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Objective: Individuals who return from armed groups present with a history of traumatic events including perpetration. Subsequent severe mental stress and heightened levels of reactive and appetitive aggression may persist and if left untreated, frequently impede peacebuilding and societal stability. In this study, we tested a revised adaptation of Narrative Exposure Therapy (NET;Schauer et al., 2011) for Forensic Offender Rehabilitation (FORNET) implemented in a sample of male former combatants in war-torn regions of the DR Congo. Method: We applied a longitudinal parallel-group randomized controlled design with treatment as usual (TAU) as control condition and 3-5 and 6-9 months follow-up assessments. The effect of treatment over time on clinical and social outcomes was tested with GLMMs; appetitive aggression and current violent behavior (CVB) were specified as primary and posttraumatic stress as secondary outcomes. Results: FORNET decreased appetitive aggression (within group Cohen's d z = 2.00), CVB (d z = .90) and posttraumatic stress (d z = 1.48) significantly more than treatment as usual. Clinical significance was obtained for all outcomes. Remarkably, NET clients also reduced their substance abuse (d z = .68) even though this was not targeted within the intervention. Depression, perceived social acknowledgement and subjective solidarity with (para)military life decreased. Conclusion: FORNET is a compact and scalable psychotherapeutic intervention that effectively reduces current aggressive behavior including physical abuse against children, intimate partner violence (IPV), and community violence. FORNET further decreases appetitive aggression, posttraumatic stress symptoms, and other clinical and social problems that commonly hinder demobilization, reintegration, and postconflict peacebuilding. Public Health Significance StatementThis study shows that Narrative Exposure Therapy (NET) adapted to the needs of former adult combatants and child soldiers (Narrative Exposure Therapy for Forensic Offender Rehabilitation [FORNET]) is not only an effective treatment for posttraumatic stress disorder, but also for current violent behavior (CVB) against children, intimate partners, and the community. It also helps to regulate aggression. The treatment proved effective for the reduction of substance involvement and other ClinicalTrials.gov Identifier: NCT02992561.

Background: Survivors of sexual violence are frequently condemned and socially excluded. Myths about rape may translate into stigmatization, diminish disclosure, prevent help-seeking from support structures and worsen mental health. Areas of conflict or organized violence remain the evident hotspots of sexual victimization. However, little is known about prevalence and predictors of rape myths in these settings or their association with survivors’ disclosure, stigmatization and psychopathology. Method: Between September 2018 and May 2019, we assessed in a representative sample of 1066 individuals from six communities in Eastern DRC traumatic exposure, sexual perpetration, threats to social integrity, perceived stigmatization (perceived lack of social acknowledgement, shame), stigmatizing attitudes towards survivors (negative attitudes and willingness to provide support, rape myths acceptance), and mental illness (PTSD, depression). Results: Survivors of sexual violence (33%, n = 184 of women, 16%, n = 84 of men) reported more traumatic exposure, threats to social integrity, shame, perceived lack of social acknowledgement, PTSD symptoms and depression. Their social environment affirmed various stigmatizing attitudes (5-89% affirmations). Beliefs in rape myths were predicted by its average acceptance in the community, education, and witness of others’ sexual victimization. The rates of cases whose history of sexual victimization was socially disclosed were higher in communities and among survivors with low rape myths acceptance and disclosure showed associations with perceived stigmatization. Rape myths acceptance among individuals without a history of sexual victimization was associated with survivors’ recently experienced threats to social integrity which predicted their stigma perceptions and mental illness. Conclusion: Rape myths acceptance in the community is associated with stigma and trauma-related mental illness of sexual violence survivors. This adds up to the psychic burden of trauma.

This study attempted to measure cognitions about adult-child sex by approaching the issue from a perspective of moral attitudes. We assessed ratings regarding direct and indirect harmfulness, nonconsent, exploitation, and differences in adults' and children's sexualities based on a description of adult-child sex without apparent child discomfort among an online sample of 120 pedohebephilic and 89 nonpedohebephilic German-speaking men. The results showed that only 7.5% among pedohebephilic men had equal or less permissive attitudes than the average control, while 4.5% of nonpedohebephilic men had equal or more permissive attitudes than the average pedohebephilic man. Both groups did not, however, differ in their appraisal that children may suffer indirect harm via stigmatization. The findings also indicate that the moral perception of adult-child sex shows little differentiation among German-speaking laypeople. We discuss the relevance of these findings for clinical practice and propose ideas for subsequent research.

Objective Former combatants are exposed to multiple traumatic stressors during conflict situations and usually participate in perpetration of violence. Ongoing perpetration of violence in post conflict areas, linked to mental health problems and appetitive aggression, destabilises peace keeping efforts. The aim of this study is to investigate lifetime exposure to violence and the relationship between this exposure and mental health and current violent behaviour in a sample of female former child soldiers with a history of perpetration of violence in Eastern DR Congo. Methods 98 female former child soldiers who had been abducted and forcibly recruited during the M23 insurgency (2012–2014) were assessed for lifetime exposure to trauma including perpetration of violence, clinical outcomes (PTSD and appetitive aggression), and current violent behaviour. Results Female former child soldiers had been exposed to extremely high levels of trauma including perpetration of violence and presented with high levels of mental health problems. Linear regression models showed that current violent behaviour was predicted by both PTSD and appetitive aggression. Conclusions Trauma exposure predicts ongoing perpetration of violence post conflict via the resulting mental health problems. The findings imply that if PTSD and appetitive aggression symptoms are successfully treated, ongoing violent behaviour in the community post conflict will also decrease.

In the originally published version of our manuscript, values in Table S1 were missing a decimal separator (dot) and some columns were moved due to program incompatibilities when transferring the original data from .csv to .xlsx. To address this, we have now added the ''.'' and corrected the columns so that the Excel file of Table S1 corresponds to the original .csv file. We apologize for the oversight and for any resulting confusion.

In areas of armed conflict such as Eastern DR Congo, a large proportion of the population is affected by violence. Trauma and violent acts can lead to mental health and behavioural problems which have ramifications beyond the individual into the family, community and societal systems, and are passed on across generations. Dynamics of avoidance and with it the dysfunctional communication about survivors' traumatic experience lead to the emergence of prejudices and marginalization of victims and prevent informed understandings in the aggregate. Cycles of violence emerge within communities that ‘build' on the inherited consequences of conflict-related trauma. This article outlines the NETfacts health system that provides an integrated approach to counter the consequences of violence at the individual and community level.

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