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Heightened levels of aggression are fuelling violent incidents at all levels, especially in post-war regions. Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) aims to address trauma symptoms along with reactive and instrumental/appetitive aggression to encounter the downward cycle of perpetration and enforce a sustainable (re-)integration into civil life. In the present study, the investigators provide an adapted version of FORNET to former combatants in the North Kivu, Eastern DR Congo. Structured baseline, 3 and 6 month follow up interviews will be administered to assess the main outcome measures recent violent acts and appetitive aggression.
Participants will be recruited through local NGOs and eligible clients randomized to the treatment or waitlist control group, respectively. The treatment will be provided by supervised local counsellors after a 4-week training. At baseline, 3-month and 6-month follow up, sociodemographic data, trauma exposure, perpetrated violent acts, PTSD, recent aggression, functionality and drug dependency will be assessed. The interviews will be conducted by blind Congolese psychological interviewers after an intensive 3-weeks training and continuous supervision.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Narrative Exposure Therapy (FORNET, adapted version) | Active Comparator | Version of Narrative Exposure Therapy for Forensic Offender Rehabilitation including one lifeline session and 5 exposure sessions as well as 6 group sessions adapted from behavioral-therapy approaches for addiction problems. |
|
| Waitlist control or treatment as usual | No Intervention | No intervention or non-specific measures of support on request |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FORNET (adapted version) | Behavioral |
|
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| Measure | Description | Time Frame |
|---|---|---|
| Appetitive aggression (sumscore; 0-60 indicating higher levels) | Appetitive Aggression Scale (Weierstall & Ebert, 2011) | Change from baseline to 3-5 and 6-9 months post treatment |
| Current violent behavior (sumscore; 0-96 indicating more acts) | A list of violent offenses perpetrated during the last 3 months (formerly used in Burundi; Crombach/Augsburger/Nandi) | Change from baseline to 3-5 and 6-9 months post treatment |
| Measure | Description | Time Frame |
|---|---|---|
| PSS-I: Posttraumatic Stress Disorder (sumscore, 0-80 indicating higher severity) | PTSD Symptom Scale (Foa & Tolin, 2000) | Change from baseline to 3-5 and 6-9 months post treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Social acknowledgement (0-45 indicating more social acknowledgment) | Social Acknowledgement Questionnaire (Maerker & Mueller, 2004) | Change from baseline to 3-5 and 6-9 months post treatment |
| Depression (0-27 indicating higher severity) |
Eligibility criteria
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Anke Köbach, PI | University of Konstanz | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Konstanz | Konstanz | Baden-Wurttemberg | 78464 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34531495 | Derived | Carleial S, Natt D, Unternahrer E, Elbert T, Robjant K, Wilker S, Vukojevic V, Kolassa IT, Zeller AC, Koebach A. DNA methylation changes following narrative exposure therapy in a randomized controlled trial with female former child soldiers. Sci Rep. 2021 Sep 16;11(1):18493. doi: 10.1038/s41598-021-98067-9. | |
| 33829803 | Derived |
| Label | URL |
|---|---|
| Results for the group of female former child soldiers | View source |
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| ID | Term |
|---|---|
| D000374 | Aggression |
| ID | Term |
|---|---|
| D000096762 | Aberrant Motor Behavior in Dementia |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D012919 | Social Behavior |
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Patient Health Questionnaire - 9 (Kroenke & Spitzer, 2002)
| Change from baseline to 3-5 and 6-9 months post treatment |
| Substance use problems | Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk et al., 2008) | Change from baseline to 3-5 and 6-9 months post treatment |
| Epigenetic changes | Genome wide methylation patterns (to be explored) | Change from baseline to 6-9 month post treatment |
| Koebach A, Carleial S, Elbert T, Schmitt S, Robjant K. Treating trauma and aggression with narrative exposure therapy in former child and adult soldiers: A randomized controlled trial in Eastern DR Congo. J Consult Clin Psychol. 2021 Mar;89(3):143-155. doi: 10.1037/ccp0000632. |
| 31639529 | Derived | Robjant K, Koebach A, Schmitt S, Chibashimba A, Carleial S, Elbert T. The treatment of posttraumatic stress symptoms and aggression in female former child soldiers using adapted Narrative Exposure therapy - a RCT in Eastern Democratic Republic of Congo. Behav Res Ther. 2019 Dec;123:103482. doi: 10.1016/j.brat.2019.103482. Epub 2019 Sep 27. |