Abstract
Although a number of effective psychotherapies for posttraumatic stress disorder (PTSD) are available, there is a need to develop alternative treatments for those who may not respond optimally to these treatments or who may not have access to clinicians who can competently deliver them. Narrative writing, which involves repeated recounting about a traumatic event in writing, is one treatment that deserves further examination as a potential alternative. In this paper, we describe the most commonly used narrative writing treatment protocols for those with either a diagnosis of PTSD or probable PTSD and discuss the available efficacy data for each of these protocols. We conclude with recommendations for using narrative writing to treat those with PTSD and offer recommendations for future work in this area.
This is a preview of subscription content,
to check access.References
Bichescu, D., Neuner, F., Schauer, M., & Elbert, T. (2007). Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behavior Research and Therapy, 45, 2212–2220. doi:10.1016/j.brat.2006.12.006.
Bragdon, R. S., & Lombardo, W. T. (2012). Written disclosure treatment for posttraumatic stress disorder in substance use disorder inpatient. Behavior Modification, 36, 875–896. doi:10.1177/0145445512451273.
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry. doi:10.1186/1471-244X-9-22.
Cienfuegos, A. J., & Monelli, C. (1983). The testimony of political repression as a therapeutic instrument. American Journal of Orthopsychiatry, 53(1), 43–51. doi:10.1111/j.1939-0025.1983.tb03348.x.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.
Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in Northern Uganda. JAMA, 306(5), 503–512. doi:10.1001/jama.2011.1060.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. doi:10.1037/0033-2909.99.1.20.
Frattaroli, J. (2006). Experimental disclosures and its moderators: a meta-analysis. Psychological Bulletin, 132, 823–865. doi:10.1037/0033-2909.132.6.823.
Gidron, Y., Peri, T., Connolly, J. F., & Shalev, A. Y. (1996). Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient? Journal of Nervous and Mental Disease, 184, 505–507. doi:10.1097/00005053-199608000-00009.
Halvorsen, J. O., & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology, 51, 495–502. doi:10.1111/j.1467-9450.2012.00821.x.
Hamblen, J. L., Schnurr, P. P., Rosenberg, A., & Eftekhari, A. (2009). A guide to literature on psychotherapy for PTSD. Psychiatric Annals, 39, 348e354. doi:10.3928/00485713-20090515-02.
Hensel-Dittman, D., Schauer, M., Ruf, M., Catani, C., Odenwald, M., Elbert, T., & Neuner, F. (2011). Treatment of traumatized victims of war and torture: A randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychotherapy and Psychosomatics, 80, 345–352. doi:10.1159/000327253.
Hijazi, A. M., Lumley, M. A., Ziadni, M. S., Haddad, L., Rapport, L. T., & Arnetz, B. B. (2014). Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: A preliminary randomized clinical trial. Journal of Traumatic Stress, 27, 314–322. doi:10.1002/jts.21922.
Hoge, C. W. (2011). Interventions for war-related posttraumatic stress disorder. Editorial. JAMA, 306, 549–551. doi:10.1001/jama.2011.1096.
Hoge, C. W., Grossman, S. H., Aucherlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014). PTSD treatment for soldiers after combat deployment: Low utilization of mental health care and reasons for dropout. Psychiatric Services, 65, 997–1004. doi:10.1176/appi.ps.201300307.
Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout treatments of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3), 394–404. doi:10.1037/a0031474.
Institute of Medicine. (2007). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: National Academies Press.
Knaevelsrud, C., & Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: A randomized controlled clinical trial. BMC Psychiatry. doi:10.1186/1471-244X/7/13.
Lange, A., Schrieken, B., van de Ven, J. P., Bredeweg, B., Emmelkamp, P. M. G., van der Kilk, J., & Reuvers, A. (2000). “Interapy:” The effects of a short protocolled treatment of posttraumatic stress and pathological grief through the internet. Behavioral and Cognitive Psychotherapy, 28, 175–192.
Neuner, F., Kurreck, S., Ruf, M., Odenwald, M., Elbert, T., & Schauer, M. (2010). Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cognitive Behaviour Therapy, 39(2), 81–91. doi:10.1080/16506070903121042.
Neuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(4), 686–694. doi:10.1037/0022-006X.76.4.686.
Neuner, F., Schauer, M., & Klaschik, C. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72(4), 579–587. doi:10.1037/0022-006X.72.4.579.
Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative exposure therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry. doi:10.1186/1471-244X-5-7.
Pabst, A., Schauer, M., Bernhardt, K., Ruf-Leuschner, M., Goder, R., Elbert, T., & Seeck-Hirschner, M. (2014). Evaluation of Narrative Exposure Therapy (NET) for borderline personality disorder with comorbid posttraumatic stress disorder. Clinical Neuropsychiatry, 11, e1–e10.
Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281. doi:10.1037/0021-843X.95.3.274.
Possemato, K., Ouimette, P., & Knowlton, P. (2011). A brief self-guided telehealth intervention for posttraumatic stress disorder in combat veterans: A pilot study. Journal of Telemedicine and Telecare, 17, 245–250. doi:10.1258/jtt.2011.100909.
Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage Publications.
Robjant, K., & Fazel, M. (2010). The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review, 30, 1030–1039. doi:10.1016/j.cpr.2010.07.004.
Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7-to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437–445. doi:10.1002/jts.20548.
Schaal, S., Elbert, T., & Neuner, F. (2009). Narrative exposure therapy versus interpersonal psychotherapy. Psychotherapy and Psychosomatics, 78, 298–306. doi:10.1159/000229768.
Schnurr, P. P. (2007). The rocks and hard places in psychotherapy outcome research. Journal of Traumatic Stress, 20, 779–792. doi:10.1002/jts.20292.
Sloan, D. M., Lee, D., Litwack, S., Sawyer, A. T., & Marx, B. P. (2013). Written exposure as an intervention for veterans with PTSD. A pilot study. Journal of Traumatic Stress, 26, 776–779. doi:10.1002/jts.21858.
Sloan, D. M., & Marx, B. P. (2004). A closer examination of the structured written disclosure procedure. Journal of Consulting and Clinical Psychology, 72, 165–175. doi:10.1037/0022-006X.72.2.165.
Sloan, D. M., Marx, B. P., Bovin, M. J., Feinstein, B. A., & Gallagher, M. W. (2012). Written exposure as an intervention for PTSD: A randomized controlled trial with motor vehicle accident survivors. Behaviour Research and Therapy, 50, 627–635. doi:10.1016/j.brat.2012.07.001.
Sloan, D. M., Marx, B. P., & Epstein, E. M. (2005). Further examination of the exposure model underlying written emotional disclosure. Journal of Consulting and Clinical Psychology, 73, 549–554. doi:10.1037/0022-006X.73.3.549.
Sloan, D. M., Marx, B. P., Epstein, E. M., & Lexington, J. (2007). Does altering the instructional set affect written disclosure outcome? Behavior Therapy, 38, 155–168. doi:10.1016/j.beth.2006.06.005.
Sloan, D. M., Marx, B. P., & Greenberg, E. M. (2011a). A test of written emotional disclosure as an intervention for posttraumatic stress disorder. Behaviour Research and Therapy, 49, 299–304. doi:10.1016/j.brat.2011.02.001.
Sloan, D. M., Marx, B. P., & Keane, T. M. (2011b). Reducing the Burden of Mental Illness in Military Veterans: Commentary on Kazdin and Blase (2011). Perspectives on Psychological Science, 6, 503. doi:10.1177/1745691611416995.
Smyth, J. M., Hockemeyer, J. R., & Tulloch, H. (2008). Expressive writing and posttraumatic stress disorder: Effects on trauma symptoms, mood states, and cortisol reactivity. British Journal of Health Psychology, 13, 85–93. doi:10.1348/135910707X250866.
Stenmark, F., Catani, C., Neuner, F., Elbert, T., & Holen, A. (2013). Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behavior Research and Therapy, 51, 641–647. doi:10.1016/j.brat.2013.07.002.
VA/DoD Management of Post-Traumatic Stress Working Group (Internet). 2010. VA/DOD clinical practice guideline for management of post-traumatic stress. Washington DC: Department of Veterans Affairs, Department of Defense. http://www.healthquality.va.gov/ptsd/ptsd_full.pdf.
van Emmerik, A. A. P., Kamphuis, J. H., & Emmelkamp, P. M. G. (2008). Treating acute stress disorder and posttraumatic stress disorder with cognitive behavioral therapy or structured writing therapy: A randomized controlled trial. Psychotherapy and Psychosomotics, 77, 93–100. doi:10.1159/000112886.
Zalta, A. K., Gillihan, S. J., Fisher, A. J., Mintz, J., McLean, C. P., Yehuda, R., & Foa, E. (2014). Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. Journal of Consulting and Clinical Psychology, 82(1), 171–175. doi:10.1037/a0034735.
Zang, Y., Hunt, N., & Cox, T. (2013). A randomized controlled pilot study: The effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake. BMC Psychiatry. doi:10.1186/1471-244X-13-41.
Acknowledgments
This work was supported by NIMH R01MH095737 Grant awarded to Denise M. Sloan. Sara Lowmaster is now at the University of South Dakota.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sloan, D.M., Sawyer, A.T., Lowmaster, S.E. et al. Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?. J Contemp Psychother 45, 215–225 (2015). https://doi.org/10.1007/s10879-014-9292-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-014-9292-x