title: Dissemination of psychotherapy for trauma spectrum disorders in postconflict settings: a randomized controlled trial in Rwanda.
abstract: BACKGROUND
  Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. We tested a train-the-trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD).
  
  
  METHODS
  We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET) treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/NET-2, n = 38). Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at 3- and 12-month follow-ups.
  
  
  RESULTS
  At the 3-month follow-up, the NET-1 participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1 were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with an effect size of Cohen's d = 1.37 at the 12-month follow-up.
  
  
  CONCLUSIONS
  A TTT model of PTSD treatment dissemination can be effective in resource-poor postconflict societies.
authors.affiliation: University of Konstanz, Konstanz, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Jacob
authors.forename: Frank
authors.initials: F
authors.lastname: Neuner
authors.forename: Anna
authors.initials: A
authors.lastname: Maedl
authors.forename: Susanne
authors.initials: S
authors.lastname: Schaal
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
mesh_terms: D000328:Adult; D054540:Child, Orphaned / Q000523:psychology; D005260:Female; D063365:Genocide / Q000523:psychology; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D062525:Narrative Therapy / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012432:Rwanda; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D040921:Stress Disorders, Traumatic / Q000523:psychology / Q000628:therapy*; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult