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Narrative Exposure Therapy (NET): Reorganizing Memories of Traumatic Stress, Fear, and Violence

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Evidence Based Treatments for Trauma-Related Psychological Disorders

Abstract

Perception results not only from the properties of a stimulus, but also from memory traces of previous emotionally arousing experiences, which become modified in the process. Memories thus develop their own intrinsic dynamics, not only driven by the original experiences themselves but also by the memories thereof, thus remodeling cognition, emotion, and behavior eventually to the extent that clinical symptoms may arise. From episodic threats to social exclusion to the continuous wear and tear associated with living in adverse situations, stressors not only cause a set of responses but also modify the body’s defensive systems. In order to readjust a disordered memory representation the experiences must be recalled and sorted along the line of life. Consequently, in Narrative Exposure Therapy (NET), a client, with the assistance of the therapist, constructs a chronological narrative with a focus on the most stressful experiences. The autobiography is recorded by the therapist in written form and corrected and filled with details during moments of high emotional arousal. Aim of this procedure is to transform the generally fragmented reports of traumatic events into a coherent narrative. For traumatic stress experiences the therapist asks in detail for sensory information (visual, auditory, tactile, olfactory and gustatory), emotions, cognitions, and physiological reactions, probes for respective observations and records these information meticulously. The patient is encouraged to relive these emotions while narrating without loosing the connection to the “here and now”: using permanent reminders to detect how feelings and physiological responses result from memories, the therapist links the experiences to episodic facts, i.e., time and place. The exposure to the traumatic experience is not terminated, until the related arousal presented and reported by the client does show a significant diminution. In this way, the narrative is driven forward in a supportive but rather directively guiding style by the therapist, in order to counter avoidance and to recover the full implicit information of the traumatic experience. At the end of treatment the patient receives the written report of her/his-story. If requested by the client, this document may be used for rights and human rights advocacy.

this is my story, I am

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References

  • Adenauer, H., Catani, C., Gola, H., Keil, J., Ruf, M., Schauer, M., & Neuner, F. (2011). Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli – Evidence from a randomized controlled treatment trial. BMC Neuroscience, 12(1), 127. doi:10.1186/1471-2202-12-127.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bichescu, D., Neuner, F., Schauer, M., & Elbert, T. (2007). Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behaviour Research and Therapy, 45, 2212–2220.

    Article  PubMed  Google Scholar 

  • Boscarino, J. (2004). Posttraumatic stress disorder and physical illness: Results from clinical and epidemiologic studies. Annals of the New York Academy of Sciences, 1032, 141–153.

    Article  PubMed  Google Scholar 

  • Brewin, C. R., and Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23(3), 339–376.

    Google Scholar 

  • Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210–232. doi:10.1037/a0018113.

    Article  PubMed Central  PubMed  Google Scholar 

  • Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical psychology review, 23(3), 339–376.

    Article  PubMed  Google Scholar 

  • Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009a). Treating children traumatized by war and tsunami: A comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka. BMC Psychiatry, 9, 22. doi:10.1186/1471-244X-9-22.

    Article  PubMed Central  PubMed  Google Scholar 

  • Catani, C., Schauer, E., Elbert, T., Missmahl, I., Bette, J. P., & Neuner, F. (2009b). War trauma, child labor, and family violence: Life adversities and PTSD in a sample of school children in Kabul. Journal of Traumatic Stress, 22(3), 163–171. doi:10.1002/jts.20415.

    Article  PubMed  Google Scholar 

  • Catani, C., Adenauer, H., Keil, J., Aichinger, H., & Neuner, F. (2009c). Pattern of cortical activation during processing of aversive stimuli in traumatized survivors of war and torture. European Archives of Psychiatry and Clinical Neuroscience, 259(6), 340–351. doi:10.1007/s00406-009-0006-4.

    Article  PubMed  Google Scholar 

  • Catani, C., Gewirtz, A. H., Wieling, E., Schauer, E., Elbert, T., & Neuner, F. (2010). Tsunami, war, and cumulative risk in the lives of Sri Lankan schoolchildren. Child Development, 81(4), 1176–1191. doi:10.1111/j.1467-8624.2010.01461.x.

    Article  PubMed  Google Scholar 

  • Crombach, A., & Elbert, T. (2014). Controlling offensive behavior using Narrative Exposure Therapy: A RCT of former street children. Clinical Psychological Science, http://dx.doi.org/10.1177/2167702614534239.

  • Crumlish, N., & O’Rourke, K. (2010). A systematic review of treatments for post-traumatic stress disorder among refugees and asylum-seekers. Journal of Nervous and Mental Disease, 198(4), 237–251.

    Article  PubMed  Google Scholar 

  • Dōmen, I., Ejiri, M., & Mori, S. (2012). Narrative Exposure Therapy for the treatment of Complex PTSD: An examination of the effect and adaptation. The Japanese Journal of Psychotherapy, 13(1), 67–74.

    Google Scholar 

  • Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345.

    Article  CAS  PubMed  Google Scholar 

  • Ejiri, M., Dōmen, I., & Mori, S. (2012). A trial study for introducing Narrative Exposure Therapy into psychiatric practice: An examination of the effect and adaption. The Japanese Journal of Psychotherapy, 13(1), 59–65.

    Google Scholar 

  • Elbert, T., & Schauer, M. (2002). Burnt into memory. Nature, 419(6910), 883. doi:10.1038/419883a.

    Article  CAS  PubMed  Google Scholar 

  • Elbert, T., Rockstroh, B., Kolassa, I.-T., Schauer, M., & Neuner, F. (2006). The influence of organized violence and terror on brain and mind: A co-constructive perspective. In P. B. Baltes, P. A. Reuter-Lorenz, & F. Rösler (Eds.), Lifespan development and the brain (pp. 326–349). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Elbert, T., Hermenau, K., Hecker, T., Weierstall, R., & Schauer, M. (2012). FORNET: Behandlung von traumatisierten und nicht-traumaisierten Gewalttätern mittels Narrativer Expositionstherapie. In J. Endrass, A. Rossegger & B. Borchard (Hrsg.), Interventionen bei Gewalt- und Sexualstraftätern. Risk-Management, Methoden und Konzepte der forensischen Therapie (S. 255–276). Berlin: MWV Medizinisch-Wissenschaftliche Verlagsgesellschaft.

    Google Scholar 

  • Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2012). Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial. JAMA, 306(5), 503–512.

    Google Scholar 

  • Gwozdziewycz, N., & Mehl-Madrona, L. (2013). Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. The Permanente Journal, 17(1), 70.

    PubMed Central  PubMed  Google Scholar 

  • Halvorsen, J. O., & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology, 51, 495–502.

    Article  PubMed  Google Scholar 

  • Hensel-Dittmann, D., Schauer, M., Ruf, M., Catani, C., Odenwald, M., Elbert, T., & Neuner, F. (2011). Treatment of victims of war and torture: A randomized controlled comparison of Narrative Exposure Therapy and Stress Inoculation Training. Psychotherapy and Psychosomatics, 80, 345–352.

    Article  CAS  PubMed  Google Scholar 

  • Hermenau, K., Hecker, T., Ruf, M., Schauer, E., Elbert, T., & Schauer, M. (2012). Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system. Child and Adolescent Psychiatry and Mental Health, 5, 29.

    Article  Google Scholar 

  • Hermenau, K., Hecker, T., Schaal, S., Mädl, A., & Elbert, T. (2013). Narrative Exposure Therapy for Forensic Offender Rehabilitation – a randomized controlled trial with ex-combatants in the eastern DRC. Journal of Aggression, Maltreatment & Trauma, 22(8), 916–934.

    Article  Google Scholar 

  • Hijazi, A. M. (2012). Narrative exposure therapy to treat traumatic stress in middle eastern refugees: A clinical trial. Wayne State University. http://digitalcommons.wayne.edu/oa_dissertations/543

  • Hijazi, A. M., Lumley, M. A., Ziadni, M. S., Haddad, L., Rapport, L. J., & Arnetz, B. B. (2014). Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: A preliminary randomized clinical trial. Journal of Traumatic Stress, 27, 314–322.

    Article  PubMed  Google Scholar 

  • Isele, D., Teicher, M., Ruf-Leuschner, M., Elbert, T., Kolassa, I. T., Schury, K., & Schauer, M. (2014). KERF – ein Instrument zur umfassenden Ermittlung belastender Kindheitserfahrungen. Zeitschrift für Klinische Psychologie, 43(2), 1–10.

    Google Scholar 

  • Jacob, N., Neuner, F., Mädl, A., Schaal, S., & Elbert, T. (2014). Dissemination of psychotherapy for trauma-spectrum disorders in resource-poor countries: a randomized controlled trial in Rwanda. Psychotherapy & Psychosomatics, 83(6), 354–363.

    Google Scholar 

  • Jongedijk, R. A. (2012). Hoofdstuk (chapter) 34. Narratieve Exposure Therapie. In E. Vermetten, R. J. Kleber, & O. van der Hart (red). Handboek Posttraumatische stress stoornissen (pp. 551–564). Utrecht: De Tijdstroom.

    Google Scholar 

  • 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: Uitgeverij Boom (Boom Publishers).

    Google Scholar 

  • Kolassa, I.-T., & Elbert, T. (2007). Structural and functional neuroplasticity in relation to traumatic stress. Current Directions in Psychological Science, 16(6), 321–325. doi:10.1111/j.1467-8721.2007.00529.x.

    Article  Google Scholar 

  • Kolassa, I.-T., Illek, S., Wilker, S., Karabatsiakis, A., & Elbert, T. (2015). Neurobiological findings in post-traumatic stress disorder. In U. Schnyder & M. Cloitre (Eds.), Evidence based treatments for trauma-related psychological disorders (chap. 4). Cham: Springer.

    Google Scholar 

  • McPherson, J. (2012). Does narrative exposure therapy reduce PTSD in survivors of mass violence? Research on Social Work Practice, 22(1), 29–42.

    Article  Google Scholar 

  • Metcalfe, J., & Jacobs, W. (1996). A “hot-system/cool-system” view of memory under stress. PTSD Research Quarterly, 1996(7), 1–3.

    Google Scholar 

  • Mollica, R. F., McInnes, K., Poole, C., & Tor, S. (1998). Dose-effect relationships of trauma to symptoms of depression and post- traumatic stress disorder among Cambodian survivors of mass violence. The British Journal of Psychiatry, 173(6), 482–488.

    Article  CAS  PubMed  Google Scholar 

  • Morath, J., Moreno-Villanueva, M., Hamumi, G., Kolassa, S., Ruf, M., Schauer, M., Bürkle, A., Elbert, T., & Kolassa, I. T. (2014a). Effects of psychotherapy on DNA strand break accumulation originating from traumatic stress. Psychotherapy & Psychosomatics, 83(5), 289–297.

    Article  Google Scholar 

  • Morath, J., Gola, H., Sommershof, A., Hamuni, G., Kolassa, S., Catani, C., Adenauer, H., Ruf-Leuschner, M., Schauer, M., Elbert, T., Groettrup, M., & Kolassa, I.-T. (2014b). The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD. Evidence from a randomized controlled trial. Journal of Psychiatric Research. doi:10.1016/j.jpsychires.2014.03.016.

    PubMed  Google Scholar 

  • Nandi, C., Crombach, A., Bambonye, M., Elbert, T. & Weierstall, R., (2014). Predictors of post-traumatic stress and appetitive aggression in active soldiers and former combatants. (submitted for publication).

    Google Scholar 

  • Neuner, F., Schauer, M., Karunakara, U., Klaschik, C., Robert, C., & Elbert, T. (2004a). Psychological trauma and evidence for enhanced vulnerability for PTSD through previous trauma in West Nile refugees. BMC Psychiatry, 4(1), 34.

    Article  PubMed Central  PubMed  Google Scholar 

  • Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004b). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72(4), 579–587.

    Article  PubMed  Google Scholar 

  • Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-Tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19, 339–347.

    Article  PubMed  Google Scholar 

  • Neuner, F., Catani, C., Ruf, M., Schauer, E., Schauer, M., & Elbert, T. (2008a). Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): From neurocognitive theory to field intervention. Child and Adolescent Psychiatric Clinics of North America, 17(3), 641–664.

    Article  PubMed  Google Scholar 

  • Neuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008b). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting Psychology, 76, 686–694.

    Article  Google Scholar 

  • Neuner, F., Kurreck, S., Ruf, M., Odenwald, M., Elbert, T., & Schauer, M. (2010). Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cognitive Behaviour Therapy, 39(2), 81–91.

    Google Scholar 

  • Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31(3), 399–417.

    Article  PubMed  Google Scholar 

  • Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5, 7.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pabst, A., Schauer, M., Bernhardt, K., Ruf, M., Goder, R., Rosentraeger, R., Elbert, T., Aldenhoff, J., & Seeck-Hirschner, M. (2012). Treatment of patients with borderline personality disorder (BPD) and comorbid posttraumatic stress disorder (PTSD) using narrative exposure therapy (NET): a feasibility study. Psychotherapy and Psychosomatics, 81, 61–63.

    Article  PubMed  Google Scholar 

  • Pabst, A., Schauer, M., Bernhardt K., Ruf, M., Goder, R., Elbert, T., Rosentraeger, R., Robjant, K., Aldenhoff, J., & Seeck-Hirschner, M. (2014). Evaluation of Narrative Exposure Therapy (NET) for borderline personality disorder with comorbid posttraumatic stress disorder. Clinical Neuropsychiatry, 11(4), 108–117.

    Google Scholar 

  • Pace, T. W. W., & Heim, C. M. (2011). A short review on the psychoneuroimmunology of posttraumatic stress disorder: From risk factors to medical comorbidities. Brain, Behavior, and Immunity, 25, 6–13.

    Article  CAS  PubMed  Google Scholar 

  • Robjant, K., & Fazel, M. (2010). The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review, 30(8), 1030–1039.

    Article  PubMed  Google Scholar 

  • Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437–445.

    Article  PubMed  Google Scholar 

  • Schaal, S., Elbert, T., & Neuner, F. (2009). Narrative exposure therapy versus interpersonal psychotherapy: A pilot randomized controlled trial with Rwandan genocide orphans. Psychotherapy and Psychosomatic, 78(5), 298–306.

    Article  Google Scholar 

  • Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218(2), 109–127.

    Article  Google Scholar 

  • Schauer, M., & Ruf-Leuschner, M. (2014). Die Lifeline – Zugang zur Narrativen Exposition (NET) in der Traumatherapie. Psychotherapeut, 59, 226–238.

    Article  Google Scholar 

  • Schauer, M., & Schauer, E. (2010). Trauma-focused public mental-health interventions: A paradigm shift in humanitarian assistance and aid work. In E. Matz (Ed.), Trauma rehabilitation after war and conflict (pp. 361–430). New York: Springer.

    Google Scholar 

  • Schauer, E., Neuner, F., Elbert, T., Ertl, V., Onyut, P. L., Odenwald, M., & Schauer, M. (2004). Narrative exposure therapy in children – A case study in a Somali refugee. Intervention, 2(1), 18–32.

    Google Scholar 

  • Schauer, M., Elbert, T., Gotthardt, S., Rockstroh, B., Odenwald, M., & Neuner, F. (2006). Wiedererfahrung durch Psychotherapie modifiziert Geist und Gehirn. Verhaltenstherapie, 16, 96–103.

    Article  Google Scholar 

  • Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative exposure therapy: A short-term treatment for traumatic stress disorders. Cambridge, MA: Hogrefe-Verlag.

    Google Scholar 

  • Schauer, M., Ruf-Leuschner, M., & Landolt, M. (2014). Dem Leben Gestalt geben: Die Lifeline in der Traumatherapie von Kindern und Jugendlichen (im Druck). In K. Priebe & A. Dyer (Eds.), Metaphern und Symbole in der Traumatherapie. Göttingen: Hogrefe.

    Google Scholar 

  • Stenmark, H., Catani, C., Neuner, F., Elbert, T., & Holen, A. (2013). Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behaviour Research and Therapy, 51, 641–647.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  Google Scholar 

  • Zech, E., & Vandenbussche F. (2010). La thérapie par exposition à la narration de Schauer, Neuner et Elbert: Manuel de traitement de l‘état de stress post-traumatique après la guerre, la torture et la terreur. Presses universitaires de Louvain.

    Google Scholar 

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Acknowledgment

We greatly appreciate the editing and comments on earlier versions of this chapter by Danie Meyer-Parlapanis and the editors of this book.

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Authors and Affiliations

  1. Department of Psychology, Clinical Psychology and Behavioural Neuroscience, University of Konstanz, Konstanz, Germany

    Thomas Elbert

  2. Department of Psychology, Clinical Psychology and Centre for Psychotraumatology, University of Konstanz, Konstanz, Germany

    Maggie Schauer

  3. Department of Psychology, Clinical Psychology and Psychotherapy, University of Bielefeld, Bielefeld, Germany

    Frank Neuner

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  1. Thomas Elbert
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  2. Maggie Schauer
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Correspondence to Thomas Elbert .

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Editors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland

    Ulrich Schnyder

  2. Dissemination & Training Division, National Center for PTSD, San Franciso, California, USA

    Marylène Cloitre

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Elbert, T., Schauer, M., Neuner, F. (2015). Narrative Exposure Therapy (NET): Reorganizing Memories of Traumatic Stress, Fear, and Violence. In: Schnyder, U., Cloitre, M. (eds) Evidence Based Treatments for Trauma-Related Psychological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-07109-1_12

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