Narrative Exposure Therapy

Narrative Exposure Therapy (NET) is a short-term trauma-focused therapeutic intervention for traumatized patients focusing, based on the “hot and cold memory” paradigm, referring to declarative and non-declarative parts of autobiographical memory. NET is a flexible therapy that can be modified based on the operating environment and therapists’ and patients’ needs. The NET therapist needs basic knowledge about psychological disorders and diagnostics. The aim of NET is to link the sensory, emotional, cognitive and physiological elements of traumatic memories with their spatiotemporal and other context. Exposure to traumatic contents acts as a habituation process. The NET procedure is divided into four phases. (For the complete manual, see Schauer, Neuner and Elbert, 2011).

In the first phase, the therapist informs the patient about the intervention. Topics to be discussed include the theoretical background, psychoeducation about the symptoms, and the different elements of the therapy the patient has to know about.

In the second phase of the procedure, during a single session, the therapist and the patient creatively visualize the patient’s lifeline in chronological order, using either pencil and paper or a rope, for example. The lifeline starts with the patient’s birth and at the other end it remains partly rolled up, representing the future. Pleasant and positive life events or persons are marked with flowers on the lifeline. In contrast, stones on the lifeline stand for traumatic life events. The lifeline acts as a guiding structure during the therapy: all life events are narrated and reprocessed in detail with the therapist.

The third phase of the treatment is narration of the lifeline. These sessions have a duration of approximately 90 to 120 minutes and, depending on the patient, there should be 3 to 12 sessions of NET. The first narrative exposure session begins with the patient’s birth and the first traumatic event. Session by session, the stones and flowers are discussed with the patient.

In the fourth phase, during the last session of treatment after narrative exposure to all lifeline events, the whole narration is read aloud for the patient.

NET for children, KIDNET (Ruf, Schauer, Neuner, Schauer, Catani & Elbert, 2012), is an adapted version for younger patients: the psychoeducation is modified to suit the child’s age (See Ruf & Elbert, 2012) and there are several possibilities to perform NET exercises in a child-friendly way using comics, figures and paintings.

The poster presentation of Finnish RCT trial (ISTSS Congress, Washington DC, 2018) available here: