“The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.” (J. Herman)
PTSD, memory and narration
Traumatized people remember, at the same time, too much and too little. Janet was the first to talk about the difference between narrative memory and traumatic memory in people who, we will say today, suffer from post-traumatic stress disorder.
Memories in people who suffer from PTSD can be fragmented, not accessible or accessible only in part. They can also be characterized by disabling memories, painful and very difficult to manage, often impossible to translate into words.
In the cognitive-behavioral model of Post-traumatic stress disorder (Ehlers & Clark, 2000) It is proposed that one of the main problems whether traumatic memories are poorly elaborate and not integrated into a temporal, spatial and consequential context with the other autobiographical memories.
This would explain the problems of intentional reminder of the memory, the characteristics of impressiveness, the non -integration of information and the ease of triggering of physiological and emotional reactions.
The most recent research on PTSD physiology They confirm this model by identifying alterations of the structure and biochemistry of brain networks responsible for recognition, emotional regulation and memorization.
The traumatic experiencesin fact, they are recorded by our brain as sensations or states of the body that are not collected and translated into a subjective story, so the memories of trauma are presented as emotional and sensory states (Van der Kolk, 2004).
La Net: Narrative Exposition Therapy
There Narrative exposure therapy (Net; Neuner, Schauer, Elbert, & Roth, 2002) is a short therapy model developed for the treatment of the PTSD. Especially in the victims of repeated violence, such as torture and captivity and serious or complex trauma, such as wars and migrations.
Takes inspiration from the well -known Exhibition techniques for PTSD (Foa et al., 1991), based on the principles of exhibition therapy used in cognitive-behavioral therapy, adapted to the needs of traumatized individuals who survived wars and torture.
Integrates these techniques with the experience of the Therapy of testimonycarried out during and after Pinochet’s dictatorship in Chile, to help the victims of regime persecutions and serious violations of human rights.
In the latter approach, used by Lira and Weinstein (published under the pseudonyms Cienfuegos and Monelli, 1983), patients built a narrative of their entire life story, exposing themselves through the story to the often multiple traumatic experiences experienced, a story that was then collected as a written testimony.
With these two reference models The NET developswhich puts particular attention to autobiography. The goal of seeing and dealing not only traumatic events individually but the connections that are generated in a history of polytraumatization.
As already mentioned by talking about narrative memories, people with PTSD symptoms do not see the totality of their history and are always activated in the management of symptoms and their consequences.
So the Net intervenes on the reworking of traumatic experiences Not as an isolated path but always inserted in the context in which the event took place and in the person’s life history in his totality.
The narrative is renovated, integrated into the interruptions due to trauma, giving meaning to all its biography.
How the Net intervenes: exposure but not only
As we have seen the main emphasis of the Net treatment is on reconstruction of the history of the person and on exposure to traumatic events that they constele it.
Emphasis is placed on the creation of a coherent narrative of the patient’s life to integrate the traumatic memory in the context of life. However, this is carried out in a context of treatment where there is much more.
Compared to other approaches of trauma treatment The net starts from the chronological story of events, without trying to classify them based on the painful impact they currently have. But by inserting them in a temporal line that represents the life of the patient, with both traumatic events and events inside, on the contrary, pleasant.
In this way you initially have an overview of theTotal life experience of the patienttherefore starting to build an integrated temporal perspective.
As we said for the authors of the Net, an event becomes traumatic because at some point the person can no longer keep the event hooked within the context in which it happened. The event decontextualizes and leaves the person in a deep sense of threat and danger.
The goal becomes restore the possibility of contextualizing the event. This first reconstruction intervention is accompanied by an in -depth psychoeducation on trauma and its consequences, to inform the patient and allow him to overcome the stigma, often present in those who face the PTSD.
It illustrates how certain experiences can induce defense reactions that are adaptive and often allow survival at the time of the event but which become dysfunctional when they reactivate subsequently leaving the nervous system in constant alarm.
After this first phase we go into the actual exhibition, with the full narration of eventsrelated to the imaginative exposure and to particular attention to associated dysfunctional meanings, in connection with somatic reactions and emotions.
Gradually the patient comes into contact with his own experiences and returns them to the chronologically integrated narrative, together with his always present and available therapist in the joint regulation of the emotional and somatic states that emerge in this process.
In addition, a written narrative of his own story is carried out during the whole treatment, which the patient can decide to use as he believes. In this way a symbolic passage of recovery of personal dignity through the realization of the need for recognition and through the orientation on human rights to “testimony”.
Net uses and prospects
Net is applied in different setting and different cultures born, as we said, for the multiple traumatization often associated with war contexts and violation of human rights.
Several studies prove its effectiveness in modulation PTSD symptoms In various groups of patients (Kaltenbach, E. et al., 2020; Jacob N. et al., 2017; Nosè et al., 2017). It presents itself as a treatment of election for extreme migration and trauma (Stenmark et al., 2013).
Several studies show that despite being a short treatment, improvements continue after the end of the path. There is also a promising approach for intergenerational transmission of the trauma, to date one of the main problems that the second generations of refugees and migrants are facing.
Over the years, forms adapted to specific clinical populations have also developed, such as the Kidnet (Schauer M. et al., 2017) for children and young refugees.
The Fornet protocol (Hecker, T. et al., 2015) has been adapted and built for authors of crime with stories of traumatic events, or for victims of trauma that manifest problems related to aggression and discontrilling impulses.
The Net protocol has also been applied to borderline patients with PTSD in hospitalization with promising results.
Finally, even before this pandemic period, the NET has been applied to patients who have had Intensive care experience (Gensichen J. et al., 2018).
The Net therefore proves to be an approach to flexible trauma, integrated and suitable for complexity.
Bibliography
- Cienfuegos, AJ, & Monelli, C. (1983). The Testimony of Political Repression as a Therapeutic Instrument. American Journal of Orthopsychiatry, 53(1), 43–51
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- Foa, EB, Rothbaum, Bo, Riggs, DS, & Murdock, TB (1991). Treatment of Posttraumatic Stress Stress Victims turnip: A Comparison Bethaeen Cognitive-Behavoral Procedures and Counseling. Journal of Consulting and Clinical Psychology, 59(5), 715–723.
- Gensichen, J., Schultz, S., Adrion, C. Et al. Effect of a Combined Brief Narrative Exposure Therapy with Case Management Versus Treatment AS Usual in Primary Care for Patients With Traumatic Stress Following Intensive Care Medicine: Study Protocol for a Multicenter Randomized Controlled Trial (Picture). Trials 19, 480 (2018)
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- Schauer, M., Neuner, F., & Elbert, T. (2017). Narrative Exposure Therapy for Children and Adolescents (Kidnet). In Ma LandoLT, M. Cloitre, & U. Schnyder (Eds.), Evidence-Based Treatments for Trauma Related Dysorders in Children and Adolescents (p. 227–250). Springer International Publishing
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- Van der Kolk, Ba (2004). Psychobiology of posttraumatic stress disorder. In J. Pandsepp (ed.), Textbook of Biological Psychiatry (p. 319–344). Wiley-Liss.
