Styrkende Narrativ: Hjelp Til Selvhjelp for Ukrainske Flyktninger / Empowering Narratives: Help to Self-help to Ukrainian Refugees
Phase: NA
Conditions: PTSD - Post Traumatic Stress Disorder, Depression Disorders, Dissociation, Refugee
Sponsor: Kristiania University College

Research Protocol Cover Page 
 
Official Study Title: 
Empowering Narratives: Aid to Self-help for Ukrainian Refugees 
A Randomized Controlled Trial of Narrative Exposure Therapy (NET) Delivered by Supervised 
Ukrainian Health Professionals in Norway 
 
ClinicalTrials.gov Identifier (NCT Number): 
NCT00000000 (Replace with actual number once registered) 
 
Document Type: 
Study Protocol – Version 4 submitted for Regionale komiteer for medisinsk og helsefaglig 
forskningsetikk (REK)  
Responsible Institution: 
Kristiania University of Applied Sciences  
School of Health Sciences and School of Art, Design, and Media 
 
Principal Investigator: 
Vanessa Nolasco Ferreira, PhD 
Associate Professor, Clinical Psychologist 
Kristiania University College 
vanessanolasco.ferreira@kristiania.no  
 
Date of Document: 
14th of October 2024 
 
 

 
Research Protocol: Empowering Narratives: Aid to Self-help for 
Ukrainian Refugees 
 
A. Project Leader 
Vanessa Nolasco Ferreira  
Position: Associate Professor in Psychology, School of Health Sciences, Institute of Psychology, 
Pedagogy and Law Kristiania University College   
Background: Clinical psychology, with a master’s in psychology and PhD in Sciences – Public Health   
B. Scientifically Designed Project Plan 
Project Purpose and Justification 
The project aims to provide training in Narrative Exposure Therapy (NET) to Ukrainian health 
professionals in Norway, enabling them to offer supervised trauma treatment to Ukrainian refugees 
living in Norway. This project addresses the mental health impacts resulting from the Russian invasion 
of Ukraine, aiming to benefit directly 70–90 people from the 73,000 Ukrainian refugees in Norway. 
The aim of the project is to offer training in the use of Narrative Exposure Therapy (NET) to Ukrainian 
healthcare professionals in Norway so that they can offer supervised treatment with NET for 
Ukrainian refugees. The healthcare professionals will also collect data for a pretest-posttest 
randomized controlled experimental study via guided practice. Data will provide an in-depth overview 
of the consequences for mental health after exposure to war and flight and will measure the 
effectiveness of treatment. The anonymized personal narratives can be used to communicate the 
effects of human rights violations through performing arts produced in a sister project – a 
psychoeducational intervention that communicates the refugees' experiences and helps to create 
understanding among the majority population. Høyskolen Kristiania (HK) is the project owner and 
collaborates with i.a. Mental Health, Universität Konstanz, NAV, Norwegian-Ukrainian aid organization 
and Vårsta Diakoni. 
Materials and Methods 
The project has two main goals: 
1. Offer Ukrainian healthcare personnel who moved to Norway further training in NET. 
2. Treat trauma symptoms in Ukrainian refugees in Norway through guided practice 
The project also provides an opportunity to integrate Ukrainian refugees into the Norwegian working 
life through the practice. We collect data in a pretest-posttest randomized controlled experimental 
study, which increases knowledge about mental health amongst refugees and contributes to a low-
threshold health service becoming available to those who need it. Through this, we can build a more 
diverse and inclusive society. 
NET is a treatment approach for PTSD as a result of organized violence or family violence. The patient 
is invited to repeatedly talk about the traumatic event in detail while reliving the emotions, 
cognitions, physiology, behavioral and sensory elements and meaning associated with the event. 

With the therapist's guidance, the patient constructs a narrative that focuses on the detailed context 
of the traumatic experiences, as well as on important elements of the emotional networks and how 
they come together. This gives the opportunity to recognize that the fear/trauma structure is the 
result of past experiences, and that the activation is nothing more than a memory. The emotional 
response to the memory of the traumatic events is reduced, leading to remission of PTSD symptoms. 
At the same time, patients gain access to lost memories and develop a sense of connection, control 
and integration. As possible challenges, we expect that the participants may experience stress in the 
exposure therapy, this is mitigated with psychoeducation, a normalization of the symptoms during the 
treatment. The project manager is trained and experienced in handling such situations. A certain 
skepticism is also expected at the beginning of the recruitment of patients, we expect that Ukrainian 
healthcare professionals who carry out the training will reduce this challenge. 
The projects imply: 
1. Training Program: A digital course in NET will be developed and offered to Ukrainian health 
professionals. 
2. Implementation: The trained health professionals will apply individual NET in Ukrainian refugees 
adults during supervised practice.  
Study Design: Pretest-posttest randomized controlled experimental study. 
Data Collection: Mental health data and demographics will be collected from participants that 
volunteer to participate in the study before the intervention/NET-treatment, right after the 
intervention and 6 months after the interventions end. Five validated instruments will to be used for 
measuring and mapping demographics and mental health including trauma, PTSD and depression. 
These five instruments are named: 1) Demographic questions, 2) PHQ-9, 3) LEC-5, 4) The International 
Trauma Questionnaire (ITQ), 5) and SHUT-D. These instruments are also available without copyright in 
Russian and Ukrainian, and these will be used in cases where the participant needs/wants them in 
their native language instead of English. Please note that the participant will not fill out these 
questionnaires themselves, they will always be filled out in the form of an interview by the health 
professional in the training program or researcher/project-participants.  
The participant in the study will be tested for chronic mental health problems before the actual 
intervention (NET) takes place. In this way, participants with diagnosis, history and / or scores 
compatible with the psychotic spectrum will be not included in the study. If the survey of a possible 
participant indicates critical mental health problems in this spectrum, the person will be advised and 
guided to contact mental health services for appropriate treatment. The primary investigator can 
issue a letter communicating the scores to the fastlege (general practician). Another exclusion criteria 
are participation in an ongoing psychological treatment for trauma and / or PTSD symptoms. In other 
words, in case a person registered interest in the study and are undergoing this type of treatment at 
the time of the intervention taking place, it will not be possible to include this person in the study. 
Right after the NET-treatment has been completed, the participants/patients will fill out the majority 
of the same forms/questionnaires/instruments as done before NET-treatment took place and have a 
follow-up 6 months after the therapy has finished with the same instruments/questionnaires. In this 
way, the effect of the treatment can be measured. These results will also be able to be published 
anonymously on a group level to see whether NET influenced PTSD symptoms. It is important to 
highlight that the method (NET) is based solely on the narratives of the participants themselves: If the 
patient refuses to share their narratives, this decision will be respected and supported. Participants 
that withdraw consent to participate in the study will have the right to continue the treatment with 

NET as planned/offered by the study. The only change is that their data will not be included in the 
study.  
Study Design and Timelines 
The project starts with the development of a digital course in NET to be offered to Ukrainian 
healthcare personnel living in Norway (responsibility VNF, SAD, AK, LA, SA, JM, SB). Mapping of 
healthcare personnel interested in joining will take place at the same time with the help of our 
collaboration with NAV (responsibility OF, CT and OB). In July 2024, VNF and ARB will apply to REK and 
SIKT for a project concerning a pretest-posttest randomized controlled experimental study. From 
November 2024 to January 2025 (change to accommodate time to get approval from REK), the course 
will be offered to between 20 and 30 healthcare personnel (responsibility VNF, SAD, AK, LA, ARB, SA, 
SB). From January 2025, Ukrainian healthcare personnel will have supervised practice (VNF, AK, SA, 
EB, JV). They will practice screening the mental health of potential participants and the use of NET in 
participants who meet the inclusion criteria for this type of therapy (VNF, SA, AK are responsible). At 
the same time, the research and data collection also start. HH and SW will be responsible for 
randomization and quantitative method. VNF, as primary investigator, will be responsible for data 
collection and data processing in accordance with all the ethical guidelines and the Declaration of 
Helsinki. The guided practice and data collection will take place until November 2025. The data 
analysis will start in May 2025 and will continue until March 2026. This activity will take place at the 
same time as the data collection (VNF, SAD, ARB, HH, SW, AK, LA, FS, NO will function in this activity, 
VNF is mainly responsible). Between March and April 2026, the final report will be constructed. This 
shows our and the health personnel's evaluation of the course, which data has been collected and the 
analysis of this data, as well as how the project can possibly be continued for other user groups (VNF, 
SAD and JM are mainly responsible for the report). 
C. Health Information Handling 
Sources and Management  
- Sources: Data will be collected from Ukrainian health professionals and refugees participating in the 
study through informed consent and voluntary participation 
- Data Transfer: Data will be securely stored using TSD (Services for Sensitive Data) and handled per 
ethical guidelines. 
- Clarification about video recording: Video recordings (with audio) will only be used for training 
purposes in the individual session when using and will be deleted as soon as the need is no longer 
there. VISO will be used to make video recordings and be directly connected to TSD 
(https://www.uio.no/tjenesters/it/adm-app/nettskjema/hjelp/viso.html). Only the main project 
participants (Vanessa Nolasco Ferreira, Ashley Rebecca Bell and Signe Alexandra Domogalla) and the 
NET supervisor for the individual participant's therapist will have access. 
To clarify the recording routine: The recording made of each session is deleted after each completion. 
The reason that recordings must be made is because the course takes place digitally online, so the 
recording should act as a learning opportunity for the course participant/health worker. The 
supervisor of each course participant is the only one who will watch this recording (and probably only 
a fraction, approx. 15min +/-) in order to be able to provide valuable feedback to course participants 
on their practice in supervision (course participants and course supervisors). After supervision, 
recordings related to the sessions that were commented on in the supervision will be permanently 
deleted from TSD. Course participants will not have access to the recording, only the individual course 
supervisor as well as project managers and project coordinator (for security reasons). 

- Data Sharing: No health information will be transferred outside the EEA. 
 
D. Handling of Human Biological Material 
Sources and Management 
Not applicable as this project does not involve collecting human biological material. 
E. Ethical Considerations 
Ethical Challenges and Risk-Benefit Assessment 
- Risks: Participants may experience stress during exposure therapy, mitigated by psychoeducation 
and symptom normalization. 
- Benefits: Participants are expected to experience reduced PTSD symptoms and improved mental 
health. The training will enable Ukrainian health professionals to integrate into the Norwegian 
workforce, fostering a diverse and inclusive society. 
- Ethical Approval: Ethical approvals will be sought from REK (Regional Committees for Medical and 
Health Research Ethics) and SIKT (Norwegian Agency for Shared Services in Education and Research). 
 
F. Funding Sources, Interests, and Dependencies 
INNTEKTER 
2024 
2025 
2026 TOTAL: 
Inntekter DAM 
109000 
270000 18000 
397000 
Egne midler Kristiania 
102047 
599446 69100 
770593 
Offentlige midler 
0 
0 
0 
0 
Andre inntekter 
0 
0 
0 
0 
SUM INNTEKTER: 
1167593 
UTGIFTER 
2024 
2025 
2026 TOTAL: 
Lønn og sosiale kostnader 
161047 
699446 87100 
947593 
Innkjøp av tjenester/honorar 
50000 
150000 
0 
200000 
Materiell/utstyr 
0 
20000 
0 
20000 
Andre utgifter 
0 
0 
0 
0 
SUM UTGIFTER: 
1167593 
 
The project is funded by the Dam Foundation and supplemented by internal resources from Kristiania 
University College. 
 
G. Plan for Dissemination of Results 
- Scientific Publications: Articles in academic journals, presentations at conferences. 
- Public Outreach: Articles in popular science media, reports to public authorities, and a book or e-
book documenting the project. 

- Digital Media: Project websites, podcasts, and social media channels. 
- Commercial Use: Potentially expanded use of research results and educational materials for broader 
applications. 
I. Emergency Procedure 
The preparedness procedure involves two possible measures that the participant is offered in case of 
signs of Complex PTSD and / or moderately severe or severe depression. 1) A psychoeducational 
conversation with the associate professor Vanessa Nolasco Ferreira who has expertise as a clinical 
psychologist. The purpose is to normalize the psychological symptoms, but also to encourage the 
participant to take the symptoms seriously. 2) Participants are also offered the possibility that the 
primary investigator issues a letter addressed to the fastlege (general practician - GP) informing on 
the screening scores so that the GP can follow up the person’s mental health. These procedures are 
optional, and the participant must agree orally to one or both offers. 
The emergency procedure is triggered when the scores for measure PTSD / complex PTSD shows 
severity, based on the frequency, intensity, severity and in PHQ-9 the scores are equal or superior 
than 15-27 (that shows moderately severe or severe depression), or if the participant answers 2-3 
(More than half of the days; Almost every day) on question 9 of the PHQ-9 depression scale: 
"Thoughts that it would be better if you were dead or about harming yourself". 
 
J. Guideline: Treatment options for participants who do not qualify for 
NET 
These guidelines will be further elaborated closer to the time of the study/data collection. Offers 
change continuously, and we will inform any participants about the health services available at the 
time via a letter like this. We will also contact these health services in advance and get a confirmation 
of whether it is okay to recommend their health services to our participants (who do not qualify for 
the study):  
• 
Fastlege 
• 
Rask helsehjelp: https://www.oslo.kommune.no/helse-og-omsorg/helsetjenester/psykisk-
helsehjelp/rask-psykisk-helsehjelp/#gref  
• 
Mental helse: https://mentalhelse.no/fa-hjelp/hjelpetelefonen  
 
 
 
 
 
 
 
 

K. Final Approval REK  
 
 
 
Available on the website: https://app.cristin.no/projects/show.jsf?id=2726408