Improving post-traumatic stress symptoms in homeless-experienced women using narrative exposure therapy: a single-arm, open pilot study

Background: Homeless-experienced women face disproportionately high rates of trauma exposure and posttraumatic stress disorder (PTSD) compared to the general population. Despite this, there is little research into the effectiveness of accessible, trauma-focused interventions for this population.Objective: This pilot study sought to determine the feasibility and preliminary effects of Narrative Exposure Therapy (NET) on PTSD and co-occurring mental health symptoms in homeless-experienced women.Methods: We conducted a single-arm, open pilot study of NET with 53 women in three urban women’s homelessness organisations. Feasibility was assessed via intervention and study protocol completion rates. We used linear mixed effects models and effect size metrics to analyse pre – to post-NET changes and strength in effects in primary (PTSD, PCL-5) and secondary outcomes variables (depressive symptoms, PHQ-9; anxiety, GAD-7; somatisation, SSS-8) in all participants who completed NET.Results: Fifty-three women began the NET protocol; 43 completed at least one outcome measurement, and 36 of these women completed the full protocol (81% treatment completion rate, 68% study protocol completion rate). We observed significant symptom reductions in all measured symptom domains one-week post-NET. Participants showed large changes in PTSD symptoms (PCL-5 change: 20.8 points, p < .001, d = 0.9) and medium changes in depressive symptoms (PHQ-9 change: 3.1 points, d = 0.57), anxiety (GAD-7 change: 3.8 points, d = 0.7), and somatisation (SSS-8 change: 3.7 points, d = 0.49).Conclusions: NET may be a feasible and clinically pragmatic intervention for reducing PTSD and co-occurring mental health symptoms in HEW. A fully powered, randomised trial to evaluate NET in this population is necessary to definitively determine intervention effects.