https://journals2.
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php/indigenous ISSN: 0852-0682 | E-ISSN: 2460-3945 Review article Effectiveness of Narrative Therapy in Addressing Psychological Challenges:
A Systematic Review of Randomised Controlled Trials Dyah Putri Permatasari1.
Heni Dwi Windarwati2.
Retno Lestari3
1,2,3
Citation:
Permatasari.
Windarwati.
, &
Lestari.
Effectiveness of narrative therapy in addressing psychological challenges: A systematic review of randomised controlled trials.
Indigenous:
Jurnal Ilmiah Psikologi 11.
, 1-13.
https://doi.
org/10.
23917/indigenous.
Article history:
Received: 10-10-2025 Revised: 04-12-2025 Accepted: 15-02-2026 Published: 28-02-2026 Faculty of Health Science.
Universitas Brawijaya Correspondence: dyah.
ppermata04@gmail.
Abstract Background: Evidence on the effectiveness of Narrative Therapy remains limited and varies across age groups, psychological conditions, and cultural contexts.
therefore, a systematic review is needed to integrate findings across studies for a more comprehensive understanding.
Objective: This review aims to evaluate the effectiveness of Narrative Therapy in reducing psychological problems across all age groups based on evidence from previously published studies.
Methods: A systematic review was conducted on 20 articles with Randomized Controlled Trial (RCT) designs obtained from major academic databases.
Study selection was performed using strict inclusion and exclusion criteria.
Research participants included children (O17 year.
, adolescents .
Ae25 year.
, adults .
Ae59 year.
, and older adults (Ou60 year.
from various clinical and community settings across different countries.
Results: Of the 20 studies analyzed, 18 showed significant results .
< .
with moderate to large effect sizes (CohenAos d = .
5Ae1.
, while 2 studies were not The highest recorded p-value was .
019, and the highest t-value was Oe9.
< .
The greatest effectiveness was observed among children with anxiety and trauma survivors, along with improvements in self-efficacy, self-image, social relationships, and quality of life.
Conclusion: Narrative Therapy is effective in reducing psychological symptoms such as depression, anxiety.
PTSD, and loneliness, while enhancing self-efficacy, self-image, and quality of life across ages and cultures.
The therapy is flexible, adaptive, and relevant for psychiatric nursing practice, making it a recommended evidence-based intervention in both clinical and community settings.
These findings have practical implications for mental health services and policy development in post-pandemic contexts, particularly in resource-limited settings.
Keywords: Narrative Therapy.
Psychological Problems.
Mental Health Intervention.
Identity Reconstruction.
Empowerment.
Systematic Review Introduction Psychological trauma, including conditions like post-traumatic stress disorder (PTSD), is recognized as a major contributor to the global health burden.
The World Health Organization evaluates this burden using disability-adjusted life years (DALY.
, a comprehensive metric that represents both premature deaths and years spent living with disabilities (Ferrari et al.
, 2.
The Global Burden of Disease (GBD) 2024 report, which examines 288 causes of death, 371 diseases and injuries, and 88 risk factors across 204 countries, identifies trauma-related disorders as a significant factor in DALYs, especially among at-risk populations (Hoppen et al.
, 2.
The effects of trauma go beyond immediate medical treatment.
persistent psychological issues lead to ongoing service requirements (OAoDonnell & Greene, 2.
In children, trauma heavily impacts healthcare requirements and diminishes quality of life, thus elevating DALY figures (Grummitt et al.
, 2.
Improvements in trauma care protocols, like advanced trauma life support training, have lowered death rates but have not completely eradicated the psychological impact (Kumar et al.
, 2.
Long-term monitoring initiatives emphasize the necessity for thorough prevention and rehabilitation approaches (Stenehjem et al.
, 2.
Copyright: A 2026 by the authors.
Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license .
ttps://creativecommons.
org/licenses/by/4.
0/).
Permatasari et al.
The mental health landscape has grown more complex since COVID-19 emerged.
A systematic review and meta-analysis reported that during the pandemic, the prevalence of stress, anxiety, and depression reached 29.
6%, 31.
9%, and 33.
7%, respectively (Salari et al.
, 2.
Among elderly refugees, 68% reported COVID-19-related anxiety (Anwar et al.
, 2.
Children and adolescents faced a sharp increase in new psychiatric diagnoses, reflecting widespread impacts on psychosocial development (Bilu et al.
, 2023.
Magson et al.
, 2.
Research in Indonesia confirms that during the pandemic, 20.
8% of adults experienced depression and 25.
4% stress, with young people at the highest risk (Izzatika et al.
, 2.
These results align with studies on midlife crisis, which show that job and future uncertainty during COVID-19 exacerbated psychosocial vulnerability among young adults (Putri et al.
, 2.
Ironically, mobility restrictions and social distancing reduced engagement with mental health services.
many avoided healthcare facilities, causing reported cases of some disorders to appear artificially lower (Duden et al.
, 2022.
Flodin et al.
For example, in Lithuania, no significant rise was observed in PTSD or adjustment disorder, possibly due to delayed diagnoses or service response differences (Kazlauskas et al.
, 2.
The pandemic also led to new mental health conditions, including increased diagnoses of eating Page 1 Indigenous: Jurnal Ilmiah Psikologi, 11.
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disorders (Taquet et al.
, 2.
and elevated psychological distress from prolonged isolation (Brooks et al.
, 2.
These trends highlight the need for policy adaptations to meet post-pandemic mental health challenges.
In mental health interventions.
NT emphasizes externalizing issues and reshaping meaning through personal narratives.
Theoretically, narrative transformation promotes identity change and enhances self-efficacy.
Evidence indicates that self-efficacy plays a crucial role in developing professional identity among nursing students (Mei et al.
, 2.
and in linking professional identity with perceived competence (Yao et al.
, 2.
Among disaster volunteers, trauma centrality mediates the connection between coping self-efficacy and post-traumatic growth, suggesting that how individuals incorporate traumatic experiences into their identities affects their recovery potential (Arpaci et al.
, 2.
Similar patterns are observed in studies on emotional regulation and psychological symptoms (Chung & Shakra, 2.
From the perspective of identity shift, social labels can influence self-efficacy.
For example, in correctional environments, viewing oneself as a AustudentAy instead of an AuinmateAy boosts civic engagement and confidence (Lerman & Sadin, 2.
Trauma-informed training for healthcare workers has also been shown to improve self-efficacy (Haverkamp et al.
, 2.
On the other hand, exposure to secondary trauma is linked to lower professional confidence (Syed Ali et al.
, and secondary traumatic self-efficacy predicts attitudes toward trauma-informed practice (Miller Itay & Turliuc, 2.
Overall, these insights emphasize NTAos ability to foster a positive identity and psychological resilience by increasing self-efficacy.
RCT publications on NT have shown a rising trend.
From 2010 to 2015, few RCTs focused specifically on NT, but since 2016, the number has grown along with increased interest in traumafocused therapies .
ummary of RCTs 2016Ae2.
This upward trend is expected to continue, with an estimated 10Ae15 NT RCTs published annually by 2025, including digital versions to address post-pandemic mental health needs .
ummary of RCTs 2021Ae2.
Nevertheless, several methodological reviews highlight common issues in psychotherapy RCTs, such as poor controls, high dropout rates, inconsistent intervention fidelity, incomplete adverse effect reporting, and selection bias (Bertolyn-Guillyn, 2024.
Crotty et al.
, 2024.
Cuijpers et al.
, 2021.
Melo-Carrillo et al.
These flaws weaken the validity of results and hinder meta-analyses, underscoring the importance of assessing methodological quality.
Similarly, not using proper comparators or attention controls can obscure the true sources of clinical change (Crotty et al.
, 2.
Premature dropout hampers accurate assessment of therapy effectiveness (Melo-Carrillo et al.
, 2.
, and variations in NT implementation reduce the comparability of study results (Cuijpers et al.
, 2.
The absence of adverse event reporting hampers risk-benefit analysis (Cuijpers et al.
, 2.
, while weak randomization can introduce selection bias (Bertolyn-Guillyn, 2.
These methodological concerns highlight the importance of conducting a systematic review using the Risk of Bias 2 (RoB-.
framework to ensure reliable evidence synthesis.
Among these challenges, there is a pressing need for affordable, adaptable, and culturally appropriate interventions.
NT provides a distinctive approach, available in individual, group, or online formats especially relevant during social distancing.
Besides reducing symptoms.
NT may improve life meaning and interpersonal relationships, essential for addressing post-pandemic social However, its effectiveness has not been fully summarized for 2020Ae2025, a period characterized by increased post-pandemic research and digital mental health innovations.
The lack of an updated review limits practitioners, researchers, and policymakers from assessing evidence with high standards.
Additionally, no review explicitly connects identity shift and self-efficacy mechanisms to NT outcomes, despite their potential role as key therapeutic mediators.
Building on this background, the manuscript seeks to: .
evaluate NT's effectiveness on PTSD, depression, anxiety, and stress symptoms in RCTs from 2020 to 2025.
determine evidence quality through JBI Critical Appraisal Tools and GRADE frameworks.
analyze how delivery mode .
ace-to-face, group, digita.
and cultural context influence outcomes.
examine the roles of identity shift and self-efficacy as mechanisms of change.
By offering a methodologically rigorous synthesis, this article aims to lay a strong scientific foundation for developing narrativebased mental health policies and practices that adapt to the changing landscape of trauma and post-pandemic psychological effects.
Research Methods The researchers performed a systematic review of English-language publications from 2020 to The online search took place in April 2025 across three major databases: ScienceDirect.
Permatasari et al.
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PubMed, and ProQuest, excluding gray literature.
The search used three keywords: AuNarrative Therapy,Ay AuPsychological Distress,Ay and AuMental Health Problems.
Ay Initially, each term was searched separately, then combined with the Boolean operator AuANDAy to yield more precise results.
Inclusion and Exclusion Criteria (PICOS) Article selection was systematic and strict, following predefined inclusion criteria.
Only studies on narrative therapy for psychological issues were considered.
All articles from the initial search were re-evaluated and selected based on the specified inclusion and exclusion criteria.
The inclusion criteria for this systematic review included: .
studies focusing on narrative therapy for psychological issues.
participants such as children (O17 year.
, adolescents .
-25 year.
, adults .
-59 year.
, and older adults (Ou60 year.
articles available in full text.
publications from 2020 to 2025.
study types accepted were randomized controlled trials (RCT.
The exclusion criteria included: .
articles discussing psychological therapies other than the narrative approach.
non-research publications, like editorials, commentaries, literature reviews, or scientific statements.
articles not published in English.
studies that were crosectional, longitudinal, or case studies.
Table 1.
PICOS criteria and justification for variable selection.
Components P (Populatio.
I (Interventio.
C (Compariso.
O (Outcome.
S (Study desig.
Operational definition of the study Children (O17 year.
, adolescents .
Ae 25 year.
, adults .
Ae59 year.
, and older adults (Ou60 year.
diagnosed with PTSD, depression, anxiety, or stress according to the DSM-5/ICD-11 All modalities of Narrative Therapy:
NET.
SNT.
Strengths-Based NAT.
Digital Writing NAT .
n-person, group, onlin.
Waiting list, usual care, psychological placebo, or active intervention (EMDR.
PE, or psychoeducatio.
Primary outcome: Change in PTSD/depression/anxiety/stress symptom scores Secondary outcomes: Social functioning, quality of life, self-efficacy, intervention acceptability, and dropout rate Randomized controlled trials (RCT.
in English, published between January 2020 and December 2025, with a sample size Ou 10 per group.
Examples of measurement tools/indicators CAPS-5.
PCL-5.
CRIES-8
for children.
BDI-II.
HAI.
Justification of the core results set (CRB) These scales are included in the COS PTSD-Depression to ensure consistency of results across trials (Allen et al.
, 2021.
Steil et al.
, 2.
Intervention manual.
session duration and frequency.
fidelity indicators.
Allows for subgroup analysis based on the application format/modality.
Bohus et al.
Qian et al.
Standardized control protocol.
Evaluate the relative effectiveness and reduce the performance bias.
Based on the COS recommendations to improve clinical and patient relevance (Gkintoni et , 2.
Wright et al.
Limited to high-quality causal Lunny et al.
Page et al.
i CAPS-5 score.
i BDI-II WHOQOL-BREF.
General Self-Efficacy Scale Key references Allen et al.
Steil et al.
Susanty et al.
Maddox et al.
Maryn-Cavestany et Quality Assessment To evaluate the methodological quality of the selected articles, the Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed, which is appropriate for the study types included in this systematic review.
Although a 60% threshold was initially used to define higher methodological quality, studies scoring below this cutoff were still included due to their relevance to the review Overall, the quality assessment showed that 15 of the 20 studies scored Ou60% on the JBI criteria, with the remaining 5 scoring below this mark .
ee Table .
The quality of the studies was considered when interpreting the results.
The selection and assessment were performed independently by two reviewers, and articles of questionable quality were re-evaluated to maintain consistency and methodological rigor.
Literature Search Strategy A total of 2331 articles were collected from online databases: 646 from ScienceDirect, 1524 from ProQuest, and 161 from PubMed.
After removing 80 duplicates, 2251 articles remained.
Based on their titles and abstracts, 2026 articles were selected, and 914 of these were available in full Following full-text evaluation, 814 articles that did not meet the research objectives were Permatasari et al.
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This process resulted in 20 articles fitting the criteria for analysis.
Figure 1 illustrates the article selection process and provides details of the 20 articles reviewed.
Figure 1.
PRISMA Flow Diagram for Literature Identification and Selection Results and Discussion Results A review of 20 randomized controlled trials highlighted the effectiveness of narrative therapy across various clinical and community settings in different countries.
This approach reliably decreases psychological symptoms like depression, anxiety, and loneliness, while boosting self-esteem, self-efficacy, and social support.
Each study was detailed with information on the author, country, design, sampling method, therapy duration, and key results with statistical data to evaluate its impact thoroughly.
Table 2.
Summary of included articles .
= .
Author and Country Tang et al.
Hong Kong Smaik et al.
Yordania Permatasari et al.
Method Findings WNT vs.
EFP vs.
telephone calls.
90 vs.
90 vs.
elderly community members in Hong Kong.
threegroup randomized clinical trial.
stratified random 6 weeks (A30 minutes/session, once a Wisdom-Enhancement Narrative Therapy (WNT) resulted in a significant decrease in loneliness in 43% of participants, an increase in life satisfaction in 12%, and a slight decrease in 5%.
Effect size: = Oe.
p = .
CohenAos d = .
60, indicating a moderate effect on reducing social loneliness.
Narrative Exposure Therapy (NET) demonstrated statistically and clinically significant effectiveness, yielding a moderate effect on PTSD .
= Oe10.
00, p < .
CohenAos d = .
and depression .
= Oe6.
00, p < .
001, d = .
, as well as a large effect on anxiety .
= Oe9.
46, p < .
001, d = .
The intervention proved to be feasible, culturally acceptable, and achieved 100% adherence and retention rates, indicating strong potential for largescale implementation.
NET vs.
MA-WL.
20 vs.
20 Syrian refugees .
ged 18Ae64 years.
PTSD).
two-group RCT.
random allocation .
10 weekly sessions, 60Ae120 minutes Score
JBI
46,2%
76,9%
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Sele et al.
Norwegia SNT vs.
PE vs.
STAIR.
30 vs.
32 vs.
30 patients with CPTSD (ICD-.
three-arm RCT.
independent block randomization.
approximately 12 weeks of group sessions followed by 8 weeks of individual sessions .
Ae90 minutes per session, once Sackeim et al.
Amerika Serikat Narrative intervention .
arrative video reflective writin.
usual care.
112 vs.
103 patients undergoing outpatient abortion.
two-arm RCT.
1:1 randomization using sequentially sealed envelopes.
4minute video plus free-writing session prior to the abortion procedure.
Tele-NT (Wisdom-Enhancement Narrative Therap.
Tele-EP (Empathy-Focused Interventio.
ACG .
ctive control group Ae routine telephone 97 vs.
95 vs.
95 community-dwelling older adults in Hong Kong .
otal n = .
three-arm RCT.
computer-generated 1:1 randomization.
4week duration with 8 telephone sessions .
wice weekly, 30 minutes per sessio.
Narrative Therapy combined with Pilates vs.
o interventio.
21 vs.
21 adolescents with internet addiction from four community centers in Yiyang.
two-arm RCT.
proportional allocation based on age, gender, and addiction severity.
8week duration, once weekly .
Ae60 minutes per Video-based Narrative Intervention vs.
usual care.
15 vs.
15 post-stroke outpatients from two hospitals in Malaysia.
two-arm RCT.
simple random 4-week duration involving educational and reflective video sessions of approximately 20 minutes each, twice weekly.
Strength-Based Narrative Therapy (SNT) vs.
o interventio.
42 vs.
43 community-dwelling older adults with depressive symptoms in Huoju.
Changsha.
two-arm RCT.
convenience sampling.
12-week duration with one session per week.
Jiang et al.
Hong Kong Gong et al.
Tiongkok Appalasamy et al.
Malaysia Zhu et al.
Tiongkok Karibwende et al.
Rwanda Narrative Therapy (NT) vs.
waitlist control.
36 vs.
36 orphans aged 6Ae12 years with ADHD and anxiety residing in SOS Villages Rwanda.
two-arm parallel quasi-experimental RCT.
purposive sampling.
10-week duration with one session per week.
Dutta et al.
Singapura Narrative e-Writing Intervention (NeW-I) vs.
waiting list.
13 vs.
13 parent-caregivers of children with Chronic Life-Threatening Illnesses (CLTI).
twoarm RCT.
convenience sampling.
4-week duration with one online writing session per week followed by therapist feedback.
Lely et al.
Belanda Narrative Exposure Therapy (NET) vs.
PresentCentered Therapy (PCT).
18 vs.
15 outpatients aged 55Ae81 years with PTSD.
two-arm RCT.
purposive sampling.
11-session intervention delivered once every 1Ae2 weeks.
Online Narrative Therapy (NT) vs.
sychological stress leafle.
46 vs.
46 clinical nurses with positive PTSD screening .
core Ou .
twoarm RCT.
random sampling.
8-week duration with one individual video call session per week .
Ae60 minutes eac.
Xue et al.
China Permatasari et al.
Prolonged Exposure (PE) produced greater reductions in PTSD symptoms compared to Schema Therapy for Negative Themes (SNT) .
= .
and achieved a higher rate of loss of PTSD diagnosis .
= .
SNT
showed limited effectiveness, with 11% of participants losing the PTSD diagnosis and 42% the CPTSD diagnosis, as well as relatively small symptom improvements .
% for PTSD.
22% for CPTSD), though it remained beneficial for some patients (HedgesAo g = .
34Ae 47 vs.
64Ae.
81 for PE).
Demographic characteristics, such as race, influenced perceived stigma and psychological distress.
Black participants reported significantly lower levels of stigma and psychological distress .
= .
001 and p = .
02, respectivel.
76,9%
Wisdom-Enhancement Narrative Therapy (Tele-NT) was shown to be effective in reducing loneliness among older adults compared to the control group ( = Ae.
= .
d = .
, particularly in the domain of social The intervention also significantly improved social support .
< .
and sleep quality .
< .
69,2%
The intervention group showed a significant reduction in internet addiction scores .
= Oe6.
p < .
and significant improvements in mental health .
= 9.
< .
and positive affect .
< .
compared to the control group.
The therapy also significantly reduced anxiety, depression, social dysfunction, and loss of interest .
ll p < .
The intervention significantly improved medication self-efficacy .
ean difference = 4.
3, p = .
and enhanced patientsAo psychological control .
< .
No adverse effects or declines in treatment adherence were observed during the intervention period.
53,8%
After 12 weeks, the intervention group showed significantly lower depression scores (HAMD-.
compared to the control group .
= Oe3.
666, p = .
Mental state scores (MMSE) were significantly higher .
= 2.
662, p = .
, and quality of life (SF-.
showed significant improvement (F = 8.
863, p = .
The therapeutic effects remained significant following long-term intervention.
Analysis revealed significant reductions in anxiety symptoms (F = 23.
838, p < .
001, pA = .
and ADHD symptoms (F = 24.
641, p < .
001, pA = .
Post-intervention t-tests were significant for both anxiety .
= 4, p < .
001, d = 1.
and ADHD .
= 6.
7, p < .
001, d = 1.
, indicating large effect sizes, with no significant pre-test differences between groups.
At least 85% of participants reported finding the intervention helpful, 76% experienced increased social support, 62% reported decreased depression, and 57% noted enhanced hope.
The effects were described as large .
stimated CohenAos d OO .
8Ae1.
0 based on Ou50% improvemen.
, although p-values and t-statistics were not reported due to the descriptive nature of the analysis.
Narrative Exposure Therapy (NET) significantly reduced PTSD symptoms .
= .
54, p < .
, depression .
= .
51, p = .
, and general psychopathology .
= .
p = .
among older adults with PTSD.
However, no significant changes were observed in resilience.
The NT group showed significant reductions in total PTSD scores (Z = Ae2.
235, p = .
, stress (Z = Ae2.
p = .
, anxiety (Z = Ae2.
850, p = .
, and depression (Z = Ae2.
434, p = .
compared to the control The proportion of participants with positive 61,5% 76,9% 61,5% 76,9% 46,2% 76,9% 76,9% Page 5 Indigenous: Jurnal Ilmiah Psikologi, 11.
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Fan et al.
China Narrative Exposure Therapy (NET) combined with personal psychological treatment vs.
ersonal psychological treatment onl.
56 vs.
55 patients with COVID-19 exhibiting post-traumatic stress symptoms (PTSS).
two-arm RCT.
8-week duration with 1Ae2 sessions per week, each lasting 90Ae120 minutes.
Chow et al.
Hong Kong Train of Life Narrative Therapy (ToL-NT) vs.
Treatment as Usual (TAU)/psychoeducation.
100 stroke survivors and their caregivers from five regional hospitals.
double-blind RCT .
stratified random sampling using the minimization method .
ased on age, gender, stroke type, and side of hemiplegi.
8 sessions, 2 hours per week for 8 Group Narrative Therapy (GNT) vs.
outine psychiatric car.
13 vs.
13 patients with amphetamine dependence.
two-arm RCT.
convenience sampling followed by 1:1 random allocation at Farabi Hospital and Kermanshah Rehabilitation Center.
10 sessions, one per week, approximately 90 minutes each.
Cognitive-Narrative Therapy (CNT) vs.
Treatment as Usual (TAU).
8 vs.
11 adult female survivors of Intimate Partner Violence (IPV) residing in a shelter house.
longitudinal RCT.
randomized sampling with 1:1 allocation using the Research Randomizer 4 therapy sessions over 4 weeks .
minutes per sessio.
Shakeri .
Iran Moreira Portugal Zarra-Nezhad et al.
Iran CCGPT vs.
Narrative vs.
Combined vs.
Waitlist 12 vs.
12 vs.
12 vs.
12 preschool children 5Ae4 years diagnosed with Separation Anxiety Disorder (SAD).
four-arm RCT with random allocation to four groups.
sampling technique: convenience or clinical recruitment.
8-week duration with one session per week .
minutes per sessio.
Sun et al.
China Narrative Therapy Standard Care vs.
Standard Care only.
47 vs.
46 patients with oral cancer aged 18Ae65 years.
two-arm RCT.
random sampling.
7week duration with one session per week .
Ae40 minutes per sessio.
Chan & Lau .
Hong Kong Narrative Group Therapy vs.
Waitlist Control.
21 elementary school students .
rades 4Ae6.
total n = .
diagnosed with dyslexia.
two-arm RCT.
purposive cluster sampling.
6-session program, 1.
hours per session.
Franz et al.
Amerika Serikat Digital narrative-based bibliotherapy vs.
266 vs.
262 users of *The Mighty* online platform who reported suicidal thoughts in the past 12 months.
two-group RCT.
online convenience sampling via digital recruitment on social media therapy duration of 14 days .
ne narrative per day, approximately 5Ae10 minutes of readin.
Permatasari et al.
PTSD and anxiety cases also decreased significantly .
< .
The NET group showed significantly greater reductions in total PTSS compared to the control group (F.
= 36.
300, p < .
, including the dimensions of re-experiencing (F = 28.
282, p < .
, avoidance/numbing (F = 8.
470, p = .
, and hyperarousal (F = 9.
643, p = No significant differences were observed in depression, anxiety, or sleep quality .
> .
The effects ranged from moderate to strong .
A = .
115Ae.
Results from the ActorAePartner Interdependence Model (APIM) indicated significant improvements in survivorsAo self-esteem .
= Ae2.
146, p < .
and reductions in depression .
= Ae1.
following ToL-NT compared with the control group.
Positive effects were also observed in well-being and hope, with an adjusted RA = 516, suggesting a strong model fit.
The GNT group showed significant reductions in depression .
= 5.
47, p < .
and anxiety .
= 5.
30, p < .
compared to the control group .
= 1.
90, p = .
and t = 2.
03, p = .
06, respectivel.
No significant change was observed in quality of life .
= .
71, p = The therapy demonstrated strong effects on emotional symptoms but not on quality of life.
No significant differences were found between groups.
however, positive effects were observed for depression (CohenAos d = .
43, p = .
PTSD .
= .
19, p = .
, and borderline symptoms .
= .
18, p = .
In contrast, a small negative effect was found for total CPTSD .
= Ae 28, p = .
The therapy demonstrated short-term effectiveness in reducing depressive and PTSD symptoms.
All interventions (CCGPT.
Narrative, and Combine.
significantly reduced total SDQ, emotional, conduct, and peer problem scores compared to the control group .
< .
The largest effects were observed in the Combined .
= Oe4.
69, p < .
and CCGPT .
= Oe3.
32, p = .
Narrative Therapy was also effective in enhancing prosocial behavior .
= 3.
50, p = .
and reducing total difficulties .
= Oe2.
78, p = .
, although it did not produce a significant effect on SADspecific symptoms.
Narrative Therapy significantly reduced stigma and enhanced self-esteem and social support among patients with oral cancer (F = 34.
401Ae144.
893, p < .
, with meaningful pre- to post-intervention improvements .
= 668, p < .
, demonstrating its effectiveness in promoting psychosocial well-being.
Narrative Group Therapy significantly improved selfefficacy (F.
= 7.
92, p < .
01, pA = .
d = 0.
and reduced social anxiety (F.
= 6.
67, p < .
01, pA = .
d = .
compared to the control group.
The interventionAos effect on social anxiety was fully mediated by enhanced self-efficacy (B = .
50, p < .
01 Ie B = Oe.
p < .
Digital bibliotherapy significantly reduced the Audesire to dieAy over the 14 days ( = Oe.
26, p = .
and remained significant at the 2-week follow-up .
= Oe2.
p = .
005, d = .
Increases in perceived shared experience fully mediated the Intervention effect .
= Oe.
p < .
and optimism .
= Oe.
85, p < .
76,9%
84,6%
61,5%
53,8%
53,8%
76,9%
61,5%
61,5%
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Figure 2.
Framework of Digital Narrative Therapy: Media.
Support, and Outcome Integration Based on the mapping of 20 studies.
Narrative Therapy has been extensively applied across diverse clinical and community groups in various countries.
Most studies utilized a Randomized Controlled Trial (RCT) design.
The study designs ranged from two-arm to four-arm trials, employing random, stratified, or purposive sampling methods tailored to each population, such as community-dwelling older adults (Jiang et al.
, 2025.
Tang et al.
, 2.
, children with anxiety disorders and dyslexia (Chan & Lau, 2025.
Zarra-Nezhad et al.
, 2.
, medical patients (Chow et , 2023.
Sun et al.
, 2.
, and individuals with trauma or post-traumatic stress disorder (PTSD) (Fan et al.
, 2021.
Lely et al.
, 2022.
Smaik et al.
, 2.
Intervention durations ranged from 4 to 12 weeks, with sessions held 1Ae2 times weekly, each lasting 30Ae120 minutes.
Modalities included in-person sessions, tele-narrative therapy, group sessions, and digital bibliotherapy, reflecting high flexibility and adaptability to participantsAo needs and delivery platforms.
Quantitatively, 18 out of 20 studies .
%) found statistically significant results .
< .
, with 10 studies .
%) showing p < .
001 and 8 studies .
%) reporting significant t-values from 2.
13 to Two studies Fan et al.
and Sackeim et al.
found no meaningful differences between intervention and control groups.
The most substantial effect sizes appeared in children with ADHD and anxiety in Rwanda .
= 6.
p < .
d = 1.
(Karibwende et al.
, 2.
and Syrian refugees with PTSD .
= 9.
p < .
d = .
(Smaik et al.
, 2.
, indicating that Narrative Therapy produces the strongest outcomes in populations experiencing high emotional This effectiveness stems from the therapyAos focus on meaning reconstruction, self-reflection, and personal empowerment, leading to deeper psychological engagement than passive or educational methods like usual care or waitlist controls.
Overall.
Narrative Therapy consistently improves self-efficacy, self-esteem, emotion regulation, and quality of life across various age groups and populations, with the greatest success seen in trauma-focused and community-based interventions.
Main Advantages of the Intervention Media Narrative Therapy is crucial in fostering identity change and redefining life purpose through reauthoring personal stories (Moreira et al.
, 2022.
Zhu et al.
, 2.
It promotes psychological empowerment, self-reflection, and the restructuring of meaning, helping participants shift from Permatasari et al.
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stories of suffering to those of hope and healing (Appalasamy et al.
, 2020.
Fan et al.
, 2.
Its effectiveness is evident across various groups, including older adults, individuals with chronic illnesses, and trauma survivors, who show gains in self-awareness, perceived control, and adaptability to life challenges (Chow et al.
, 2023.
Jiang et al.
, 2025.
Smaik et al.
, 2.
Statistically.
Narrative Therapy demonstrates high effectiveness in alleviating psychological symptoms across diverse populations and age groups.
Of the 20 studies reviewed, 18 .
%) yielded statistically significant outcomes .
< .
, with 10 studies showing p < .
001 and 8 reporting significant t-values between 2.
13 and 11.
The strongest effects were observed in children with ADHD and anxiety .
< .
pA = .
(Karibwende et al.
, 2.
and Syrian refugees with PTSD .
= Oe9.
p < .
d = .
(Smaik et al.
, 2.
Moderate to strong effects were also noted among adults and older adults suffering from depression, loneliness, and lower quality of life (CohenAos d = .
p = .
(Tang et al.
, 2025.
Zhu et al.
, 2.
However, two studies from Fan et al.
1 and Sackeim et al.
found non-significant results, likely due to shorter intervention periods and the primarily educational approach of the therapy.
Beyond reducing symptoms.
Narrative Therapy also supports social and cultural recovery, as seen in better social connectedness .
< .
and less stigma .
= .
among older adults and refugees (Sele et al.
, 2023.
Smaik et al.
, 2023.
Tang et al.
, 2.
Using symbols, language, and local values in culturally adapted approaches has been shown to increase participant engagement and boost the overall effectiveness of interventions (Appalasamy et al.
, 2020.
Karibwende et al.
, 2.
For medical patients.
Narrative Therapy helps improve self-image and body acceptance, especially in those with cancer or traumatic pasts (Sackeim et al.
, 2022.
Sun et al.
, 2.
Its overall success can be attributed to mechanisms like narrative reflection, cognitive restructuring, and enhanced self-efficacy, which foster emotional resilience and better emotional regulation in various psychological settings.
Methodological and Support Advantages The success of Narrative Therapy depends not only on the narrative process but also on how it is implemented, the intervention media used, and the social support provided.
Using flexible, adaptable, and culturally sensitive approaches has been shown to improve therapeutic results across various populations significantly.
Narrative Therapy is flexible and adaptable to different cultural and situational contexts.
It can be delivered through various formats such as individual face-to-face sessions, small groups, and online methods like tele-narrative therapy and digital bibliotherapy, which enhance accessibility and effectiveness, especially in settings with limited resources (Chow et al.
, 2023.
Franz et al.
Gong et al.
, 2.
Multiple studies show high satisfaction among patients, caregivers, and healthcare providers with digital approaches, highlighting their broad acceptability across different age groups and clinical settings (Dutta et al.
, 2.
In addition to methodological strengths, social support and the therapeutic environment further boost treatment outcomes.
Family and caregiver participation, as shown in Chow et al.
encouraged empathy, emotional resilience, and lowered depression levels among older adults with PTSD .
= .
The use of video-based and screen-based interventions in hospital settings also improved self-reflection and communication between healthcare providers and patients (Jiang et , 2.
Overall, integrating digital access, active social support, and culturally relevant adaptation makes Narrative Therapy a powerful, transformative, and sustainable method for enhancing psychological well-being across diverse populations and throughout different life stages.
Discussion A review of twenty studies shows that Narrative Therapy is highly effective in reducing different psychological symptoms across all ages and settings.
It enhances personal empowerment, encourages self-reflection, and helps restructure lifeAos meaning.
This process allows participants to turn negative experiences into more positive and meaningful stories.
These mechanisms support greater emotional resilience and overall mental health.
A meta-analysis by Hu et al.
found that narrative therapy significantly lessened depressive symptoms .
< .
and improved self-efficacy and self-control in adults with somatic disorders.
Permatasari et al.
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confirming its role as an effective cross-sectional psychological approach.
Supporting this, narrative reconstruction has demonstrated effectiveness in decreasing PTSD and depression symptoms both short and long term by aiding the integration of adaptive and coherent emotional memories (Siehl et al.
, 2.
Compared to traditional treatments, narrative therapy tends to be more effective because it helps individuals rebuild meaning and self-identity by incorporating complex emotional experiences, such as trauma or chronic illnesses, into a coherent life story, which helps reduce depression and anxiety symptoms (Geng et al.
, 2.
Narrative Therapy's strength also includes its adaptability and cultural sensitivity.
Digital adaptations like tele-narrative and video-based interventions have improved access to psychosocial services, especially in areas with limited resources (Lippke et al.
, 2.
Multiple studies indicate that online formats produce outcomes similar to traditional face-to-face sessions and can improve participant engagement (Jiang et al.
, 2.
Additionally, social support from family, caregivers, and healthcare providers enhances therapy by promoting empathy, emotional bonds, and effective communication (Sun et al.
, 2.
This review has some limitations, including small sample sizes, inconsistent therapy durations, and varying cultural and implementation settings.
Additionally, some studies did not consider external influences such as social support and socioeconomic status.
Therefore, larger, long-term experimental research is needed to determine the best treatment durations, evaluate lasting effects, and understand how cultural and social factors affect results.
Overall.
Narrative Therapy shows considerable potential for further growth as an evidence-based psychosocial approach that supports recovery and mental health across diverse populations.
Conclusion This comprehensive review shows that Narrative Therapy effectively reduces psychological issues such as depression, anxiety.
PTSD, and loneliness.
It also boosts self-efficacy, self-image, and quality of life across ages and cultures.
The change process involves narrative reflection, cognitive restructuring, and empowering individuals to find meaning in life, which helps build a positive identity and emotional resilience.
This therapy is adaptable, culturally appropriate, and highly relevant to mental health nursing because it promotes meaning-focused positive adaptation and recovery.
Consequently.
Narrative Therapy is recommended as an evidence-based approach suitable for both clinical and community nursing settings.
Permatasari et al.
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Acknowledgements The authors gratefully acknowledge the individuals and institutions whose support during the literature review process significantly contributed to the establishment of the conceptual and methodological foundation of this study.
Author Contributions Conceptualization: First Author.
Second Author.
methodology: First Author.
Second Author.
investigation: First Author.
Second Author.
writing original draft preparation:
First Author.
Second Author.
writing review and editing: First Author.
Second Author.
visualization: First Author.
Second Author.
All authors have read and agreed to the published version of the manuscript.
Conflict of interest The authors declare that there are no conflicts of interest that could have influenced the results of this study, and they affirm their commitment to maintaining the highest standards of scientific integrity.
Data availability No new data were generated or analyzed in this study.
All data supporting the findings are derived from previously published sources and are available within the article and its supplementary materials.
Funding This research received no external References