Narrative Exposure Therapy: What’s your story?

 

A lot of time and resources have been spent on investigating Post Traumatic Stress Disorder (PTSD) in soldiers- and it’s warranted (more on how to live with PTSD). With the constant bombing, fighting, and unavoidable death that surrounds them it is no wonder that people pay attention to soldier’s needs. But there is one huge group of people dealing with the same issues that are not getting the same amount of attention: refugees. As many as 40% of refugees meet the criteria for PTSD because of the prolonged, repeated exposure to trauma. Narrative Exposure Therapy is a fairly new treatment for survivors like these, who are extremely susceptible to PTSD and have suffered through multiple types of trauma.

Refugees are Very Susceptible to PTSD

Refugees are Very Susceptible to PTSD
PC: Don O’Brien

There are approximately 21.3 million refugees across the world right now. According to the UN, approximately 34,000 people are displaced every day- that is 34,000 more people facing loss, resettlement, war and torture, and a host of other traumatic experiences every day. Narrative Exposure Therapy is about reconciling those who have gone through that sort of trauma with their life story. With Narrative Exposure Therapy, you piece together a coherent, chronological narrative of your life, focusing on the traumatic events. Those who have a very unstable life, like refugees, often have fragmented, disjointed, memories. The goal of Narrative Exposure Therapy is to transform these disorderly memories into a cohesive story- a testimonial of sorts. This testimony, if you agree, can also be used as evidence when prosecuting humans rights violations or raising awareness about them. While Narrative Exposure Therapy is still an up-and coming therapy, it is supposed to help not only the patient process painful emotions but potentially others suffering from the same injustices as well.

Narrative Exposure Therapy: How it Works

Narrative Exposure Therapy functions under the premise that the more trauma you experience, the larger your fear network is. Your fear network is made up of the emotional memories that are associated with sensory, cognitive, and physiological elements. The larger your fear network is, the more triggers there are that can set off PTSD.

Narrative Exposure Therapy: The NET Model

In Narrative Exposure Therapy, there are two types of memories associated with trauma: hot memories and cold memories. The hot memories are the ones in your fear network: the sensory details, emotions, and physiological reactions to the trauma. For example, if you experienced increased heartbeat and smelled gasoline during the incident, these would be a part of the hot memories and your fear network. Your cold memories are the opposite: they are the facts. Place, date, time of day, the people that were there- these are the sorts of things that your therapist would try and make you remember. According to the Narrative Exposure Therapy model, when you have PTSD, your hot memories are triggered without any reference to the cold ones. By making a chronological autobiography, you link the hot memories to the “cold”, hard facts to solidify and contextualize the trauma. You revisit the traumatic event in a safe environment, this time from the perspective of your entire life, instead of reliving it as a reaction to stress in the present.

Narrative Exposure Therapy: The Lifeline

Lifeline is exactly what it sounds like- a line that describes your life. Taking a birds-eye view of your life allows distance and space to reflect on all the good and bad moments. With a therapist, roll out a long piece of rope, ribbon, or string- one end represents your birth and the other represents your life that is yet to be lived. There are two objects that you lay down to represent different events in your life: stones and flowers. The stones represent shameful, difficult, and especially traumatic memories, and the flowers represent positive ones. This exercise is usually done during the first session because using the lifeline you can plan out which ‘stones’ you want to focus on in your future sessions.

Narrative Exposure Therapy: Stones and Flowers

Narrative Exposure Therapy: Stones and Flowers

Narrative Exposure Therapy: Going Forward

The lifeline is actually not a mandatory part of Narrative Exposure Therapy but can be helpful. Over your therapy sessions, you can go through the flowers and the stones, taking the time to unpack and sort through the stones. The goal of talking about these traumatic memories is to bridge together the ‘hot’ and ‘cold’ aspects of the trauma. The therapist may start by asking the when, what, where and other contextually relevant things. What were you doing a few hours before the event happened? Who were you with when it happened? The therapist may tell you to stay in the past tense when talking about the trauma so that it doesn’t trigger a flashback or dissociation, but also they will challenge any attempts to avoid talking about it. Reconciling how you felt about what happened, the facts of what happened, and how you feel about it all now is the main goal of Narrative Exposure Therapy.

There are many people in the world today that require therapy but do not have the resources to do so. Specifically, those who are displaced or refugees who come from extremely traumatic backgrounds could really benefit from methods such as Narrative Exposure Therapy. Narrative Exposure Therapy model is not meant to be a long- term therapy, but rather a quick and effective short-term therapy. Hopefully, by the end, you have reconciled more of your past and have a better outlook on your future. Also, your sessions could have a larger impact on the world should you decide to turn your autobiography into a testimony.

Hopefully, by the end, you have reconciled more of your past and have a better outlook on your future. Also, your sessions could have a larger impact on the world should you decide to turn your autobiography into a testimony. Narrative Exposure Therapy at the end of the day can be not only helpful for you, but for others in similar situations.

Deepti is a writer that specialises in neuroscience and psychology. She is passionate about modern medicine and finding other therapeutic techniques, and how both of these effect the developing brain. Deepti is extremely interested in the future of mental health awareness and treatment, and is always open to advice.