title: Narrative exposure therapy for posttraumatic stress disorder associated with repeated interpersonal trauma in patients with severe mental illness: a mixed methods design.
abstract: BACKGROUND
  In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients.
  
  
  OBJECTIVE
  The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients' experiences with NET and to identify influencing factors on treatment results.
  
  
  METHODS
  This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes.
  
  
  CONCLUSIONS
  The results of this study will provide more insight into influencing factors for clinical changes in this population.
authors.affiliation: GGNet Mental Health Care Center, Warnsveld, The Netherlands.|Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; M.mauritz@ggnet.nl.
authors.forename: Maria W
authors.initials: MW
authors.lastname: Mauritz
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
authors.forename: Betsie G I
authors.initials: BG
authors.lastname: Van Gaal
authors.affiliation: Foundation Centrum '45, Oegstgeest, The Netherlands.|Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Ruud A
authors.initials: RA
authors.lastname: Jongedijk
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.|Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.|Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, The Netherlands.|University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University Ghent, Belgium.|GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands.
authors.forename: Peter J J
authors.initials: PJ
authors.lastname: Goossens
keywords: Physical abuse; flexible assertive community treatment; in-depth interview; mixed methods; mood disorder; personality disorder; posttraumatic stress disorder; repeated measures; schizophrenia; sexual abuse