Feasibility and effectiveness of narrative exposure therapy and cognitive behavioral therapy in a context of ongoing violence in South Africa.

Hinsberger, Martina; Holtzhausen, Leon; Sommer, Jessica; Kaminer, Debra; Elbert, Thomas; Seedat, Soraya; Wilker, Sarah; Crombach, Anselm

doi:10.1037/tra0000197

Cited by 21 publications

(20 citation statements)

References 33 publications

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“…The present study investigates the long-term effects of FORNET and CBT on symptoms of PTSD, aggressive attitude and behaviour in a sample of juvenile and adult offenders from the low-income urban areas around Cape Town. It constitutes an extension of an earlier report in which the results of the first follow-up demonstrated that exposure-based interventions can successfully reduce PTSD symptoms 8 months post-therapy in a context of continuous stress (Hinsberger et al, 2017). The long-term effects are presented on average 17 months post-treatment.…”

Section: Introductionmentioning

confidence: 69%

Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents

Hinsberger

Holtzhausen

Sommer

et al. 2019

Behav. Cogn. Psychother.

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Background:Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa.Aims:We investigated the long-term effects (15–20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention ‘Thinking for a Change’ (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list.Method:Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types.Results:The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen’s d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen’s d = 1.00). There were no significant changes observed for CBT or for the waiting list.Conclusions:The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.

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Section: Introductionmentioning

confidence: 69%

Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents

Hinsberger

Holtzhausen

Sommer

et al. 2019

Behav. Cogn. Psychother.

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“…Scores for appetitive aggression and committed offense types did not significantly change in any of the treatment conditions. Further information on the treatments, therapists, and outcomes of the intervention study is detailed elsewhere (see Hinsberger et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

“…Items were rated dichotomously: 1 if the event had been experienced, 0 if not. This measure has excellent psychometric properties (Fincham et al, 2009) and has previously been administered in South African high-risk males (Hinsberger et al, 2016). Kuder-Richardson’s alpha in this sample was .86.…”

Section: Methodsmentioning

confidence: 99%

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Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males

Sommer

Hinsberger

Holtzhausen

et al. 2017

European Journal of Psychotraumatology

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Background: In violent communities, social rejection as a person with victim–offender attributes is associated with more intense symptoms of posttraumatic stress disorder (PTSD) and a higher propensity towards violence, i.e. appetitive aggression. Successful community reintegration encompassing adequate social acknowledgment of individuals with both a history of violence exposure and perpetration may be necessary to enhance the treatment effects of interventions addressing PTSD and aggression. Objective: In this study, the effects of treatment and post-treatment traumatic events, violent offenses, and social acknowledgment (with sub-dimensions of general disapproval, family disapproval, and recognition as a person with both a history of violence exposure and commission) on changes in PTSD symptom severity and appetitive aggression from baseline to 8-month follow-up were investigated. Method: Data were collected from 54 males recruited through a Cape Town offender reintegration programme for an intervention study targeting trauma and aggression (n = 28 treatment; n = 26 wait-list). Changes in PTSD symptom severity after treatment were assessed with the PTSD Symptom Scale-Interview, changes in appetitive aggression with the Appetitive Aggression Scale (AAS), post-treatment traumatic events with an adapted version of the Child’s Exposure to Violence Checklist, offenses with an adapted checklist from the AAS, and social acknowledgment with an adapted form of the Social Acknowledgment Questionnaire. Results: Path analyses revealed negative relationships between ongoing societal disapproval and changes in PTSD symptom severity and appetitive aggression at 8-months, controlling for age. All other variables were non-significant, except for treatment, which was associated with PTSD symptom reduction. Conclusions: As a complementary strategy to effective psychotherapeutic treatment, increased social acknowledgment may contribute significantly to the alleviation of PTSD symptoms and appetitive aggression. Psychological interventions should, therefore, not neglect the impact of societal factors on treatment effects.

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“…Igreja, Kleijn, Schreuder, van Dijk, and Verschuur (2004) demonstrated the positive impact of a single session testimony approach with rural survivors of the Mozambican civil war. Studies have examined the efficacy of NET for the treatment of PTSD in various populations in Uganda (Neuner et al, 2008), Rwanda (Schaal, Elbert and Neuner, 2009) and South Africa (Hinsberger et al, 2017) with encouraging results. In the Democratic Republic of Congo (DRC), cognitive processing therapy was shown to reduce the incidence of depression, anxiety and PTSD symptoms among female survivors of sexual violence (Bass et al 2013).…”

Section: S C I E N T I F I C a R T I C L Ementioning

confidence: 99%

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

Higson-Smith

Eagle²

2018

Torture

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Introduction: If the right to rehabilitation is to become a meaningful reality for torture survivors in sub-Saharan Africa, it is necessary that counseling practice be responsive to the contextual and cultural demands of the region. Recent reviews of evidence-based practice with torture survivors are discussed with a focus on those approaches developed and/or tested with torture survivors in sub-Saharan Africa. Methods: The results of a mixed methods study of ongoing torture rehabilitation work are reported. This study incorporated a review of 85 case files of torture survivors treated at torture rehabilitation centers in three countries in sub-Saharan Africa, and in depth interviews with fifteen counsellorsand fourteen clients at those same centers. Quantitative data are presented in tabular form supported by uni- and bi-variate statistical analyses as appropriate. Qualitative data are presented in terms of themes identified through emergent coding. Results and discussion: Help-seeking torture survivors in this region are a diverse and highly symptomatic group, often struggling to survive with their families in precarious circumstances and under ongoing threat. In addition to incorporating key aspects of existing evidence-based practice, counselorsalso use a range of psychosocial approaches to assist torture survivors to protect and support their families in the face of seemingly overwhelming life challenges. We propose that more systematic methodologies that facilitate the inclusion of the voicesof clients and clinicians in ongoing international debates relating to evidencebased practice with torture survivors will enhance the application of such practices in diverse contexts.

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Feasibility and effectiveness of narrative exposure therapy and cognitive behavioral therapy in a context of ongoing violence in South Africa.

Cited by 21 publications

References 33 publications

Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents

Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents

Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

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