Social cognitive training improves emotional processing and reduces aggressive attitudes in ex-combatants

ABSTRACT: Emotional processing (EP) is a complex cognitive function necessary to successfully adjust to social environments where we need to interpret and respond to cues that convey threat or reward signals. Ex- combatants have consistently shown atypical EP as well as poor social interactions. Available reintegration programs aim to facilitate the re-adaptation of ex-combatants to their communities. However, they do not incorporate actions to improve EP and to enhance cognitive-emotional regulation. The present study was aimed at evaluating the usefulness of an intervention focused on Social Cognitive Training (SCT), which was designed to equip ex-combatants enrolled in the Social Reintegration Route with EP and social cognition skills. A group of 31 ex-combatants (mean age of 37.2, 29 men) from Colombian illegal armed groups were recruited into this study. Of these, 16 were invited to take part in a SCT and the other continued with the conventional reintegration intervention. Both groups underwent 12 training sessions in a period 12–14 weeks. They were assessed with a comprehensive protocol which included Psychosocial, Behavioral, and Emotion Processing instruments. The scores on these instruments prior to and after the intervention were compared within and between groups. Both groups were matched at baseline. Ex-combatants receiving the SCT experienced significant improvements in EP and a reduction in aggressive attitudes, effects not observed in those continuing the conventional reintegration intervention. This is the first study that achieves such outcomes in such a population using SCT intervention. We discuss the implications of such results toward better social reintegration strategies

Zusammenhänge zwischen weiblicher Genitalverstümmelung, psychischer Gesundheit und endokrinen Veränderungen bei Frauen in Äthiopien

In der vorliegenden Arbeit werden die Zusammenhänge verschiedener Formen weiblicher Geni- talverstümmelung, psychischer Gesundheit und endokriner Veränderungen anhand einer Studie mit Frauen in Jijiga (Somali Region, Äthiopien) untersucht.Bisherige Forschungsarbeiten aus dem Bereich weibliche Genitalverstümmelung (engl.: Female Genital Mutilation, FGM) betrachten vor allem die physischen und gynäkologischen Folgen des Eingriffs. Der Zusammenhang von psychischer Gesundheit und weiblicher Genitalverstüm- melung hingegen wird nur in wenigen Studien aus den Ländern Senegal (Behrendt & Moritz, 2005), Ägypten (Chibber et al., 2011) und Irak (Kizilhan, 2011) untersucht. Insgesamt ist dieses Forschungsgebiet bisher wenig erschlossen, weshalb das Hauptanliegen dieser Arbeit die Untersuchung des Zusammenhangs der psychischen Gesundheit und verschiedenen Formen von FGM darstellt. Der Schwerpunkt liegt hierbei auf posttraumatischer Belastungsstörung, Dissoziation, Ängstlichkeit und Depression sowie endokrinen Veränderungen in Zusammenhang mit FGM.Darüber hinaus wird in dieser Arbeit durch die Untersuchung weiterer endokriner Zusammen- hänge ergänzt. Unsichere Lebensumstände, traumatisches Erleben und Stress steigern die Anforderungen des menschlichen Organismus an seine Umwelt, was langfristig unter ande- rem zu Veränderungen des Glukokortikoidspiegels, wie beispielsweise dem des Kortisols, führt (Charmandari et al., 2005). Das Haarkortisol ist ein biologischer Marker für Stress, der sich in den letzten Jahren als retrospektiver Kalender für die Segregation von Kortisol herausgestellt hat (Kirschbaum et al., 2009; Russell et al., 2012). Über die Veränderung des Kortisolgehalts beschnittener Frauen hinaus, ist es ein weiteres Anliegen dieser Arbeit Zusammenhänge der Anzahl traumatischer Lebensereignistypen und der posttraumatischen Belastungsstörung mit den Haarkortisolwerten zu untersuchen.An der Studie nahmen 167 Frauen (FGM I: n = 60, FGM II/III: n = 87) im Alter von 13 bis 80 Jahren teil. Zur Erfassung von Einzelheiten während des Eingriffs der Beschneidung wurde ein ausführlicher Fragenkatalog entworfen. Darüber hinaus wurde familiäre Gewalt über die Checklist of Domestic Violence (Catani et al., 2008) und die Anzahl traumatischer Lebensereig- nistypen anhand der Ereignisliste der Posttraumatic Diagnostic Scale (Foa et al., 1993) erfasst. Die psychische Gesundheit wurde über Symptome der posttraumatischen Belastungsstörung (Posttraumatic Stress Disease Symptom Scale - Interview, Foa et al., 1993), der Dissoziation (Shutdown Dissociation Scale, Schauer & Elbert, 2011), der Depression, der Ängstlichkeit (Hopkins Symptom Checklist 25, Derogatis et al., 1974), der Major Depression, des Sub- stanzmissbrauchs und der -abhängigkeit sowie psychotischen Störungen (Mini International Neuropsychiatric Interview, Sheehan et al., 1998) untersucht.Die Befunde zeigen, dass Frauen, die am schwersten beschnitten (FGM II und FGM III) sind, wie erwartet auch die stärkste Beeinträchtigung der psychischen Gesundheit (PTBS, Ängstlichkeit, Major Depression und Depressivität) aufweisen im Vergleich zu nicht beschnittenen und nach Typ I beschnittenen Frauen. Hinsichtlich dieser Störungen ergeben sich keine Unterschiede zwischen den beiden letztgenannten Gruppen. Dieser Befund spiegelt sich auch unter Einbezug des Effekts der Anzahl traumatischer Lebensereignistypen wider, wobei hier eine Sonderstellung nicht beschnittener Frauen deutlich hervortritt. Bezüglich der Dissoziationssymptomatik unterscheiden sich hingegen beschnittene (FGM I jedoch nur tendenziell) von nicht beschnittenen Frauen, die Beschneidungstypen jedoch nicht untereinander. Die erwarteten Zusammenhänge mit dem Haarkortisol können lediglich für die Anzahl traumatischer Lebensereignistypen bestätigt werden. So zeigt sich kein Zusammenhang verschiedener Formen weiblicher Genitalverstümmelung (No FGM, FGM I und FGM II/III) oder der posttraumatischen Belastungsstörung mit den Haarkortisolwerten. Es wird allerdings ein negativer Zusammenhang von Dissoziation und Haarkortisol unter Kontrolle des Effekts der Anzahl traumatischer Lebensereignistypen entdeckt. Abschließend wird in dieser Arbeit ein pathologisch bedingter Zusammenbruch der adaptiven Steigerung der HHNA-Aktivität in Abhängigkeit traumatischer Erfahrungen diskutiert.Die vorliegende Arbeit kann als Pilotstudie betrachtet werden, die als Grundlage für größere epidemiologische Untersuchungen oder Interventionsplanungen im Bereich FGM herangezogen werden kann. Zum Nachweis kausaler Beziehungen und einer besseren Generalisierbarkeit bedarf es jedoch weiterer Forschung. Darüber hinaus beleuchtet diese Arbeit neue Aspekte der endokrinologischen Forschung anhand einer Stichprobe, die größtenteils frühem Lebensstress ausgesetzt war

Sensitive Periods for Developing a Robust Trait of Appetitive Aggression

Violent behavior can be intrinsically rewarding; especially combatants fighting in current civil wars present with elevated traits of appetitive aggression. The majority of these fighters were recruited as children or adolescents. In the present study, we test whether there is a developmental period where combatants are sensitive for developing a robust trait of appetitive aggression. We investigated 95 combatants in their demobilization process that were recruited at different ages in the Kivu regions of the eastern Democratic Republic of Congo. Using random forest with conditional inference trees, we identified recruitment at the ages from 16 and 17 years as being predictive of the level of appetitive aggression; the number of lifetime, perpetrated acts was the most important predictor. We conclude that high levels of appetitive aggression develop in ex-combatants, especially in those recruited during their middle to late teenage, which is a developmental period marked by a natural inclination to exercise physical force. Consequently, ex-combatants may remain vulnerable for aggressive behavior patterns and re-recruitment unless they are provided alternative strategies for dealing with their aggression.publishe

NETfacts : una intervención comunitaria que integra el tratamiento del trauma a nivel individual y colectivo

The aim of this article is to present a research-based rationale for NETfacts, a newly developed integrated approach at the individual and the community level in order to mitigate the mental and social sequelae of war and crisis. To this end, we provide a selective review of relevant literature from neuroscience, clinical psychology, and social science. In psychotraumatology, individual avoidance describes the effort to prevent exposure to trauma reminders. Among patients with post-traumatic stress disorder (PTSD), this becomes pathological, exacerbating distress and preventing recovery. This silence resonates in traumatized communities and consequently taboo builds – ultimately to the advantage of the perpetrators. The resulting collective avoidance leads to a fragmented collective memory about trauma or human rights violations in the community so that a shared account of the group’s history becomes impossible. The deficient collective memory promotes ambiguous truths and anxiety, enabling a reactive construction of safety based on selective information that leads to an endorsement of extreme opinions. Ongoing insecurity, violence and crime lead to increasing anxiety and fear. The self-interest of the perpetrators and the abnormal behaviour of survivors leads to an escalation in stigma and social exclusion resulting in the prevention or limitation of community exposure to traumatic material, i.e., to reduce tension and protect the construction of safety. The exposure to and recognition of traumatic facts subject to avoidance is key to a coherent collective memory and sense of communion, and to prevent further cycles of violence. The NETfacts health system combines individual and community-based intervention to treat the structure of memory at both the individual and collective levels.publishe

Combat high or traumatic stress : violent offending is associated with appetitive aggression but not with symptoms of traumatic stress

Former members of armed groups in eastern DR Congo had typically witnessed, experienced, and perpetrated extreme forms of violence. Enhanced trauma-related symptoms had been shown in prior research. But also lashing out in self-defense is a familiar response to threat defined as reactive aggression. Another potential response is appetitive aggression, in which the perpetration of excessive violence is perceived as pleasurable (combat high). What roles do these forms of aggressive behavior play in modern warfare and how are they related to posttraumatic stress symptoms? To answer the question, we sought to determine predictors for appetitive aggressive and trauma-related mental illness, and investigated the frequency of psychopathological symptoms for high- and low-intensity conflict demobilization settings. To this end, we interviewed 213 former members of (para)military groups in the eastern Democratic Republic of Congo in regard to their combat exposure, posttraumatic stress, appetitive aggression, depression, suicidality, and drug dependence. Random forest regression embedded in a conditional inference framework revealed that perpetrated violent acts are not necessarily stressful. In fact, the experience of violent acts that typically implicated salient cues of hunting (e.g., blood, suffering of the victim, etc.) had the strongest association with an appetite for aggression. Furthermore, the number of lifetime perpetrated violent acts was the most important predictor of appetitive aggression. However, the number of perpetrated violent acts did not significantly affect the posttraumatic stress. Greater intensity of conflict was associated with more severe posttraumatic stress symptoms and depression. Psychotherapeutic interventions that address appetitive aggression in addition to trauma-related mental illness, including drug dependence, therefore seem indispensible for a successful reintegration of those who fought in the current civil wars

Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations

Abstract Background Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables. Methods We investigated a convenience sample of N = 167 women, supported by the women’s affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure. Results The majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure. Conclusion More extensive forms of FGM are associated with more severe psychopathological symptoms – particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system

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

Köbach A, Schaal S, Hecker T, Elbert T. Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage. Clinical Psychology &amp; Psychotherapy. 2015;24(4):n/a-n/a

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

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.publishe

Violent Offending Promotes Appetitive Aggression Rather than Posttraumatic Stress : A Replication Study with Burundian Ex-Combatants

Research has identified appetitive aggression, i.e., the perception of committed, violent acts as appealing, exciting and fascinating, as a common phenomenon within populations living in precarious and violent circumstances. Investigating demobilized soldiers in the Democratic Republic of Congo (DRC) demonstrated that violent offending is associated with appetitive aggression and not necessarily with symptoms of posttraumatic stress. In the present study, we sought to replicate these results in an independent and larger sample of demobilized soldiers from Burundi. As with the Congolese ex-combatants, random forest regression revealed that the number of lifetime perpetrated violent acts is the most important predictor of appetitive aggression and the number of lifetime experienced traumatic events is the main predictor for posttraumatic stress. Perpetrated violent acts with salient cues of hunting (pursuing the victim, the sight of blood, etc.) were most predictive for perceiving violent cues appealingly after demobilization. Moreover, the association of violent acts and appetitive aggression as well as traumatic events and posttraumatic stress remains strong even years after demobilization. Patterns of traumatic events and perpetrated acts as predictors for posttraumatic stress and appetitive aggression seem to be robust among different samples of ex-combatants who fought in civil wars. Psychotherapeutic interventions that address these complementary facets of combat-related disorders-namely, posttraumatic stress and appetitive aggression-are indispensable for a successful reintegration of those who fought in armed conflicts and to achieve a successful transition to peace.publishe