Narrative Exposure Therapy (NET) is a psychotherapeutic treatment method for survivors of life-threatening, complex traumatic events. NET is based on the recognition that traumatizing experiences are stored in two distinct memory systems, associative memory, in which all sensory perceptions and feelings associated with the event are registered, and autobiographical memory, in which the temporal sequence is recorded. The goal of NET is to restore the link between the two memory systems, which no longer functions during traumatizing events.
What is narrative exposure therapy?
Narrative exposure therapy involves a psychotherapeutic treatment method that combines two different therapeutic techniques. It is a linkage between “Testimony Therapy” (TT) and exposure. Testimony therapy is based on putting traumatizing experiences, which are only remembered in fragments, into context and completing them into coherent events in several sessions. The patient is repeatedly confronted with the painful and stressful events through exposure within Narrative Exposure Therapy. The aim of this is to re-establish a connection and association between the associative and autobiographical memory. In the associative memory, multisensory perceptions such as smells, sounds, visual impressions, tastes as well as the emotions associated with the impressions are stored, which are related to the traumatizing events. Autobiographical memory serves to “record” and assign chronological sequences and geographic location of individual events. Due to flooding with stress hormones, a disintegration of the two memory systems takes place during traumatizing events, so that the events are often remembered chronologically and even spatially incorrectly. The stress hormones ensure a one-sided orientation of the body toward flight or attack and toward short-term muscular peak performance and toward minimizing the risk of bleeding in case of injury. At the same time, the stress hormones activate the amygdala, which strengthens associative memory, and block the hippocampus, where the associated biographical data are stored. During individual therapeutic treatments, the link between the two memory systems for specific events should be restored.
Function, effect, and goals
Narrative Exposure Therapy was originally developed at the University of Konstanz, Germany, as a targeted and time-saving psychotherapeutic treatment method for traumatized adults to help people in crisis and war zones process their traumatizing experiences and put them into a context that would allow them to resume their normal social lives. The therapy is designed to enable individual patients to recall the multiple traumatizing events in a way that does not require reliving over and over again the emotions stored in associative memory. NET was developed for acute situations where there was no time for long, elaborate psychotherapeutic treatments. That is, it was originally a typical crisis and disaster intervention therapy. An essential point on which NET is based is the experience that the “hot” experience contents, which are felt with the highest emotions, lose the link to the rational, “cold” experience contents during traumatizing, deeply impressive events (hot spots). The most important intermediate goal of NET is to enable the patient to put the traumatizing events into a coherent context and to re-establish the originally existing logical link between the associative and the autobiographical memory, which locates the events in time and space. In order to achieve this goal, the patient’s entire life story is rewound again and again from a distance, i.e., from the “ex-position,” including positive experiences and including emotional feelings, until what has been experienced is linked together without contradiction in both associative and biographical memory.The patient is now able to address the traumatizing events from a distance in time and space. In the course of therapy, therefore, there is an overall view of the patient’s own life. The affected person is able to recognize and accept his own life pattern and its connections. In the meantime, positive empirical data on the effectiveness of Narrative Exposure Therapy are available, which have encouraged the adaptation of the therapy so that it can also be applied to traumatized children. Thus, KIDNET, the child-friendly form of NET, was developed from NET. Children can express themselves not only verbally, but also by drawing and acting out scenes, i.e., nonverbally.
Risks, side effects and dangers
Narrative Exposure Therapy is usually done without the administration of any medication. The therapy is based solely on the conversation between therapist and patient and on the empathic connection and trust that develops between therapist and patient during the course of treatment. In this respect, NET is free of side effects. However, the therapy does not claim to be a complete cure. As a rule, complete healing from severe traumatization can only take place in a lifelong process that is always associated with setbacks. This means that there is a risk of not fully achieving the therapy goals. Even if the therapy does not fully achieve its set goals, because the traumatization turns out to be more severe and complex than originally thought, it can help the patient overcome the worst consequences of the most distressing traumas. In these cases, NET can be seen as a starting point for an individual healing process. A problem may also be that the patient is unable or unwilling to support the therapy to the best of his or her ability for his or her own benefit.
