Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat‐related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage

Abstract

BackgroundDepending on the exposure to traumatic stressors and combat, 20% to 50% of ex‐combatants present with trauma‐related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma‐related suffering and the lowered threshold for aggressive behaviour.ObjectiveSupporting the demobilization process of ex‐combatants in the eastern DR‐Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET).MethodIn two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3‐week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment‐as‐usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success.ResultsSix months post‐intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months.ConclusionsIndividuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.Key Practitioner Message Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET).The intervention is effective in the context of ongoing conflict.Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET.It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors.Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war‐torn regions.

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual, Family, Community, and Socio‐Political Contexts

“…One goal of NET developers was to demonstrate that the model could be effectively delivered by individuals with no formal background in mental health, an approach referred to as tasksharing (Padmanathan & De Silva, 2013). Multiple studies have shown that local community members, such as refugees, could be trained to deliver NET in low-and middle-income countries, including Rwanda, Uganda, Republic of Congo, and Sri Lanka (Ertl et al, 2011;Jacob et al, 2014;K€ obach et al, 2015). In fact, a meta-analysis found that studies that trained local paraprofessionals to deliver NET had, on average, reported larger effect sizes in decreasing PTSD symptoms than studies using highly trained mental health counsellors (Gwozdziewycz & Mehl-Madrona, 2013).…”

“…Improving trauma symptoms can lead to improvements in interpersonal functioning, family relationships, and decreases in depression and substance use (Bichescu, Neuner, Schauer, & Elbert, 2007;Pabst et al, 2014). Additionally, NET has been successfully disseminated by lay paraprofessionals in low-and middle-income countries, resulting in an increase in trained trauma-based mental health professionals (e.g., K€ obach, Schaal, Hecker, & Elbert, 2015).…”

Narrative Expositionstherapie (NET) für Menschen nach Gewalt und Flucht

“…Deutliche Linderungen des seelischen Leidens ergeben sich in den ersten Monaten nach der Behandlung und gewinnen weiter bis zum Einjahresnachuntersuchungszeitpunkt, was auf eine positive Veränderung der Gesundheit, Funktionalität und Lebensqualität der Patienten schließen lässt. Sie bilden sich auch in der Erholung körper-licher Beeinträchtigungen ab (Morath et al 2014 (Neuner et al, 2008;Ertl et al 2011;Jacob et al 2014;Köbach et al 2015). Die NET kann also von entsprechend geschulten Traumaberatern als Modul angeboten werden und wäre damit innerhalb einer gesundheitlichen Gesamtversorgung von Geflüchteten in Deutschland denkbar (Elbert et al 2016).…”

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

“…Short-term interventions such as the Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) have shown promising results in reducing both posttraumatic stress disorder (PTSD; Hermenau, Hecker, Schaal, Maedl, & Elbert, 2013; Köbach, Schaal, Hecker, & Elbert, 2015) and aggressive behaviour in victim–offender populations living in violent environments (Crombach & Elbert, 2015). Effective psychological treatment may be the core facilitator of such reductions in PTSD and the propensity toward violence – also known as appetitive aggression (Elbert, Weierstall, & Schauer, 2010) – in these populations.…”

“…surroundings with many potential traumatic events) could be a breeding ground for appetitive aggression, as confirmed by a positive association between traumatic events and appetitive aggression (Sommer et al, 2017b). Furthermore, as violence perpetration increases, aggression may be perceived more positively (Sommer et al, 2017b; Köbach et al, 2015; Weierstall et al, 2013). As a result, newly experienced traumatic events and newly committed offenses may rekindle an individual’s ‘addiction to violence’ (Hecker, Hermenau, Crombach, & Elbert, 2015) following the completion of a psychological treatment programme and thereby decrease the likelihood of a reduction in appetitive aggression.…”