Testimony method to ameliorate post-traumatic stress symptoms: Community-based intervention study with Mozambican civil war survivors

Correspondence: Victor Igreja, c/o Wim Kleijn, Centrum ‘45, Rijnzichtweg 35, 2342 AX Oegstgeest, The Netherlands. Tel: [phone]; e-mail: [email protected]

Declaration of interest

None. This study was partly funded by Associação Esperanc a Para Todos, Mozambique.

A literature review of 135 epidemiological studies on the prevalence of post-traumatic stress disorder (PTSD) showed that only 6% were situated in developing countries (de Girolamo & McFarlane, 1996). The recent history of Mozambique is characterised by almost three decades of war, and a recent study showed that 5 years after this war 63% of the study participants suffered from high levels of psychiatric symptoms (Schreuder et al, 2001). Governmental authorities in post-conflict countries in Africa, along with the World Health Organization, regularly address these problems but there are almost no studies on the merits of interventions aimed at the post-traumatic symptoms among this population (World Health Organization, 2002). In circumstances where scarcity of mental health care resources is the rule, the testimony method of psychotherapy potentially could be valuable. The testimony method is a variant of a trauma exposure technique and it is relatively easy to master, is brief and does not require sophisticated materials. Trauma survivors are invited to tell the story of their traumatic experiences and, together with the interviewer, they create a narrative document of these experiences (Weine et al, 1998). The act of constructing a coherent trauma story helps the survivor to function. The method has been used with survivors of state-sponsored violence in particular (Cienfuegos & Monelli, 1983; Weine et al, 1998). The literature on similar exposure treatment techniques applied with other types of trauma victims shows effectiveness in ameliorating PTSD (Foa et al, 1995; Van der Kolk et al, 1996). The objectives of this study were to examine the effectiveness of the testimony method in reducing post-traumatic stress symptoms in survivors of civil war and to examine the feasibility of the testimony method in a rural, impoverished, war-stricken African population.

METHOD

General procedure

This study, to evaluate the effectiveness of the testimony method, was an extension of a previous investigation in rural and central Mozambique into how survivors dealt with the memories of the civil war (Schreuder et al, 2001). To introduce the study, public...