Addressing Heightened Levels of Aggression in Traumatized Offenders With Psychotherapeutic Means

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Addressing Heightened Levels of Aggression in Traumatized Offenders With Psychotherapeutic Means: A Randomized Controlled Trial in Eastern DR Congo

Conditions
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Appetitive Aggression

Intervention / Treatment
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* Behavioral: FORNET (adapted version)


Participation Criteria
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Eligibility Criteria
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Eligibility criteria Former participant of an armed group in DR Congo Involvement in violent attacks Inclusion Criteria: PTSD diagnosis or AAS sum score of 22 or higher Exclusion Criteria: Acute intoxification (alcohol or other drugs) Acute psychotic symptoms Sign of cerebro-organic diseases

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Narrative Exposure Therapy (FORNET, adapted version)<br>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. | Behavioral: FORNET (adapted version)<br> <br> * Other names: Narrative Exposure Therapy for Forensic Offender Rehabilitation (adapted version);|
| No Intervention: Waitlist control or treatment as usual<br>No intervention or non-specific measures of support on request | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aggression, Violence, Post-conflict reconstruction, Demobilization, Traumatized offenders