Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators
2021-07, Siehl, Sebastian, Robjant, Katy, Crombach, Anselm
Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET).
Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short- (< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression.
Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term.
Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.
Feasibility and Effectiveness of Narrative Exposure Therapy and Cognitive Behavioral Therapy in a Context of Ongoing Violence in South Africa
2017, Hinsberger, Martina, Holtzhausen, Leon, Sommer, Jessica, Kaminer, Debra, Elbert, Thomas, Seedat, Soraya, Wilker, Sarah, Crombach, Anselm, Weierstall, Roland
Objective: In an observer-blinded intervention trial, we tested the reduction of posttraumatic stress symptoms, aggressive attitude, and behavior in young males living in a context of ongoing community and gang violence by means of (a) forensic offender rehabilitation narrative exposure therapy (FORNET), and (b) the cognitive-behavioral intervention "Thinking for a Change" (TFAC). A waiting list served as the control condition. Method: A total of 39 young men were included in the data analysis: 15 completed FORNET, 11 underwent cognitive-behavioral therapy (CBT), and 13 were on a waiting list for later treatment. The primary efficacy endpoints were the PTSD Symptom Scale-Interview (PSS-I) severity score, the Appetitive Aggression Scale (AAS) score, and the number of perpetrated violent event types 8 months (on average) after treatment. Results: Only in the sample receiving FORNET were posttraumatic stress disorder (PTSD) scores significantly reduced at the first follow-up (Cohen's d = -0.97) and significantly different from those of the control group (Cohen's d = -1.03). The changes in scores for appetitive aggression and perpetrated events were not significant for any of the treatment conditions. Conclusions: The study shows that trauma-focused treatment can reduce the psychological symptoms of posttraumatic stress even for individuals living under unsafe conditions in low-income urban communities. However, achieving changes in violent behavior within a context of ongoing violence may require more than the treatment of trauma-related suffering, confrontation with one's offenses, or cognitive-behavioral interventions.
Predicting domestic and community violence by soldiers living in a conflict region
2017-11, Nandi, Corina, Elbert, Thomas, Bambonye, Manassé, Weierstall, Roland, Reichert, Manfred, Rukundo-Zeller, Anja C., Crombach, Anselm
Past research revealed war trauma and posttraumatic stress disorder (PTSD) symptoms as potential predictors for domestic and community violence in crisis regions and among soldiers in different armed conflicts. The impact of family violence and other adversities experienced in childhood as well as of a combat-enhanced appeal for aggressive behavior (appetitive aggression) remains to be specified.
In the present study, the authors separately predicted violence against children, intimate partner violence and community violence in 381 Burundian soldiers returning from foreign deployment and living in a post- conflict region. Using path analysis, they aimed to disentangle the independent contributions and pathways of the following variables: Exposure to war trauma and childhood familial violence, PTSD and depression symptom severity, and appetitive aggression.
Childhood familial violence had an independent effect on all contexts of violence and was the only significant predictor for violence against the soldiers’ own children. Intimate partner violence was additionally predicted by depression symptom severity, while community violence was additionally predicted by PTSD symptom severity and appetitive aggression.
Besides war-related mental ill-health and appetitive aggression, violent experiences during childhood development must not be overlooked as a factor fueling the cycle of violence in conflict regions.
Treating and Preventing Psychological Trauma of Children and Adolescents in Post-Conflict Settings
2017, Crombach, Anselm, Wilker, Sarah, Hermenau, Katharin, Wieling, Elizabeth, Hecker, Tobias
Several factors endanger the psychological well-being of children and adolescents growing up in post-conflict settings. The risk of experiencing traumatic events at early stages of their development renders them more vulnerable for developing mental disorders. Furthermore, they have to deal with ongoing socioeconomic insecurity, loss of close relatives, disrupted family systems, and the disruptive consequences of their caregivers’ mental health status on child-rearing practices. In this chapter we identify the particular risk factors for children and adolescents growing up in post-conflict settings. We highlight the need for and provide an overview of existing and developing evidence-based interventions aimed at preventing and treating trauma-related disorders in children and adolescents in these potentially insecure and volatile environments. Specifically, we present the research-based interventions Parent Management Training Oregon model adapted to family systems in post-conflict settings and Interaction Competences with Children for Caregivers in institutional facilities, both aimed at promoting caring and violence-free child-rearing practices. The initial results of both interventions indicate their feasibility of implementation, including first hints of effectiveness, cultural acceptance, and adaptability to specific post-conflict settings. Finally, we introduce Narrative Exposure Therapy for Forensic Offender Rehabilitation as a promising treatment approach to reduce trauma-related symptoms and the risk of aggressive behavior in street children and child soldiers. Throughout the chapter we highlight the feasibility of scientifically evaluating interventions in post-conflict settings and emphasize the need for evidence-based prevention and treatment approaches.
Is the Implicit Association Test for Aggressive Attitudes a Measure for Attraction to Violence or Traumatization?
2017-07, Bluemke, Matthias, Crombach, Anselm, Hecker, Tobias, Schalinski, Inga, Elbert, Thomas, Weierstall, Roland
Traumatic exposure is particularly devastating for those who, at a young age, have become combatants or experienced massive adversity after abduction by armed movements. We investigated the impact of traumatic stressors on psychopathology among war-affected young men of Northern Uganda, including former child soldiers. Adaptation to violent environments and coping with trauma-related symptoms often result in an increasing appetite for violence. We analyze implicit attitudes toward violence, assessed by an Implicit Association Test (IAT), among 64 male participants. Implicit attitudes varied as a function of the number of experienced traumatic event types and committed offense types. As the number of traumatic experiences and violence exposure increased, more appetitive aggression was reported, whereas the IAT indicated increasingly negative implicit attitudes toward aggression. The IAT was also the strongest predictor of cortisol levels. Diffusion-model analysis was the best way to demonstrate IAT validity. Implicit measures revealed the trauma-related changes of cognitive structures.
Appetitive aggression and its relation to posttraumatic stress in Burundian ex-combatants
2016, Nandi, Corina, Crombach, Anselm, Bambonye, Manassé, Elbert, Thomas, Weierstall, Roland
Former combatants have experienced many traumatic events and violence in their past. Symptoms of posttraumatic stress disorder (PTSD) are prevalent among them, but at the same time, many combatants do not suffer from PTSD. Appetitive aggression—the perception of violent acts as appealing and exciting—was found to reduce the risk of developing PTSD symptoms in several studies with combatants of different countries. However, this protective influence waned when traumatization of combatants got too severe. The aim of the present study was to replicate previous findings in a sample of Burundian ex-combatants. The relationship between appetitive aggression and PTSD symptom severity was investigated, and a negative correlation between these variables was expected. On the basis of previous studies, we expected to find this relationship only after excluding the most traumatized participants. Semistructured interviews were conducted with 392 Burundian ex-combatants to assess traumatic event types, self-committed violent acts, PTSD symptom severity (PTSD Symptom Scale Interview) and appetitive aggression (Appetitive Aggression Scale). Appetitive aggression was not correlated with PTSD symptoms severity in the total sample. After the most severely traumatized participants were excluded, appetitive aggression was negatively related to PTSD symptom severity. The findings of the present study confirmed previous findings on the relationship between appetitive aggression and PTSD. Appetitive aggression was shown to lower PTSD symptom severity but is no ultimate protection against PTSD.