Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial

Clinical Snapshot

Key Findings

• P Value: p < .001 for clinician-assessed PTSD improvements; p = .006 for self-reported PTSD improvements

• Effect Size: Large within-group improvements: STAIR-R + NET g = -1.41; SPS + NET g = -1.54

• Primary Outcome: No significant between-group differences in clinician-assessed PTSD symptoms (CAPS-5) at any timepoint

• Nnt Or Sensitivity: Not calculable from available data - no between-group differences detected

• Confidence Interval: Not reported in abstract

Clinical Application

Both interventions require 13 sessions total, feasible in specialist trauma services with appropriately trained clinicians Highly relevant to Australian refugee mental health services. Both interventions could be considered for PBS-subsidised psychological therapy programs. Aligns with RACGP guidelines for trauma-informed care in refugee populations Refugees with PTSD in Australian healthcare settings, particularly those with varying levels of visa and family security

Abstract

Background: Responses to evidence-based interventions for posttraumatic stress disorder (PTSD) in refugees vary considerably. Emotion regulation difficulties are associated with greater PTSD severity in refugees and thus represent a potential treatment target.Objective: This study aimed to test the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) and Narrative Exposure Therapy (NET) or Supportive Problem-Solving (SPS) and NET. An exploratory aim was to examine relative efficacy in refugees with high and low levels of visa and family insecurity.Methods: Seventy-one participants were randomly assigned to STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) +NET (7 sessions). Assessments occurred at baseline, post-treatment, and 3-month follow-up, with additional self-report at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5) and secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, difficulties in relationships and environmental quality of life.Results: Intent-to-treat linear mixed models showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both groups demonstrated significant improvements at 3-month follow-up in clinician-assessed (STAIR-R + NET, g = -1.41; SPS + NET, g = -1.54, p < .001) and self-reported (STAIR-R + NET, g = -0.49; SPS + NET, g = -0.44, p = .006) PTSD symptoms. Moderatorg analyses revealed that those with high insecurity (n = 16) obtained greater benefits in STAIR-R + NET from pre-treatment to follow-up on self-reported PTSD (g = 1.35), depression (g = 1.11), emotion regulation difficulties (g = 1.24), relationship difficulties (g = 1.12) and quality of life (g = -1.05).Conclusions: While there were no overall between group-differences, refugees in both conditions showed reduced PTSD symptoms. There is preliminary evidence that those with high insecurity showed a better response to STAIR-R + NET than SPS + NET across several clinical outcomes, although the small sample size necessitates replication of these. These findings highlight the potential importance of tailored intervention approaches for refugees living in different environmental circumstances. Emotion regulation difficulties represent a promising treatment target for refugees with PTSD.A randomized controlled trial comparing Skills Training in Affective and Interpersonal Regulation for Refugees + Narrative Exposure Therapy (STAIR-R + NET) to Supportive Problem Solving Training + Narrative Exposure Therapy (SPS + NET) revealed no significant differences at 3-month follow-up, with both groups improving on PTSD symptoms.Moderator analyses provided preliminary evidence that refugees living with high insecurity (i.e. insecure visa or separated from all family) showed greater improvements following STAIR-R + NET than SPS + NET.

References

1. 1.Nickerson, A., Cloitre, M., Neuner, F., O'Donnell, M., Bryant, R. A., Liddell, B. J., Tissue, A., Murphy, S., Willoughby, C., Hoffman, J., Byrow, Y., Uppal, S., Mastrogiovanni, N., Peach, N., Funnell, S., Mai, V., Gurzeda, M., Im, J. J. Y., Al-Damook, G., Mozayani, F., Yacoub, R., & Specker, P. (2026). Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial. European Journal of Psychotraumatology. https://doi.org/10.1080/20008066.2026.2648941