Skip to main content
Log in

Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

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, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Frattaroli, J. (2006). Experimental disclosures and its moderators: a meta-analysis. Psychological Bulletin, 132, 823–865. doi:10.1037/0033-2909.132.6.823.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hoge, C. W. (2011). Interventions for war-related posttraumatic stress disorder. Editorial. JAMA, 306, 549–551. doi:10.1001/jama.2011.1096.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • Institute of Medicine. (2007). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: National Academies Press.

    Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage Publications.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Schaal, S., Elbert, T., & Neuner, F. (2009). Narrative exposure therapy versus interpersonal psychotherapy. Psychotherapy and Psychosomatics, 78, 298–306. doi:10.1159/000229768.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Denise M. Sloan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-014-9292-x

Keywords

Navigation