Overview Workshops
Workshop: Narrative Exposure Therapy - Josita Versteeg
Article: Narrative exposure therapy for PTSD page 187-205 (Neuer, Elbert & Schauer, 2020)
Workshop: Treatment of prolonged grief following traumatic loss - Jeroen Knipscheer
Article: Prolonged grief disorder: Cognitive-behavioral theory and therapy (Boelen, Hout & Bout, 2013)
Article: Cognitive Therapy for prolonged grief in children (Spuij, Londen-Huiberts & Boelen)
Note: Articles are the same as the articles prescribed for week 6 literature.
Workshop: Imagery Rescripting - Franziska Lechner-Meichsner
Article: Using imagery rescripting to treat PTSD in refugees (Lechner-Meichsner et al., 2022)
Article: Imagery rescripting and eye movement desensitization (...) (Boterhoven de Haan et al., 2020)
Workshop: Sexual trauma - Simone Belt
Article: Understanding PTSD and sexual assault (Dworking et al., 2019)
Workshop: Mourners social space - Anneke Vedder
Article: A micro-sociological theory of adjustment to loss (Maciejewski et al., 2022)
, Narrative Exposure Therapy
Workshop: Narrative Exposure Therapy - Josita Versteeg
Narrative Exposure Therapy (NET) is a short term therapy for patients with multiple trauma, based on CBT. It is
especially developed for people with PTSD living in unstable conditions. It is now seen as evidence-based,
however it has less proof than exposure therapy.
NET emphasizes on memory processes. During traumatic events, there is decreased functioning of the
hippocampus and increased functioning of the amygdala.
● hippocampus: facts and knowledge - cold memory
● amygdala: sensory, emotional and physiological perception
- hot memory
During emotional events, memories are stored more than in normal
events. This counts for all sorts of memory/information, including
sensory, emotional and physiological information.
During a traumatic event, you become aroused and your brain can
create a trauma network. Instead of facts, a fear network is created. All the fears become connected. This can cause
a small cue, like a smell or something internally like an increased heart rate, to activate the trauma network. The
information of the hippocampus (what, when, etc, called cold memories) is left out of the memorie, because the
emotional response (hot memorie) was intense. Therefore, traumatized people can’t always remember all the facts
around their trauma. NET aims to connect the facts with the emotions, thus the cold memories with the hot
memories. In that way, the patient can get a more clear image of what happened.
Therapeutic principles in NET
1. You make a lifeline (chronological reconstructions of all important life events) (end of
the rope is always rolled up, because life has not ended yet)
2. Exposure to the hot memories activation of the fear network
3. Integration of the hot and cold memories
4. Cognitive re-evaluation of the life events as a result of processing (giving meaning)
5. Testimony: go through and write down, it gives dignity and gives a statement for the
patient and for others (therapist write this)
In practice, NET is done with for example flowers and stones. Other commonly used items are
sticks (stand for violence you used yourself) and candles (stand for a loss). You always start
with a flower. Later in the conversation, the therapist will talk with the client about the meaning
of every flower or stone. It is helpful to make short notes of every flower and stone, and a
picture to remember. An example of a lifeline made for NET is shown on the right.
In therapy, you always start with the flower and shortly go over the pretrauma period. Then you gather global
information of the experience (activating cold memories). When you have this global view, restart, but slower and
ask for details to activate the hot memories. Ask specifically for sensory, emotional, cognitive and physical
information. Interventions that can help to activate elements of the trauma can be direct questioning and feedback
of the observation (I see that you are smiling)
Hot and cold memories
Cold memory (facts) Hot memory (emotions/feelings)
● space: Where did it happen? ● sensory: What did you see/smell/hear/etc?
● time: When did it happen? ● cognitive: What did you think?
● chronology: What happened? What happened ● emotional: How did you feel?
next? ● physiological: How did your body react?
, Article: Narrative Exposure Therapy for PTSD page 187-205 (Neuer, Elbert & Schauer, 2020)
Narrative Exposure Therapy
Narrative Exposure Therapy (NET) is a trauma-focused psychotherapy that has a lot in common with other
evidence-based treatments for PTSD. Like other treatments, it aims to change the structure of trauma-related
memories, cognitions and emotions that are related to the traumatic event(s). In NET, the patient creates a written
autobiography that includes major emotional memories from birth to present. Through this whole process, the
therapist guides the patient. The focus of NET is to reconstruct the fragmented memories of the trauma into a
coherent memory that is connected to the temporal and spatial context of the lifetime periods. At the end of the
treatment, a copy of the coherent life line is handed to the patient. If the patient accepts, the therapist also keeps a
copy that can be used for human rights purposes.
Besides that NET has similarities with other trauma-focused therapies, there are also some differences. In
war-affected populations, PTSD prevalence rates are up to 50%. NET was originally developed and tested as a brief
and economic procedure for such settings in conflict areas. An important part of NET therefore is that the
procedure can be applied across context and cultures with limited adaptations. This is based on the idea that trauma
reactions are a universal phenomena.
Thereby, an unique future of NET is the life-span-approach. Most trauma-focused therapies focus on the trauma
that had the most impact (called the index trauma). However, war victims often have a series of traumatic events
that happened to them and thus, a whole period of traumatic events. A key assumption of NET is that the distorted
memory is caused by an accumulation of traumatic events over the life span (and not by a single index trauma
memory). The life-span-approach aims to integrate the traumatic memories into a meaningful autobiographical
memory, which is key for identity and self-acceptance.
A third difference is that NET is directly connected to advocacy for the survivors of severe human rights violations
and thus not taking a neutral position. Because of a lot of different factors, including shame and avoidance, victims
often have difficulties with expressing their trauma. Thereby comes that society is often ignorant, making it even
harder. NET can provide comprehensible documentations of individuals' life stories that facilitate feelings of
empathy for the victims and contribute to social recognition. At request of the survivor, the testimonies can be used
by agencies for human rights work.
Thus, NET differs from other trauma-focused therapies because:
● aims to change and connect memories into a coherent whole
● can be used in different cultures and contexts
● uses a life-span-approach
Treatment Rationale
Current research confirms that the re-creation of a context is the key mechanism for unlearning fear. Based on this,
NET aims to reestablish a consistent autobiographical context of the traumatic events and reconnect the context to
the threat, to tie cold memories around hot memories. In practice, the procedure involves the reconstruction of a
meaningful narrative for the client. In 90-minute sessions, the fragmented memories of the traumatic event will be
transformed into a coherent narrative.
Studies into PTSD share the assumption that the disorder is caused and maintained by memory processes.
Emotional experiences are represented in episodic memory, which consist of associative networks (hot
memory/fear structure) that are tied to contextual information (cold memory). Extreme stress, for example during a
traumatic event can cause a dissociation of the associative memories from their context. This can lead to PTSD
symptoms.
