1
|
Van Voorhees EE, Dillon KH, Crombach A, Beaver T, Kelton K, Wortmann JH, Visn-Mid-Atlantic Mirecc Workgroup, Nieuwsma J. Enjoying the violence of war: Association with posttraumatic symptomatology in U.S. combat veterans. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:618-625. [PMID: 37384480 PMCID: PMC10755059 DOI: 10.1037/tra0001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Engaging in war-related violence can have a devastating impact on military personnel, with research suggesting that injuring or killing others can contribute to posttraumatic stress disorder (PTSD), depression, and moral injury. However, there is also evidence that perpetrating violence in war can become pleasurable to a substantial number of combatants and that developing this "appetitive" form of aggression can diminish PTSD severity. Secondary analyses were conducted on data from a study of moral injury in U.S., Iraq, and Afghanistan combat veterans, to examine the impact of recognizing that one enjoyed war-related violence on outcomes of PTSD, depression, and trauma-related guilt. METHOD Three multiple regression models evaluated the impact of endorsing the item, "I came to realize during the war that I enjoyed violence" on PTSD, depression, and trauma-related guilt, after controlling for age, gender, and combat exposure. RESULTS Results indicated that enjoying violence was positively associated with PTSD, β (SE) = 15.86 (3.02), p < .001, depression, β (SE) = 5.41 (0.98), p < .001, and guilt, β (SE) = 0.20 (0.08), p < .05. Enjoying violence moderated the relationship between combat exposure and PTSD symptoms, β (SE) = -0.28 (0.15), p < .05, such that there was a decrease in the strength of the relationship between combat exposure and PTSD in the presence of endorsing having enjoyed violence. CONCLUSIONS Implications for understanding the impact of combat experiences on postdeployment adjustment, and for applying this understanding to effectively treating posttraumatic symptomatology, are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | | | | | - Jennifer H Wortmann
- Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | | | - Jason Nieuwsma
- Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| |
Collapse
|
2
|
Moran JK, Jesuthasan J, Schalinski I, Kurmeyer C, Oertelt-Prigione S, Abels I, Stangier U, Starck A, Gutermann J, Zier U, Wollny A, Richter K, Krüger A, Schouler-Ocak M. Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees. JAMA Netw Open 2023; 6:e2324511. [PMID: 37471088 PMCID: PMC10359962 DOI: 10.1001/jamanetworkopen.2023.24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/04/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms. Objective To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees. Design, Setting, and Participants For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers. Exposure Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises. Main Outcomes and Measures Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance. Results For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health. Conclusions and Relevance The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.
Collapse
Affiliation(s)
- James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin, St Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic Charité, St Hedwig Hospital, Berlin, Germany
| | - Inga Schalinski
- Universität der Bundeswehr München, Department of Human Sciences, Institute of Psychology, Munich, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Ingar Abels
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrike Zier
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Now with Ministry of Science and Health of Rhineland-Palatinate, Mainz, Germany
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Knejinja Richter
- CuraMed Tagesklinik Nürnberg, Nuremberg, Germany
- Technische Hochschule Nürnberg, Nuremberg, Germany
| | - Antje Krüger
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | | |
Collapse
|
3
|
Mohammed R, Neuner F. Putative juvenile terrorists: the relationship between multiple traumatization, mental health, and expectations for reintegration among Islamic State recruited adolescent and young adult fighters. Confl Health 2022; 16:58. [DOI: 10.1186/s13031-022-00489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In several conflicts worldwide children are recruited as fighters in irregular forces. These children need to be reintegrated into the society after the conflict. However, concurrent to various reservations in the communities, the reintegration of former child soldiers is challenged by the fact that many of the affected children were indoctrinated by the armed group and traumatized through war events. Even several years after the defeat of the terrorist organization ISIS in Iraq, systematic efforts towards the reintegration of children who had been recruited by ISIS are notably absent.
Methods
we conducted clinical interviews with a sample of N = 59 adolescents and young adults who were incarcerated for terrorism in the prisons of the Kurdistan Region of Iraq to assess levels and types of trauma exposure, PTSD, depression, readiness to reintegrate and ongoing identification with ISIS.
Results
We found high levels of PTSD and depression that were associated with trauma exposure. The subjective readiness to reintegrate into the communities was associated with trauma exposure and was mediated by depression, even after controlling for the influence of ongoing identification with the armed group.
Conclusion
The study indicates that trauma-related mental ill-health should be considered in efforts to reintegrate young former terrorists.
Collapse
|
4
|
Robjant K, Schmitt S, Carleial S, Elbert T, Abreu L, Chibashimba A, Hinkel H, Hoeffler A, Rukundo Zeller AC, Rockstroh B, Koebach A. NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence. Proc Natl Acad Sci U S A 2022; 119:e2204698119. [PMID: 36306329 PMCID: PMC9636916 DOI: 10.1073/pnas.2204698119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.
Collapse
Affiliation(s)
- Katy Robjant
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Sabine Schmitt
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Samuel Carleial
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Thomas Elbert
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Liliana Abreu
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
| | - Amani Chibashimba
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | | | - Anke Hoeffler
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
| | - Anja C. Rukundo Zeller
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Brigitte Rockstroh
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Anke Koebach
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
| |
Collapse
|
5
|
Grillo L. A Possible Anti-anxiety Effect of Appetitive Aggression and a Possible Link to the Work of Donald Winnicott. Scand J Child Adolesc Psychiatr Psychol 2022; 10:102-113. [PMID: 36133733 PMCID: PMC9454322 DOI: 10.2478/sjcapp-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.
Collapse
Affiliation(s)
- Luigi Grillo
- San Giorgio su Legnano via Ragazzi del 99Milano MI, Italy
| |
Collapse
|
6
|
Santamaría-García H, Baez S, Aponte-Canencio DM, Pasciarello GO, Donnelly-Kehoe PA, Maggiotti G, Matallana D, Hesse E, Neely A, Zapata JG, Chiong W, Levy J, Decety J, Ibáñez A. Uncovering social-contextual and individual mental health factors associated with violence via computational inference. PATTERNS (NEW YORK, N.Y.) 2021; 2:100176. [PMID: 33659906 PMCID: PMC7892360 DOI: 10.1016/j.patter.2020.100176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023]
Abstract
The identification of human violence determinants has sparked multiple questions from different academic fields. Innovative methodological assessments of the weight and interaction of multiple determinants are still required. Here, we examine multiple features potentially associated with confessed acts of violence in ex-members of illegal armed groups in Colombia (N = 26,349) through deep learning and feature-derived machine learning. We assessed 162 social-contextual and individual mental health potential predictors of historical data regarding consequentialist, appetitive, retaliative, and reactive domains of violence. Deep learning yields high accuracy using the full set of determinants. Progressive feature elimination revealed that contextual factors were more important than individual factors. Combined social network adversities, membership identification, and normalization of violence were among the more accurate social-contextual factors. To a lesser extent the best individual factors were personality traits (borderline, paranoid, and antisocial) and psychiatric symptoms. The results provide a population-based computational classification regarding historical assessments of violence in vulnerable populations.
Collapse
Affiliation(s)
- Hernando Santamaría-García
- Doctorado de Neurociencias, Departamentos de Psiquiatría y Fisiología, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Diego Mauricio Aponte-Canencio
- Universidad Externado de Colombia, Bogotá, Colombia
- Agencia para la Reincorporación y la Normalización (ARN), Bogotá, Colombia
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | - Guido Orlando Pasciarello
- Multimedia Signal Processing Group–Neuroimage Division, French-Argentine International Center for Information and Systems Sciences (CIFASIS)–National Scientific and Technical Research Council (CONICET), Rosario, Argentina
- Laboratory of Neuroimaging and Neuroscience (LANEN), INECO Foundation Rosario, Rosario, Argentina
| | - Patricio Andrés Donnelly-Kehoe
- Multimedia Signal Processing Group–Neuroimage Division, French-Argentine International Center for Information and Systems Sciences (CIFASIS)–National Scientific and Technical Research Council (CONICET), Rosario, Argentina
- Laboratory of Neuroimaging and Neuroscience (LANEN), INECO Foundation Rosario, Rosario, Argentina
| | | | - Diana Matallana
- Doctorado de Neurociencias, Departamentos de Psiquiatría y Fisiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Eugenia Hesse
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Argentina
| | - Alejandra Neely
- Latin American Institute for Brain Health (BrainLat), Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | | | - Winston Chiong
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Jonathan Levy
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya (IDC), Israel
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | | | - Agustín Ibáñez
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Argentina
- Latin American Institute for Brain Health (BrainLat), Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
7
|
Ramos-Lima LF, Waikamp V, Antonelli-Salgado T, Passos IC, Freitas LHM. The use of machine learning techniques in trauma-related disorders: a systematic review. J Psychiatr Res 2020; 121:159-172. [PMID: 31830722 DOI: 10.1016/j.jpsychires.2019.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/22/2019] [Accepted: 12/05/2019] [Indexed: 12/27/2022]
Abstract
Establishing the diagnosis of trauma-related disorders such as Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) have always been a challenge in clinical practice and in academic research, due to clinical and biological heterogeneity. Machine learning (ML) techniques can be applied to improve classification of disorders, to predict outcomes or to determine person-specific treatment selection. We aim to review the existing literature on the use of machine learning techniques in the assessment of subjects with ASD or PTSD. We systematically searched PubMed, Embase and Web of Science for articles published in any language up to May 2019. We found 806 abstracts and included 49 studies in our review. Most of the included studies used multiple levels of biological data to predict risk factors or to identify early symptoms related to PTSD. Other studies used ML classification techniques to distinguish individuals with ASD or PTSD from other psychiatric disorder or from trauma-exposed and healthy controls. We also found studies that attempted to define outcome profiles using clustering techniques and studies that assessed the relationship among symptoms using network analysis. Finally, we proposed a quality assessment in this review, evaluating methodological and technical features on machine learning studies. We concluded that etiologic and clinical heterogeneity of ASD/PTSD patients is suitable to machine learning techniques and a major challenge for the future is to use it in clinical practice for the benefit of patients in an individual level.
Collapse
Affiliation(s)
- Luis Francisco Ramos-Lima
- Post-graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil; Psychological Trauma Research and Treatment Program (NET-Trauma), Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.
| | - Vitoria Waikamp
- Post-graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil; Psychological Trauma Research and Treatment Program (NET-Trauma), Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Thyago Antonelli-Salgado
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Ives Cavalcante Passos
- Post-graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil; Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Lucia Helena Machado Freitas
- Post-graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil; Psychological Trauma Research and Treatment Program (NET-Trauma), Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
8
|
Baez S, Santamaría-García H, Ibáñez A. Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia. Front Psychol 2019; 10:73. [PMID: 30761041 PMCID: PMC6361777 DOI: 10.3389/fpsyg.2019.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023] Open
Abstract
Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.
Collapse
Affiliation(s)
- Sandra Baez
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Hernando Santamaría-García
- Centro de Memoria y Cognición, Intellectus-Hospital Universitario San Ignacio, Bogotá, Colombia.,Physiology and Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| |
Collapse
|
9
|
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. Clin Psychol Psychother 2017; 24:807-825. [PMID: 26676201 PMCID: PMC5573918 DOI: 10.1002/cpp.1986] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depending 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. OBJECTIVE Supporting 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). METHOD In 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. RESULTS Six 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. CONCLUSIONS Individuals 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.
Collapse
Affiliation(s)
- Anke Köbach
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
| | - Susanne Schaal
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of UlmUlmGermany
| | - Tobias Hecker
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of ZürichZürichSwitzerland
| | - Thomas Elbert
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
| |
Collapse
|
10
|
Trujillo S, Trujillo N, Lopez JD, Gomez D, Valencia S, Rendon J, Pineda DA, Parra MA. Social Cognitive Training Improves Emotional Processing and Reduces Aggressive Attitudes in Ex-combatants. Front Psychol 2017; 8:510. [PMID: 28428767 PMCID: PMC5382221 DOI: 10.3389/fpsyg.2017.00510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/20/2017] [Indexed: 01/15/2023] Open
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.
Collapse
Affiliation(s)
- Sandra Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Doctoral Program in Psychology, Department of Psychology, Universidad de GranadaGranada, España.,Department of Experimental Psychology, University of GranadaGranada, Spain
| | - Natalia Trujillo
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia.,Grupo de Neurociencias, Universidad de AntioquiaMedellin, Colombia
| | - Jose D Lopez
- SISTEMIC, Facultad de Ingeniería, Universidad de AntioquiaMedellín, Colombia
| | - Diana Gomez
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Stella Valencia
- Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de AntioquiaMedellín, Colombia
| | - Jorge Rendon
- Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - David A Pineda
- Grupo de Neuropsicología y Conducta, Universidad de AntioquiaMedellin, Colombia
| | - Mario A Parra
- School of Social Sciences, Psychology, Heriot-Watt UniversityEdinburgh, UK.,Cerebro, Cognición y Procesos Sociales, Psicologia, Universidad Autónoma del CaribeBarranquilla, Colombia
| |
Collapse
|
11
|
Conrad D, Wilker S, Pfeiffer A, Lingenfelder B, Ebalu T, Lanzinger H, Elbert T, Kolassa IT, Kolassa S. Does trauma event type matter in the assessment of traumatic load? Eur J Psychotraumatol 2017; 8:1344079. [PMID: 28804594 PMCID: PMC5533143 DOI: 10.1080/20008198.2017.1344079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
Background: The likelihood of developing Posttraumatic Stress Disorder (PTSD) depends on the interaction of individual risk factors and cumulative traumatic experiences. Hence, the identification of individual susceptibility factors warrants precise quantification of trauma exposure. Previous research indicated that some traumatic events may have more severe influences on mental health than others; thus, the assessment of traumatic load may be improved by weighting event list items rather than calculating the simple sum score. Objective: We compared two statistical methods, Random Forests using Conditional Interference (RF-CI) and Least Absolute Shrinkage and Selection Operator (LASSO), based on their ability to rank traumatic experiences according to their importance for predicting lifetime PTSD. Methods: Statistical models were initially fitted in a sample of N1 = 441 survivors of the Northern Ugandan rebel war. The ability to correctly predict lifetime PTSD was then tested in an independent sample of N2 = 211, and subsequently compared with predictions by the simple sum score of different traumatic event types experienced. Results: Results indicate that RF-CI and LASSO allow for a ranking of traumatic events according to their predictive importance for lifetime PTSD. Moreover, RF-CI showed slightly better prediction accuracy than the simple sum score, followed by LASSO when comparing prediction results in the validation sample. Conclusion: Given the expense in time and calculation effort by RF-CI and LASSO, and the relatively low increase in prediction accuracy by RF-CI, we recommend using the simple sum score to measure the environmental factor traumatic load, e.g., in analyses of gene × environment interactions.
Collapse
Affiliation(s)
- Daniela Conrad
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.,Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Birke Lingenfelder
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Hartmut Lanzinger
- Institute of Number Theory and Probability Theory, Ulm University, Ulm, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | | |
Collapse
|