Volume 23, Issue 3 (7-2026)                   | Back to browse issues page

Ethics code: IR.IAU.AHVAZ.REC.1403.381


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Karimpour S, Safarzadeh S, Farashbandi A, Hafezi F. The Effectiveness of Narrative Exposure Therapy and Meta-Emotional Psychotherapy on Symptom Severity in Individuals with Complex Post-Traumatic Stress Disorder. Mod Care J 2026; 23 (3) :38-46
URL: http://mcj.bums.ac.ir/article-1-624-en.html
1- Department of Psychology, Ahv.C., Islamic Azad University, Ahvaz, Iran
2- Department of Psychology, Ahv.C., Islamic Azad University, Ahvaz, Iran , safarzadesa@gmail.com
Abstract:   (200 Views)
Introduction: Complex post-traumatic stress disorder (CPTSD) is characterized by core PTSD symptoms alongside disturbances in self-organization (DSO), arising from prolonged or repeated trauma. Narrative exposure therapy (NET) targets traumatic memory integration through chronological narration, while meta-emotional psychotherapy (MEP) focuses on regulating secondary (meta-)emotional processes to improve emotional awareness and self-organization.
Objectives: This randomized clinical trial aimed to compare the efficacy of NET and MEP on symptom severity in individuals with CPTSD.
Methods: Using a pretest–posttest and three-month follow-up design, 45 participants in Ahvaz, Iran (2025) were recruited via convenience sampling and randomly assigned to NET (n = 15), MEP (n = 15), or a wait-list control group (n = 15). Both intervention groups received 14 weekly 90-minute sessions delivered by a trained psychotherapist following structured protocols. Data were analyzed using repeated-measures ANOVA with Bonferroni post hoc tests in SPSS (version 26). Symptom severity was assessed with the International Trauma Questionnaire (ITQ).
Results: Repeated measures ANOVA revealed significant group × time interactions for all symptom domains (all p < 0.001, with large effect sizes, partial η² ranging from 0.47 to 0.79). Both NET and MEP significantly reduced overall symptom severity compared to the control group (p < 0.001). No significant differences were found between NET and MEP in total CPTSD symptom severity (p > 0.05). NET showed greater reductions in re-experiencing symptoms, whereas MEP demonstrated superior effects on affective dysregulation and DSO.
Conclusion: Both NET and MEP effectively reduced CPTSD symptoms, with differential strengths aligning with their theoretical mechanisms. However, given the small sample size and convenience sampling, findings should be interpreted cautiously and require replication in larger, rigorously controlled trials.
Full-Text [PDF 574 kb]   (122 Downloads)    
Article Types: Research Article | Subject: General
Received: 2026/02/21 | Accepted: 2026/08/1 | Published: 2026/08/11

References
1. Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, et al. Complex post-traumatic stress disorder. Lancet. 2022 Jul;400(10345):60-72. [PMID: 35780794]. [DOI:10.1016/S0140-6736(22)00821-2]
2. Li D, Luo J, Yan X, Liang Y. Complex Posttraumatic Stress Disorder (CPTSD) as an Independent Diagnosis: Differences in Hedonic and Eudaimonic Well-Being between CPTSD and PTSD. Healthcare (Basel). 2023 Apr;11(8):1188. [PMID: 37108021]; [PMCID: PMC10137946]. [DOI:10.3390/healthcare11081188]
3. Billings J, Nicholls H. PTSD and complex PTSD, current treatments and debates: a review of reviews. Br Med Bull. 2025 Sep;156(1): ldaf015. [PMID: 41004137]; [PMCID: PMC12466117]. [DOI:10.1093/bmb/ldaf015]
4. Bagheri Sheykhangafshe F, Fathi-Ashtiani A, Savabi Niri V, Jahani Zangir M, Bourbour Z. Efficacy of Internet-based Cognitive Behavioral Therapy for Mental Health, Post-traumatic stress disorder, and obsessive-compulsive disorder in Students with COVID-19 Anxiety. Mod Care J. 2023;20(2): e131399. [DOI: 10.5812/modernc-131399]. [DOI:10.5812/modernc-131399]
5. Gai Y, Berle D. The Association of Posttraumatic Stress Disorder, Complex Posttraumatic Stress Disorder and Depression: A Network Approach. Clin Psychol Psychother. 2025;32(4): e70125. [PMID: 40678969]; [PMCID: PMC12272819]. [DOI:10.1002/cpp.70125]
6. Kinley JL, Reyno SM. The relationship between Complex PTSD symptoms and functional impairment in individuals with attachment trauma and comorbid mental illness. Eur J Trauma Dissociation. 2025 Sep;9(3):100565. [DOI:10.1016/j.ejtd.2025.100565]
7. Guzman Torres E, Krause-Utz A, Sack M. Predictors of complex PTSD: the role of trauma characteristics, dissociation, and comorbid psychopathology. Bord. personal. disord. emot. dysregul. 2023 Jan;10(1):1. [PMID: 36600291]; [PMCID: PMC9814348]. [DOI:10.1186/s40479-022-00208-7]
8. Simon JJ, Spiegler K, Coulibaly K, Stopyra MA, Friederich HC, Gruber O, et al. Beyond diagnosis: symptom patterns across complex PTSD and borderline personality disorder. Front Psychiatry. 2025 Oct; 16:1668821. [PMID: 41244875]. [DOI:10.3389/fpsyt.2025.1668821]
9. Jongedijk RA. Narrative exposure therapy: an evidence-based treatment for multiple and complex trauma. Eur J Psychotraumatol. 2014 Dec; 5:26522. [PMID: 25511727]; [PMCID: PMC4265174]. [DOI:10.3402/ejpt.v5.26522]
10. Lely JCG, Smid GE, Jongedijk RA, W Knipscheer J, Kleber RJ. The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. Eur J Psychotraumatol. 2019Mar;10(1):1550344. [PMID: 31007868]; [PMCID: PMC6450467]. [DOI:10.1080/20008198.2018.1550344]
11. Hoeboer C, Wienen L, Smiddy M, van der Werff S, Maric M, Tjoa E, et al. Effectiveness of Narrative Exposure Therapy for Treatment of PTSD Following Childhood Trauma: A Single-Case Series Design. Clin Psychol Psychother. 2024 Sep;31(5): e3044. [PMID: 39210631]. [DOI:10.1002/cpp.3044]
12. Wei Y, Chen S. Narrative exposure therapy for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Psychol Trauma. 2021;13(8):877-84. [PMID: 33617284]. [DOI:10.1037/tra0000922]
13. Norman E, Furnes B. The Concept of "Metaemotion": What is There to Learn From Research on Metacognition? Emot Rev. 201 Apr6;8(2):187-93. 10.1177/1754073914552913. [DOI:10.1177/1754073914552913]
14. Frost G, Strodl E, Akosile W. Meta-emotion therapy for complex trauma and binge eating: A case study. Psychol Trauma. 2025 May;17(4):904-11. [PMID: 38497745]. [DOI: 10.1037/tra0001675]. [DOI:10.1037/tra0001675]
15. Bahri F, Ghanadzadegan HA, Fakhri MK. Comparative Effects of Meta-diagnostic and Self-compassion-based Psychotherapies on Positive Metaemotions in Generalized Anxiety Disorder (GAD) Patients. Avicenna J Neuro Psycho Physiology. 2024 Nov ;11(4):181. [DOI:10.32592/ajnpp.2024.11.4.181]
16. Fouladi A, Khademi A, Shaker DA. The effectiveness of compassion therapy and meta-cognitive therapy on the level of nurses' meta-emotion. Journal of J Res Psychopathol. 2023;4(11):23-32.[DOI: 10.22098/jrp.2022.11300.1131].
17. Schauer M, Neuner F, Elbert T. Narrative Exposure Therapy (NET): A Short-Term Treatment for Traumatic Stress Disorders. 2nd ed. Cambridge: Hogrefe Publishing; 2011. 118 p. ISBN: 9781616763886. [Link].
18. Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol.2014 Sep;5(1):25097. [PMID: 25279111]; [PMCID: PMC4165723]. [DOI:10.3402/ejpt.v5.25097]
19. Ghabeshi MB, Bijari AF, Dehshiri G, Mehrinejad SA. Psychometric properties of the persian version of international trauma questionnaire (ITQ) in Iranian women. J of Psychological Science. 2022;20(108):2181-94. [DOI:10.52547/JPS.20.108.2181]
20. Julian JM, Held JI, Hixson K, Conn BM. The Implementation of Narrative Exposure Therapy (NET) for Transgender and Gender Diverse Adolescents and Young Adults. J Child Adolesc Trauma. 2023 Mar;16(3):1-10. [PMID: 37359461]. [DOI:10.1007/s40653-023-00530-4]
21. Park JK, Park J, Elbert T, Kim SJ. Effects of Narrative Exposure Therapy on Posttraumatic Stress Disorder, Depression, and Insomnia in Traumatized North Korean Refugee Youth. J Trauma Stress. 2020 Jun;33(3):353-9. [PMID: 32216143]. [DOI:10.1002/jts.22492]
22. Raghuraman S, Stuttard N, Hunt N. Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base. Clin Psychol Psychother. 2021;28(1):1-23. [PMID: 32525597]. [DOI:10.1002/cpp.2486]
23. Buyukoksuz E, Giray G. Metacognitive therapy in post-traumatic stress disorder: A meta- analysis. Dusunen Adam. 2024 Mar;37(1):44-53. [PMID: 42459905]. [DOI:10.14744/DAJPNS.2024.00236]
24. Wells A, Sembi S. Metacognitive therapy for PTSD: A core treatment manual. Cogn. Behav. Pract. 2004 Sep;11(4):365-77. [DOI:10.1016/S1077-7229(04)80053-1]
25. Esteki Azad N, Golparvar M, Sajjadian I. The Effectiveness of Filial Therapy and Cognitive-Behavioral Art-Play on Meta-emotion View of Mothers of Single-parent Children During Coronavirus Quarantine. J Research Health. 2022;12(2):121-130. [DOI:10.32598/JRH.12.2.119.3]

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