Assessing autonomic nervous system via heart rate variability to measure responses during trauma-focused Narrative Exposure Therapy sessions: Protocol of a pretest-posttest quasi-experimental feasibility study

Abstract Background The Russian invasion of Ukraine has led to repercussions, including the displacement of people, challenges to physical and mental health, and strains on health systems across Europe. Narrative Exposure Therapy as an evidence-based method aims to mitigate Posttraumatic Stress Disorder and its comorbidities; the physiological mechanisms underlying its results remain unexplored. Heart rate variability provides a non-invasive method to examine autonomic responses during therapy, offering insights into therapeutic outcomes and attitudes toward violence. The overall aim of the study is to assess the effectiveness of Narrative Exposure Therapy by examining biological biomarkers. Methods This study will involve Ukrainian refugees residing in Norway who meet the inclusion criteria. Eligible participants will engage in six to eight individual sessions of Narrative Exposure Therapy. During these therapy sessions, heart rate variability will be continuously monitored using commercially available Polar devices equipped with a chest strap. This data will be gathered to evaluate therapeutic outcomes. Primary objectives of the study are: (I) Compare pre- and post-treatment screening results to measure the effectiveness of Narrative Exposure Therapy in reducing symptoms of Posttraumatic Stress Disorder, depression, and dissociation six months post conclusion of the therapy amongst Ukrainian refugees in Norway; (II) Utilize biofeedback as an outcome measure to assess therapy functioning during exposure sessions in Narrative Exposure Therapy. Secondary objective: (III) Develop a comprehensive plan for providing mental health support to refugees arriving in Norway, aiming to mitigate trauma triggered by the consequences of the exposure to the Russian invasion. Conclusion This pretest-posttest quasi-experimental feasibility study aims to evaluate the use of biological feedback in measuring the effectiveness of narrative exposure therapy. The findings will help determine the feasibility of this approach, potentially informing the design and implementation of future randomized control trials. Trial registration: The trial is registered in the Regional Committees for Medical and Health Research Ethics under the reference number 588073, and in the Norwegian Agency for Shared Services in Education and Research under the reference number 662949.