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Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents

Published online by Cambridge University Press:  31 May 2019

Martina Hinsberger ,
Leon Holtzhausen ,
Jessica Sommer ,
Debra Kaminer ,
Thomas Elbert ,
Soraya Seedat ,
Mareike Augsburger ,
Maggie Schauer  and
Roland Weierstall
Martina Hinsberger*
Affiliation:
Department of Psychology, University of Konstanz, Germany
Leon Holtzhausen
Affiliation:
Department of Social Development, University of Cape Town, South Africa
Jessica Sommer
Affiliation:
Department of Psychology, University of Konstanz, Germany
Debra Kaminer
Affiliation:
Department of Psychology, University of Cape Town, South Africa
Thomas Elbert
Affiliation:
Department of Psychology, University of Konstanz, Germany
Soraya Seedat
Affiliation:
Department of Psychiatry, Stellenbosch University, South Africa
Mareike Augsburger
Affiliation:
Department of Psychology, University of Konstanz, Germany
Maggie Schauer
Affiliation:
Department of Psychology, University of Konstanz, Germany
Roland Weierstall
Affiliation:
Department of Clinical Psychology and Psychotherapy, Medical School Hamburg, Germany
*
*Corresponding author. Email: [email protected]
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Abstract

Background:

Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa.

Aims:

We investigated the long-term effects (15–20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention ‘Thinking for a Change’ (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list.

Method:

Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types.

Results:

The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen’s d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen’s d = 1.00). There were no significant changes observed for CBT or for the waiting list.

Conclusions:

The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.

Keywords

aggressionCBTFORNETgang violencePTSD
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 1 , January 2020 , pp. 1 - 13
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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