Treating trauma and aggression with narrative exposure therapy in former child and adult soldiers: A randomized controlled trial in Eastern DR Congo.

Abstract

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.

Life With Corona: Increased Gender Differences in Aggression and Depression Symptoms Due to the COVID-19 Pandemic Burden in Germany

“…Thus, screening for traumatic events should become a routine part of psychological treatment. Combined trauma therapy with extended group sessions allowing for skills training and help to abstain from aggression has shown promising results ( Robjant et al, 2019 ; Koebach et al, 2021 ). In addition, systemic approaches help to de-escalate intrinsic family dynamics that lead to aggression and violence (e.g., Oka and Whiting, 2011 ).…”

“…Aggression can be defined as any behavior intended to cause harm in others motivated either reactively, thus occurring as a response to a perceived threat, or instrumentally/proactively ( Anderson and Bushman, 2002 ). Increasing evidence points to the rewarding and thus self-perpetuating nature of aggression ( Nell, 2006 ; Elbert et al, 2010 , 2018 ; Koebach and Elbert, 2015 ; Golden and Shaham, 2018 ; Golden et al, 2019 ; Koebach et al, 2021 ). In recent aggression models, aggressive behavior is described as a consequence of situational (e.g., stress, frustration, discomfort, threatening stimuli) and personal factors (e.g., traits, attitudes, gender, trauma history), as well as internal states (e.g., cognition, affect, and arousal; e.g., Anderson and Bushman, 2002 ; Bushman, 2016 ; Elbert et al, 2018 ).…”

When reintegration fails: Stigmatization drives the ongoing violence of ex‐combatants in Eastern Democratic Republic of the Congo

“…Ultimately, a downward spiral seems to arise that accelerates the cycles of violence: Ex-combatants who live in a social environment that holds strong rejecting attitudes toward former recruits, who encounter social threats (which they often attribute to their armed group history), and who perceive this stigma doubt that reintegration and re-establishment of their social reputation are possible and in consequence likely feel lonely and dissatisfied with their "new" civilian life are likely less successful in minimizing trauma-and combat-related aggressive tendencies, which again decreases others' openness to reapproach and trust. paper Elbert et al, 2012;development Robjant et al, 2019;Koebach et al, 2021) as well as social tensions. Social approaches have shown promising results; however, they often either required intense individualized therapeutic guidance (e.g., multisystemic therapy, Limbos et al, 2007) or addressed general and not community-specific discriminatory attitudes and behavior toward particular groups (e.g., radio edutainment, Iqbal & Bilali, 2017).…”

NETfacts: a community intervention integrating trauma treatment at the individual and collective level

“…Another strength of NET is that the majority of studies were conducted in humanitarian and emergency settings (e.g. Koebach, Carleial, Elbert, Schmitt, & Robjant, 2021 ; Neuner, Schauer, Klaschik, Karunakara, & Elbert, 2004 ; Orang et al, 2018 ; Schaal, Elbert, & Neuner, 2009 ). Biological studies have revealed impacts on the immune system (Morath, Gola, et al, 2014 ; Morath, Moreno-Villanueva, et al, 2014 ) and DNA methylation in genes relevant to memory processes (Carleial et al, 2021 ).…”