One psychological treatment for PTSD is narrative exposure therapy (NET).  In this treatment, a psychologist tries to help a client by giving meaning to their trauma.  The theory is that it is the lack of meaning of trauma that leads people to believe that they have no control over what happens to them and that bad things could happen again. This external locus of control and fear of the unexpected leads to anxiety and depression, characteristics of PTSD.

The therapy is based on the idea of habituation. The theory is that by repeatedly telling their story to the psychologist in a safe environment, there is a decrease in the automatic physiological responses that are characteristic of PTSD. As part of this therapy, the psychologist will ask the client to document their experience with the goal of helping others. As part of the creation of this story, survivors also consider how they feel about the experience and how it has affected their lives. This is why it is called “exposure” therapy - the reliving of the experience exposes them again to the trauma, but with the hope that doing this in a safe environment – and repeatedly – will eventually lessen the response to the trauma.

Knaevelsrud carried out a study of 30 survivors of World War II who had been diagnosed with PTSD to see if NET would be effective in decreasing their symptoms. The survivors took part in a 6-week online NET program. The clients wrote about their personal experiences and the therapist gave positive and empathetic feedback.  After six weeks, the participants showed a decrease in PTSD symptoms.  A follow-up interview at 3 months showed that they were still doing well.

This study shows that NET may be an effective treatment for PTSD. However, the study is not an experiment, so we cannot know if there is a cause and effect relationship.  Also, there was a very small sample size and the sample was self-selected.  There may be something about these participants which made the therapy more successful. They also were very old, so their age may have played a role in the success of the therapy. Finally, although it is positive that they were still doing well after 3 months, it would be important to do another follow-up to see if they are still doing better a year later to see the long-term effects of NET.

Another study was carried out by Alghamdi on the effectiveness of NET on 30 Saudi firefighters with PTSD. In this case, the study was an experiment.  The participants were randomly allocated to either the NET condition or the “waiting list” condition.  The NET condition had treatment for three-weeks; the waiting list group had no treatment until after the first three weeks. The participants were assessed for the severity of symptoms before starting therapy, after completing therapy, and after six months.  The findings were that the group that received NET showed significant improvement compared to the control group.  When the control group received therapy, they also showed significant improvement, meaning that participant variability of the two conditions is not a concern. However, after six months, the majority of the participants had relapsed.

This study is able to show a cause and effect relationship – those that received therapy improved while those that did not, did not.  The sample size, however, is small so it difficult to generalize the findings.  In addition, it is difficult to compare this study to the study with WW2 veterans.  The first study looked at old people who were no longer fighting the war, but the second study looked at young people who were still working as firefighters. This difference may be the reason why one of the studies found that NET was effective and the other showed that it was only a short-term effect.  The other issue, as I said above, is that the first study’s follow-up study was after only three months.  This may not be long enough to see a relapse.

There is a lot of research that supports the use of NET in the treatment of PTSD.  However, there are also many different types of trauma.  It may be that NET works best for some traumas (e.g. war) than for others (e.g. rape).  Research has shown that it is most effective in refugee populations (Lely et al). Unlike drug therapies that may have side effects, NET has no side effects. The exposure to the past trauma may temporarily increase flashbacks, nightmares, or intrusive thoughts, but the therapy is based on the ideas of Carl Rogers that the therapist needs to be a non-judgmental and supportive guide. 

It is difficult to study the effectiveness of any psychological therapy.  Since therapy takes time, research cannot be done under controlled lab conditions.  The research overall lacks internal validity. In addition, unlike drug therapy, it is not possible to standardize the treatment.  The therapy is adapted in response to the client. Also, in order to try to standardize as much as possible, a limited team of psychologists is used.  This is why sample sizes are often small, making it difficult to generalize the findings.  It is also difficult to operationalize the level of “empathy” or “social support” that the therapists give to their clients. Finally, as mentioned above, there may be a certain type of client that wants to “tell their story” which means that they are seeking this type of therapy.  This means that the samples of some of the research may be biased.

NET may be a good alternative to drug therapy, however, as with drug therapy, it does not seem to work for everyone.  However, unlike drug therapy, this therapy has a low attrition rate.  NET may also be better as it does not have side effects.  The most common drug for PTSD is Zoloft. Its side effects include insomnia, diarrhea, and weight loss.  It also leads to withdrawal symptoms. The question will remain – is the disorder more about the way we interpret what has happened to us – or the biological footprint of what has happened to us?