Narrative exposure therapy: an evidence-based treatment for multiple and complex trauma

Abstract

Narrative exposure therapy (NET) is a recently developed, short-term treatment for patients with a posttraumatic stress disorder (PTSD) as a result of multiple trauma. NET can be applied very successfully in patients with complex trauma complaints (Jongedijk, 2014; Schauer, Neuner, & Elbert, 2011).

An important feature of NET is that trauma processing is never an isolated event but is always embedded in the context of a traumatic event and in the life history as a whole. At the start, the lifeline is laid. The lifeline is made up of a rope, with flowers (happy events), stones (traumatic events), sometimes candles (grief), or recently also sticks for aggressive acts (NET for offenders; see Stenmark, Cuneyt Guzey, Elbert, & Holen, 2014). These symbols are laid down along the rope, in chronological order. Subsequently, in the subsequent therapy sessions the lifeline is processed in chronological order, giving attention to all the important events a person has experienced in his or her life, both the adverse as well as the pleasurable ones. The narration ends with a written testimony.

To date, there is good evidence NET is effective in the treatment of PTSD patients, with support from 18 RCTs (N=950). For culturally diverse populations, NET is recommended as the most evidence-based trauma treatment, besides culturally adapted CBT. NET has been investigated in different populations in Africa, Europe, and Asia. In Asia, research has been carried out in Sri Lanka as well as in China. In China, NET was conducted and investigated with survivors of the Sichuan earthquake (Zang, Hunt, & Cox, 2013, 2014). NET is understandable, even appealing and also supportive for patients with multiple trauma. In this presentation, the treatment principles and the practice of NET will be explained.

References

Jongedijk, R. A. (2014). Levensverhalen en psychotrauma. Narratieve exposure therapie in theorie en praktijk [Life stories and psychotrauma. Narrative exposure therapy in theory and practice]. Amsterdam, The Netherlands: Boom Uitgevers.

Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy: A short-term intervention for traumatic stress disorders (2nd ed). Göttingen, Germany: Hogrefe.

Stenmark, H., Cuneyt Guzey, I., Elbert, T., & Holen, A. (2014). Gender and offender status predicting treatment success in refugees and asylum seekers with PTSD. European Journal of Psychotraumatology , 5 , 20803, doi: http://dx.doi.org/10.3402/ejpt.v5.20803

Zang, Y., Hunt, N., & Cox, T. (2013). A randomized controlled pilot study: The effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake. BMC Psychiatry , 13 , 41. doi: 10.1186/1472-244X-13-41.

Zang, Y., Hunt, N., & Cox, T. (2014). Adapting narrative exposure therapy for Chinese earthquake survivors: A pilot randomised controlled feasibility study. BMC Psychiatry , 14 , 262. doi: 10.1186/s12888-014-0262-3. PubMed Central Full Text |

About The Author

Ruud A. Jongedijk

Netherlands