Narrative exposure therapy for PTSD and structural dissociation and Techniques for its conduct: A Case study in Japanese psychiatric hospital

Narrative exposure therapy (NET) addresses post-traumatic stress disorder (PTSD) by recalling, exposing, and habituating traumatic memories. It organizes autobiographical memories by reconstructing one's entire life history, and facilitates cognitive restructuring. It is particularly effective in dealing with complicated trauma. NET's significant symptom relief is observed shortly after implementation, followed by sustained symptom reduction up to one year later, with the maximum effect being reached at that point. NET was conducted in the outpatient department of a psychiatric hospital to treat a patient with PTSD and structural dissociation (structural dissociation was defined as van der Hart). Structural dissociation posed difficulties in maintaining the motivation to participate in psychotherapy and recall memories, as one's personality is split into multiple parts. Five techniques were used to address this problem: providing treatment for a prolonged period, devising ways to interact with multiple parts, making determinations related to NET, ensuring patient safety, and emphasizing developmental psychoeducation. In the current case, a significant reduction in PTSD symptoms, dissociative symptoms, and depression was observed one year after NET, along with a reduction in eating disorder and dissociative identity disorder (DID) symptoms. Generally, NET takes approximately four to six months for patients in their forties. In the current case, NET took 19 months; however, it was ultimately safely performed, and maladaptation was reduced. The potential adaptation of NET for DID has been suggested, and further accumulation of evidence is expected in the future.