttraumatic Stress Disorder (PTSD):  Emotional Freedom Techniques (EFT) Vs. Narrative Exposure Therapy (NET). Journal of Traumatic Stress Disorders and Treatment, 4:4.

Abstract

Background: Post-Traumatic Stress Disorder (PTSD) is a common psychological reaction after traumatic events. The aim of this study was to evaluate the efficacy of Emotional Freedom Techniques (EFT) and Narrative Exposure Therapy (NET) as treatments for PTSD with traumatised people.

Methods: A randomized controlled trial design was used. Sixty Iraqi students were selected who met the DSM-IV PTSD criteria. Participants were male students who were aged between 16-19 years. Participants were randomly divided into three groups, with 20 participants in each group. Those in the EFT and NET groups received 4 therapy sessions, while the control group received no treatment. One person from the NET group withdrew. All participants were assessed on PTSD symptoms, anxiety and depression, social support.

Results: The results showed that the participants who received EFT reported a significant difference in all PTSD cluster at pre-test and post-test from T1 to T2 (p>0.05). However, although the NET group reported a significant difference between pre-test and post-test in avoidance and re-experience, no significant difference was found in hyper arousal (p<0.05). However, no significant differences were found in the experiential group with social support, coping strategies, and religious coping (p<0.05).

These changes of PTSD, PTSD clusters, anxiety and depression remained stable for 3, 6 and 12 month follow-ups in EFT group, while these changes were unstable during the follow-ups. Measures of coping strategies showed that seeking support and active coping improved since the interventions. In conclusion, both EFT and NET showed their effectiveness among traumatised Iraqi people.

Craig’s Notes

This study, conducted in Iraq, sought to examine the effectiveness of EFT and NET (Narrative Exposure Therapy) in decreasing symptoms of PTSD, depression and anxiety. The researchers looked at the two modalities’ immediate effects as well as those over time. The study also examined whether there was a change in social support and coping strategies after treatment with either modality.

The researchers note that despite the prevalence of PTSD in Iraq and three decades of traumatic events and war, that mental health services have been drastically reduced since the ‘80s. This has created a need for treatments and interventions for PTSD that don’t require long-term treatment facilitated by a qualified therapist. Both EFT and NET are low-cost, have been shown to be effective with short-term treatment, and do not require a highly trained professional to administer. Not noted in the study is that EFT can also be self-administered. Although both EFT and NET have been found to be effective in the treatment of PTSD, anxiety and depression, neither modality had been studied in Iraq – a place where there is great need for effective therapies for helping traumatized people.

The study took place over a two-month period, and was comprised of 60 secondary school students in Baghdad. All participants were male as it is difficult to obtain parental consent for females. Study participants were divided into two experimental groups and one control group. They were between 16-19 years old and all met the criteria for PTSD as measured by the Scale of Post-traumatic Stress Syndromes. All participants had similar levels of PTSD before any intervention was given.

Participants were randomly allocated into the three groups – one to receive EFT, one NET, and the other the control group. Those in the EFT and NET groups received four sessions lasting 60-90 minutes over a period of two weeks with 3-4 days between sessions. The control group received no treatment. All three groups were assessed post-treatment, in a six-month follow-up, and 12-month follow-up. A univariate analysis of covariance (ANCOVA) was used to analyze the changes from pre- to post-treatment while controlling for pre-treatment scores.

So, what were the results?

After initial treatment both the EFT and NET groups experienced significant reductions in PTSD symptoms, avoidance, hyper-arousal, re-experience, anxiety and depression. But no significant changes were found in coping strategies and social support.

When assessed over time, EFT was shown to have a more long-lasting effect that NET. The control group continued to show little change. When measured for active coping skills, the EFT group improved most dramatically over the course of the three follow-ups.

PTSD scores in both experimental groups at all post-tests were lower than at pre-test, while the scores of the control group actually increased at post-test. The NET group showed a significant decrease in avoidance and re-experience, but no difference was found in hyper-arousal, which researchers theorized could indicate that more than four sessions of NET are needed to reduce hyper-arousal symptoms.

The results over time put EFT slightly in the lead. The follow-up tests clearly indicated that EFT had a more long-lasting effect on reducing all symptoms than did NET. The researchers wondered if this may be specific to Iraqi culture where males prefer not to talk about their lives as is required in NET. With regard to reducing symptoms of anxiety and depression, EFT was also found to be significantly more effective than NET in the follow-up tests, and these reductions remained consistent over the 12 months. In fact, anxiety and depression symptoms actually increased for the NET group between 3 and 12 months. No changes in anxiety and depression were found in the control group. Significant improvements in coping strategies were found in both the EFT and NET groups.

Although this study was performed exclusively with secondary school males, researchers postulate that the two therapies could be equally effective for females, and that they could well help traumatized people of Iraq of all ages. They suggest there could be a great benefit in establishing PTSD centers throughout the city of Baghdad where both therapies could be offered to traumatized people.