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Background: Survivors of sexual violence are frequently condemned and socially excluded. Myths about rape may translate into stigmatization, diminish disclosure, prevent help-seeking from support structures and worsen mental health. Areas of conflict or organized violence remain the evident hotspots of sexual victimization. However, little is known about prevalence and predictors of rape myths in these settings or their association with survivors’ disclosure, stigmatization and psychopathology. Method: Between September 2018 and May 2019, we assessed in a representative sample of 1066 individuals from six communities in Eastern DRC traumatic exposure, sexual perpetration, threats to social integrity, perceived stigmatization (perceived lack of social acknowledgement, shame), stigmatizing attitudes towards survivors (negative attitudes and willingness to provide support, rape myths acceptance), and mental illness (PTSD, depression). Results: Survivors of sexual violence (33%, n = 184 of women, 16%, n = 84 of men) reported more traumatic exposure, threats to social integrity, shame, perceived lack of social acknowledgement, PTSD symptoms and depression. Their social environment affirmed various stigmatizing attitudes (5-89% affirmations). Beliefs in rape myths were predicted by its average acceptance in the community, education, and witness of others’ sexual victimization. The rates of cases whose history of sexual victimization was socially disclosed were higher in communities and among survivors with low rape myths acceptance and disclosure showed associations with perceived stigmatization. Rape myths acceptance among individuals without a history of sexual victimization was associated with survivors’ recently experienced threats to social integrity which predicted their stigma perceptions and mental illness. Conclusion: Rape myths acceptance in the community is associated with stigma and trauma-related mental illness of sexual violence survivors. This adds up to the psychic burden of trauma., Highlights • Survivors of sexual violence experience more threats to physical and social integrity than others. • Stigma is high and predicted by the average attitudes in the community, education and witness of others’ victimization. • Restricted disclosure of victimization is associated with elevated levels of rape myths acceptance in the community. • The community’s beliefs in rape myths predict survivors’ experienced and perceived stigma and worsen their mental health .

Exposure to violence can lead to appetitive aggression (AA), the positive feeling and fascination associated with violence, and posttraumatic stress disorder (PTSD), characterised by hyperarousal, reexperience and feelings of ongoing threat. Psychotherapeutic interventions may act via DNA methylation, an environmentally sensitive epigenetic mechanism that can influence gene expression. We investigated epigenetic signatures of psychotherapy for PTSD and AA symptoms in South African men with chronic trauma exposure. Participants were assigned to one of three groups: narrative exposure therapy for forensic offender rehabilitation (FORNET), cognitive behavioural therapy or waiting list control (n = 9-10/group). Participants provided saliva and completed the Appetitive Aggression Scale and PTSD Symptom Severity Index at baseline, 8-month and 16-month follow-up. The relationship, over time, between methylation in 22 gene promoter region sites, symptom scores, and treatment was assessed using linear mixed models. Compared to baseline, PTSD and AA symptom severity were significantly reduced at 8 and 16 months, respectively, in the FORNET group. Increased methylation of genes implicated in dopaminergic neurotransmission (NR4A2) and synaptic plasticity (AUTS2) was associated with reduced PTSD symptom severity in participants receiving FORNET. Analyses across participants revealed a proportional relationship between AA and methylation of TFAM, a gene involved in mitochondrial biosynthesis.

Bei Menschen, die zunehmend und kumulativ chronischen und traumatischen Stressoren ausgesetzt sind, steigt die Wahrscheinlichkeit, psychische Störungen und Verhaltensdeviationen, aber auch körperliche Erkrankungen zu entwickeln. Geflüchtete sind häufig durch das Erleben organisierter, aber zusätzlich auch häuslicher Gewalt beeinträchtigt. Funktionsuntüchtigkeit behindert die soziale Integrationskapazität und schwächt so über sozialen Ausschluss zusätzlich seelische Gesundheit. Für Traumafolgestörungen gibt es eine Reihe von Behandlungsverfahren, deren Wirksamkeit in wissenschaftlichen Studien ausgezeichnet dokumentiert worden ist. In einkommensstarken Ländern ist in der Regel zu fordern, dass diese Verfahren durch ausgebildete und approbierte Psychotherapeuten durchgeführt werden. Auch wenn die psychotherapeutische Versorgung in Deutschland gut ausgebaut ist, so ist doch die Kapazität nicht ausreichend, um diese zusätzliche Belastung in den bestehenden Strukturen zu schultern. Es bietet sich daher an, die Erfahrung aus systematischen wissenschaftlichen Studien in ressourcenarmen Kriegs- und Krisengebieten zu nutzen, wo mit Personal begrenzter Ausbildung erhebliche Erfolge erzielt werden konnten: In Form von Kaskadenmodellen lernen Mitglieder der jeweiligen Flüchtlings- und Exilgemeinschaft, belastete Personen zu identifizieren, die eine weitere ausführliche Diagnostik benötigen.. Gebildete und zweisprachige Personen, die idealerweise bereits in das psychosoziale Versorgungssystem des Heimatlandes integriert sind (z. B. Krankenschwestern, Lehrer, Sozialarbeiter), werden geschult, um unter der Supervision zentral organisierter approbierter Psychotherapeuten eine weitere Untersuchung in Form eines strukturierten Interviews durchzuführen und niederschwellig evidenzbasierte und robuste Interventionsmodule durchzuführen. Schwer zu beurteilende oder komplexe und therapierefraktäre Fälle werden an lokale Psychotherapeuten/Psychiater, stationäre Einrichtungen oder an entsprechend spezialisierte Behandlungszentren überwiesen. Diese humanitären Angebote basieren auf den Menschenrechtskonventionen und sichern den Schutz, die Freiheit und Würde der Personen. published

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241–250, 2017. © 2016 Wiley Periodicals, Inc.

Die weibliche Genitalverstummelung (FGM: Female Genital Mutilation) ist auch heute noch in vielen Landern vertreten und erfolgt vorwiegend aus traditionellen Grunden. Untersucht wird, ob die Zusammenhange zwischen dem Schweregrad von FGM (Typ I u. III) und Angstlichkeit, Depressivitat und Symptomen einer Posttraumatischen Belastungsstorung (PTBS) von 5 Einstellungen zur FGM-Tradition moderiert werden. Hierfur wurden die Daten von N=109 von FGM-Typ I und III betroffenen Frauen aus Athiopien erhoben und mittels Varianzanalysen ausgewertet. Es liesen sich Moderationseffekte durch die Einstellungen nachweisen. Die Symptomatik der PTBS war bei einer FGM-bejahenden Einstellung bei Frauen mit FGM-Typ III geringer ausgepragt als bei Frauen mit Typ I. Auch die Depressivitat bei FGM-Typ III fiel milder aus, wenn FGM befurwortet wurde. Eine befurwortende Einstellung scheint mit einer besseren Belastungsbewaltigung einherzugehen, nicht zuletzt aufgrund der in Zusammenhang mit FGM erfahrenen sozialen Integration und Anerkennung. In Hinblick auf Aufklarungs- und Abschaffungsbemuhungen zeigt diese Studie die Bedeutung der Einstellung zu FGM in der Bevolkerung auf.

The endocannabinoid system has been implicated in the regulation of the stress response, fear memory formation, and inflammatory processes. Posttraumatic stress disorder (PTSD) can result from exposure to extreme stress and is characterized by strong, associative memories for the traumatic events experienced. Furthermore, an elevated physical disease risk has been observed in PTSD, likely to be mediated by inflammatory processes. Therefore, altered endocannabinoid regulation can be expected in individuals with PTSD. However, attempts to assess PTSD-associated differences in the endocannabinoid system from human blood samples have provided inconsistent results, possibly due to fluctuating levels of endocannabinoids. In hair, these neuromodulators are accumulated over time and thus give access to a more stable and reliable assessment. We therefore investigated PTSD-associated differences in hair concentrations of endocannabinoids (N-acyl-ethanolamides palmitoylethanolamide [PEA], oleoylethanolamide [OEA] and stearoylethanolamide [SEA]) in 38 rebel war survivors from Northern Uganda suffering from PTSD and N=38 healthy rebel war survivors without current and lifetime PTSD. PTSD diagnosis and symptom severity were assessed in structured clinical interviews employing the Posttraumatic Diagnostic Scale (PDS). A significant group difference was observed for OEA, with PTSD patients showing reduced hair concentrations. Regression analyses further revealed strong negative relationships between all investigated N-acyl-ethanolamides and symptom severity of PTSD. The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD. published

Most individuals diagnosed with borderline personality disorder (BPD) have been exposed to severe and traumatic stressors and thus frequently present with symptoms of a posttraumatic stress disorder (PTSD). Severe sleep disturbances often accompany these complex cases, but changes of sleep parameters during therapy and the impact of sleep on treatment response have barely been studied. Narrative Exposure Therapy (NET) is an evidence-based approach for the treatment of trauma-related psychological disorders. To investigate the effect of NET on sleep in patients with BPD and comorbid PTSD, we screened 45 inpatients and outpatients who met the inclusion criteria of both diagnoses according to DSM-IV and who had a minimum of 2 weeks' stable medication. Patients were allocated to NET (N = 13) or treatment as usual (TAU; N = 8) in blocks. Polysomnographies and psychological questionares were performed before, directly and 6 months after the last therapy session. The aim of this pilot study was to investigate the effectiveness of trauma therapy by NET on sleep quantity (total sleep time) and sleep continuity (sleep efficiency and awakenings) in patients with comorbid BPD and PTSD. Participants of the NET group compared with those who received TAU showed an increased reduction in sleep latency from baseline to the end of therapy and a reduction in arousals over time. Patients with longer pre-treatment total sleep time and pre-treatment REM sleep duration showed a better outcome of NET with respect to PTSD symptoms. NET seems not lead to a change in sleep for the worse during therapy and seems to improve sleep as good as treatment as usual. Furthermore, our results provide evidence of an influence of sleep structure at baseline on treatment success later on. published

Zusammenfassung. Belastende Kindheitserfahrungen erhöhen die Wahrscheinlichkeit für psychopathologische Entwicklungen. Misshandelte Kinder weisen ein mehrfaches Risiko auf an Depressionen zu erkranken. Der Krankheitsverlauf beginnt früher, ist schwerer und die Behandlungserfolge sind verringert. Personen, die besonders zurückweisungsempfindlich sind, berichten außerdem mehr belastende Kindheitserfahrungen. In der vorliegenden Studie wird in einer allgemeinpsychiatrischen Klinik mit stationärer und tagesklinischer Behandlung der Zusammenhang zwischen belastender Kindheit und Verlauf der Depression sowie Zurückweisungsempfindlichkeit quantifiziert. Bei 48 Patienten mit einer Diagnose der Depression (F31, F32, F33) wurde zu Behandlungsbeginn und -ende mit einem Selbsteinschätzungs- (BDI) und einem Fremdeinschätzungsmaß (HAM-D) die Schwere depressiver Symptomatik beurteilt. Während des Aufenthalts wurden die Patienten mit der «Skala belastende Kindheitserfahrungen» (KERF-I, Kurzversion) zu belastenden Kindheitserlebnissen interviewt und füllten einen Fragebogen zu Zurückweisungsempfindlichkeit (RSQ) aus. Die Hypothesen wurden mit Korrelationsanalysen getestet. Belastende Kindheitserfahrungen waren mit der BDI-basierten Selbsteinschätzung der Depressivität positiv assoziiert, aber nicht mit dem HAM-D Rating. Patienten mit rezidivierender Depression berichteten doppelt so viele belastende Erfahrungen in ihrer Kindheit als Patienten mit einer einzelnen depressiven Episode. Dreifach höhere Belastungswerte zeigten sich bei Patienten in stationärer Behandlung gegenüber solchen in tagesklinischer Behandlung. Belastende Kindheitserfahrungen waren mit einer erhöhten Zurückweisungsempfindlichkeit assoziiert und diese mit einem geringeren Therapieerfolg. Die Zusammenhänge von belastenden Kindheitserfahrungen mit depressiver Symptomatik und Zurückweisungsempfindlichkeit geben Hinweise auf die Bildung negativer kognitiver Schemata. Die negative Korrelation von Therapieerfolg und Zurückweisungsempfindlichkeit bietet eine Erklärung für den ungünstigeren Verlauf einer depressiven Erkrankung bei Patienten mit vielen belastenden Kindheitserfahrungen.

Hintergrund: Der Konstanzer Index (KINDEX) ist ein strukturiertes Interview, das entwickelt wurde, um bereits pränatal zuverlässig und umfassend Risiken für eine beeinträchtigte psychische Entwicklung des Kindes und der Mutter zu erfassen. Um eine unmittelbare automatisierte Auswertung zu ermöglichen, haben wir das Instrument in Form einer Tablet-gestützten Anwendung (KINDEX-App) weiterentwickelt, die die schwangere Frau eigenständig bedienen kann. Methoden: In dieser Studie kam die KINDEX-App in gynäkologischen Praxen und in Frauenkliniken bei insgesamt N = 956 schwangeren Frauen als Selbstbeurteilungsinstrument zum Einsatz. Zur Bestimmung der Validität des Instruments wurden Vergleiche der Prävalenzen der erhobenen psychosozialen Belastungen mit repräsentativen Studien vorgenommen und Cronbachs alpha wurde berechnet. Des Weiteren wurde die Akzeptanz des Instrumentes sowohl bei den schwangeren Frauen als auch bei Gynäkologinnen und Hebammen erhoben. Ergebnisse: Die Prävalenzzahlen aus unserer Erhebung entsprechen weitgehend anderen Befunden, die in vergleichbaren Kollektiven erhoben wurden, wodurch die externe Validität der App angenommen werden kann. Die Anzahl fehlender Werte war äußerst gering (< 6%) und lässt den Schluss auf eine gute Akzeptanz zu. Die interne Konsistenz der App lag im akzeptablen Bereich (α = 0,68). Schlussfolgerungen: Die KINDEX-App ist ein praktikables und valides Screening-Instrument zur Erfassung psychosozialer Belastungsfaktoren bereits während der Schwangerschaft und bildet damit eine gute Basis für die Prävention und frühe Intervention, sodass eine gelingende Mutter-Kind-Bindung und eine gesunde kindliche Entwicklung gefördert werden können.

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. Language: en

The probability to develop posttraumatic stress disorder (PTSD), characterized by vivid, intrusive emotional memories of the encountered traumatic events, depends - among other factors - on the number of previous traumatic experiences (traumatic load) and individual genetic vulnerability. So far, our knowledge regarding the biological underpinnings of PTSD is relatively sparse. Genome-wide association studies (GWAS) followed by independent replication might help to discover novel, so far unknown biological mechanisms associated with the development of traumatic memories. Here, a GWAS was conducted in N = 924 Northern Ugandan rebel war survivors and identified seven suggestively significant single nucleotide polymorphisms (SNPs; p ≤ 1 × 10−5) for lifetime PTSD risk. Of these seven SNPs, the association of rs3852144 on chromosome 5 was replicated in an independent sample of Rwandan genocide survivors (N = 370, p N = 2698 healthy Swiss individuals. Finally, investigations on N = 90 PTSD patients treated with Narrative Exposure Therapy indicated an additive effect of genotype on PTSD symptom change from pre-treatment to four months after treatment, but not between pre-treatment and the 10-months follow-up. In conclusion, emotional memory formation seems to decline with increasing number of rs3852144 G-alleles, rendering individuals more resilient to PTSD development. However, the impact on therapy outcome remains preliminary and further research is needed to determine how this intronic marker may affect memory processes in detail.

The risk of developing posttraumatic stress disorder (PTSD) increases with the number of traumatic event types experienced (trauma load) in interaction with other psychobiological risk factors. The NOTCH (neurogenic locus notch homolog proteins) signaling pathway, consisting of four different trans‐membrane receptor proteins (NOTCH1–4), constitutes an evolutionarily well‐conserved intercellular communication pathway (involved, e.g., in cell–cell interaction, inflammatory signaling, and learning processes). Its association with fear memory consolidation makes it an interesting candidate for PTSD research. We tested for significant associations of common genetic variants of NOTCH1–4 (investigated by microarray) and genomic methylation of saliva‐derived DNA with lifetime PTSD risk in independent cohorts from Northern Uganda (N 1 = 924) and Rwanda (N 2 = 371), and investigated whether NOTCH‐related gene sets were enriched for associations with lifetime PTSD risk. We found associations of lifetime PTSD risk with single nucleotide polymorphism (SNP) rs2074621 (NOTCH3) (p uncorrected = 0.04) in both cohorts, and with methylation of CpG site cg17519949 (NOTCH3) (p uncorrected = 0.05) in Rwandans. Yet, none of the (epi‐)genetic associations survived multiple testing correction. Gene set enrichment analyses revealed enrichment for associations of two NOTCH pathways with lifetime PTSD risk in Ugandans: NOTCH binding (p corrected = 0.003) and NOTCH receptor processing (p corrected = 0.01). The environmental factor trauma load was significant in all analyses (all p, Integrating genetic, epigenetic, and gene set enrichment analyses, while accounting for the environmental factor traumatic load, we identified stress‐ and memory‐associated neurogenic locus notch homolog protein (NOTCH) genes and related gene sets as potential risk mediators for the development of posttraumatic stress disorder (PTSD) after trauma. Thus, our results strengthen the presumed role of memory‐ and inflammation‐associated genes in PTSD development, and revealed a promising target for future treatment studies. Furthermore, we demonstrated the importance of traumatic load in PTSD etiology, and of an integrated approach in order to obtain a more comprehensive understanding of the functionality of PTSD‐associated markers.

Victims of war, torture and natural catastrophes are prone to develop posttraumatic stress disorder (PTSD). These individuals experience the recurrent, involuntary intrusion of traumatic memories. What neurocognitive mechanisms are driving this memory disorder? Here we show that PTSD symptoms in heavily traumatized refugees are related to deficits in the effective control of memory retrieval. In a think/no-think task, PTSD patients were unable to forget memories that they had previously tried to suppress when compared to control participants with the same trauma history but without PTSD. Deficits in voluntary forgetting were clinically relevant since they correlated with memory intrusions in everyday life. Magnetoencephalography (MEG) recorded during suppression attempts revealed that PTSD patients were unable to downregulate signatures of sensory long-term memory traces in the gamma frequency band (70–120 Hz). Thus, our data suggest that the inability to suppress unwanted memories through modulation of gamma activity is related to PTSD symptom severity.

Objective Women and girls make up a sizeable proportion of armed groups in conflict regions. However, compared to males, research into the mental health of female combatants is limited and there have been no investigations into treatments. Psychological sequalae amongst predominantly male former combatants most prominently include PTSD and appetitive aggression indicating a need for trauma-focused therapy that also addresses violent behaviour with additional components that strengthen social behaviour and inclusion. The aim of this study is to research the effectiveness of a revised adaptation of Narrative Exposure Therapy in a sample of female former child soldiers. Methods 92 female former child soldiers who had been forcibly recruited during the M23 insurgency (2012–2014) in Eastern DRC who were found to have PTSD were randomised into groups receiving a version of Narrative Exposure Therapy adapted for offenders (FORNET) or treatment as usual. Clinical outcomes for PTSD, appetitive aggression and depression were assessed, as well as social outcomes (current violent behaviour, guilt and perceived social acknowledgement). Results High levels of trauma, historical perpetration of extreme violence and ongoing violent behaviour were found within this group. The intervention was found to be superior to treatment as usual at 3–4 month and 9 month follow up for all clinical and social endpoints. Moderate to large effect sizes were found for PTSD, aggression and depression. Conclusions This study investigates the effectiveness of psychotherapy for former female child soldiers, and includes long term follow up. It demonstrates that FORNET combined with group therapy can effectively reduce mental health problems as well as ongoing acts of violence in female former child soldiers within post conflict communities. Trial registration ClinicalTrials.gov Identifier: NCT02992561.

Recent functional magnetic resonance imaging (fMRI) and event-related brain potential (ERP) studies provide empirical support for the notion that emotional cues guide selective attention. Extending this line of research, whole head magneto-encephalogram (MEG) was measured while participants viewed in separate experimental blocks a continuous stream of either pleasant and neutral or unpleasant and neutral pictures, presented for 330 ms each. Event-related magnetic fields (ERF) were analyzed after intersubject sensor coregistration, complemented by minimum norm estimates (MNE) to explore neural generator sources. Both streams of analysis converge by demonstrating the selective emotion processing in an early (120-170 ms) and a late time interval (220-310 ms). ERF analysis revealed that the polarity of the emotion difference fields was reversed across early and late intervals suggesting distinct patterns of activation in the visual processing stream. Source analysis revealed the amplified processing of emotional pictures in visual processing areas with more pronounced occipito-parieto-temporal activation in the early time interval, and a stronger engagement of more anterior, temporal, regions in the later interval. Confirming previous ERP studies showing facilitated emotion processing, the present data suggest that MEG provides a complementary look at the spread of activation in the visual processing stream.

A variety of mental disorders are related to deviant brain activity, but these neural alterations do not validate psychiatric diagnostic categories. High symptom overlap and variable symptom patterns encourage a dimensional approach. Following the logic of the Research Domain Criteria (RDoC), we investigated trauma survivors for symptom clusters that might be associated with characteristics of ERPs, in particular with the early posterior negativity (EPN) elicited during affective picture processing. In rapid serial visual presentation, 90 adolescents (40 male/50 female, age M = 15.0 ± 2.5 years) who had been exposed to varying amounts of traumatic stress passively viewed a stream of high‐arousing positive and low‐arousing neutral pictures taken from the International Affective Picture System (IAPS). Using standardized interviews, symptoms of trauma‐related mental disorders were assessed (including those for PTSD, depression, borderline personality disorder, and behavioral problems). A principal component analysis was performed to derive potential dimensions of psychopathology. Multiple regression analysis confirmed a factor comprising problems concentrating, sleeping difficulties, and mistrust as a predictor of a larger EPN difference between high‐arousing positive and low‐arousing neutral IAPS pictures (β = 0.19, p, Based on the RDoC heuristic, symptom clusters that may be associated with the early posterior negativity (EPN) elicited during affective picture processing were investigated in youth trauma survivors. Analysis confirmed a factor comprising problems concentrating, sleeping difficulties, and mistrust as a predictor of a larger EPN difference between high arousing positive and low arousing neutral IAPS pictures using rapid serial visual presentation (RSVP). The EPN component was also modulated by sex. The findings also extend those of prior research on emotional processing confirming that EPN suppression can also be found in adolescents.

Humans are experiencing wars that target primarily civilians and that are characterized by mass recruitment into armed forces and atrocities. An increasing number of victims is forced to flee from wars and persecution. Following the traumatic events experienced in the context of war and flight, a large proportion of post-conflict populations and refugees is traumatized. Refugees face additional stressors as host countries are not well prepared to meet the mental health needs of incoming refugees. Narrative Exposure Therapy (NET) is a short-term, robust, low-threshold, evidence-based and disseminable treatment module that aims to restore psychosocial functioning while counteracting human rights violations. This treatment has proven to reduce posttraumatic stress disorder even for war victims living in low resource settings and conditions of ongoing threat.

War-related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression--an aggressive reaction to a perceived threat--has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression--a hedonic, intrinsically motivated form of aggression--seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma-related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War-related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war-related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = -.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD.

Objective: The mental health needs of women affected by intimate partner violence (IPV) and living under continuous domestic violence are currently not well understood. The present study investigates the feasibility and efficacy of narrative exposure therapy (NET), compared with commonly used counselling (treatment-as-usual, TAU), in a group of currently IPV-affected women in Tehran, Iran. Method: Forty-five IPV-affected women with a diagnosis of post-traumatic stress disorder (PTSD) were randomized to 10 to 12 sessions of either NET (n = 24) or TAU (n = 21). Primary outcome measures, including PTSD, depression, and perceived stress symptoms, were examined at pretreatment and 3- and 6-month follow-ups. IPV experiences, general lifetime traumatic events, childhood adversities, borderline symptoms, and daily functioning impairment were also inspected. Results: NET participants showed a significantly greater symptom reduction in comparison with the TAU group in PTSD, depression, and perceived stress at both follow-ups. Improvement in daily functioning and reduction of IPV experiences and borderline symptoms at 3- and 6-month follow-ups were pronounced but not significantly different between the two treatment groups. Conclusion: IPV-affected women living under continuous threat and violence would benefit from trauma-focused interventions such as NET. © 2018 John Wiley & Sons, Ltd.

Cognitive and physical activities can benefit cognition. However, knowledge about the neurobiological mechanisms underlying these activity-induced cognitive benefits is still limited, especially with regard to the role of white matter integrity (WMI), which is affected in cognitive aging and Alzheimer's disease. To address this knowledge gap, we investigated the immediate and long-term effects of cognitive or physical training on WMI, as well as the association between cognitive and physical lifestyles and changes in WMI over a 6-month period. Additionally, we explored whether changes in WMI underlie activity-related cognitive changes, and estimated the potential of both trainings to improve WMI by correlating training outcomes with WMI. In an observational and interventional pretest, posttest, 3-month follow-up design, we assigned 47 community-dwelling older adults at risk of dementia to 50 sessions of auditory processing and working memory training (n = 13), 50 sessions of cardiovascular, strength, coordination, balance and flexibility exercises (n = 14), or a control group (n = 20). We measured lifestyles trough self-reports, cognitive training skills through training performance, functional physical fitness through the Senior Fitness Test, and global cognition through a cognitive test battery. WMI was assessed via a composite score of diffusion tensor imaging-based fractional anisotropy (FA) of three regions of interest shown to be affected in aging and Alzheimer's disease: the genu of corpus callosum, the fornix, and the hippocampal cingulum. Effects for training interventions on FA outcomes, as well as associations between lifestyles and changes in FA outcomes were not significant. Additional analyses did show associations between cognitive lifestyle and global cognitive changes at the posttest and the 3-month follow-up (β ≥ 0.40, p ≤ 0.02) and accounting for changes in WMI did not affect these relationships. The targeted training outcomes were related to FA scores at baseline (cognitive training skills and FA composite score, rs = 0.68, p = 0.05; functional physical fitness and fornix FA, r = 0.35, p = 0.03). Overall, we found no evidence of a link between short-term physical or cognitive activities and WMI changes, despite activity-related cognitive changes in older adults at risk of dementia. However, we found positive associations between the two targeted training outcomes and WMI, hinting at a potential of long-term activities to affect WMI. published

Highlights • Hyperarousal and traumatic life events associated with right frontal oscillatory activity. • Childhood stress interacts with mood-related symptoms in left frontal oscillatory activity. • Intrusions related to left frontal beta band activity. • Lateralized DLPFC function could underlie stress and memory dysregulation in PTSD., Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N = 401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2–4 Hz; theta: 4–8 Hz; alpha: 8–12 Hz; beta: 12–24 Hz; gamma: 24–48 Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.

Narrative Exposure Therapy (NET) provides an effective treatment module for children as well as adults who have suffered from multiple and complex traumatization due to violent interpersonal experiences and forced displacement. The chronological processing of a narration of the individual biography of the refugee through NET enables survivors of traumatic stress to obtain a holistic review of their life and thus the integration of life events into a narrative. This process activates resources and enables corrective relationship experiences by revisiting previous social painful situations together with the therapist. Due to the close and interactive nature of the therapy, attachment repair can occur and shame can be reduced as clients discuss memories without being met with rejection or devaluation. This further assists the development of a positive sense of identity. As an empathic listener, the therapist supports the safe recall or even reliving of the most arousing and meaningful life - events, the positive as well as the negative ones. The NET procedure enables recognition of the person and the life history, testifying to human rights violations and regaining dignity.

In KIDNET, the child, with the assistance of the therapist, constructs a chronological narrative with a focus on traumatic experiences. Creative elements are included in this child-friendly version of Narrative Exposure Therapy (NET). Empathic understanding, active listening, congruency and unconditional positive regard are key components of the therapist’s behaviour. Aim of this procedure is to transform the generally fragmented reports of the traumatic experiences into a coherent narrative. For traumatic stress experiences the therapist asks in detail for emotions, cognitions, sensory information and physiological reactions in the past and also in the presence as the child recalls the most arousing experiences. If requested by an adolescent, a written report may be used for rights and human rights advocacy.

The peritraumatic cognitive process of mental defeat, the complete loss of inner resistance, has been identified as a key predictor of PTSD. Yet, most evidence on cognitive risk factors stems from industrialized countries where survivors typically report few traumata. Research from postconflict settings indicates that individual differences decrease with accumulating traumatic experiences, as almost everybody develops PTSD at extreme levels of trauma load. Would this leave less room for the impact of cognitive processes? In a sample of 227 Ugandan rebel war survivors, we investigated whether mental defeat influences trauma-related psychopathology in regression models accounting for cumulative trauma exposure. We found strong main effects of mental defeat on lifetime PTSD risk, current PTSD severity and dissociative symptoms, but no mental defeat × trauma load interaction effects. Our results indicate that peritraumatic mental defeat is central to understand individual differences in psychological reactions after single traumatic events as well as multiple traumatization.

Many mental disorders represent the extremes of the normal distribution of traits, which are related to multiple cognitive and emotional dimensions. By performing whole-exome sequencing of healthy, young subjects with extremely high versus extremely low aversive memory performance, we identified TROVE2 as a gene implicated in emotional memory in health and disease. TROVE2 encodes Ro60, a broadly expressed RNA-binding protein implicated in the regulation of inflammatory gene expression and autoimmunity. A regulatory TROVE2 variant was linked to higher emotional memory capacity and higher emotional memory-related brain activation in healthy subjects. In addition, TROVE2 was associated with traumatic memory and the frequency of post-traumatic stress disorder in genocide survivors. TROVE2, a gene implicated in inflammatory response and autoimmunity, is also associated with enhanced memory for emotionally charged events in post-traumatic stress disorder.

Violence exposure poses a risk for posttraumatic stress disorder (PTSD) and appetitive aggression. Does acknowledgment of violent experiences by one’s social environment also affect these adverse consequences of violence? We investigated relations between number of traumatic event types, number of violent offenses, PTSD symptoms, appetitive aggression, and social acknowledgment. A total of 290 participants were recruited through a Cape Town rehabilitation center for offenders. Using path analysis, we demonstrate higher societal disapproval to be associated with more intense PTSD symptoms and greater appetitive aggression. However, past experiences of recognition were also related to more intense PTSD symptoms. Violence exposure was positively associated with PTSD symptoms and appetitive aggression, and a higher number of violent offenses was related to greater appetitive aggression. Results indicate that besides violence exposure, social acknowledgment may play a significant role in the severity of PTSD and appetitive aggression. Intervention programs should not neglect targeting social structures.

The objectives of this study were to investigate rates of posttraumatic stress disorder (PTSD) and levels of appetitive aggression and potential risk factors for appetitive aggression in a sample of 200 Rwandan genocide perpetrators. Five percent of the perpetrators presented with PTSD, and high levels of appetitive aggression were common. High levels of appetitive aggression were associated with male gender, a high number of past committed offenses, and low levels of positive and elevated levels of negative religious coping. Considering the substantial extent of appetitive aggression, the reintegration of these individuals into the community should consider the inclusion of programs that restrain appetitive aggression and restore psychological functioning to facilitate a peaceful coexistence.

In their review article, Mundt et al. (2014), ‘Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy’, (Intervention, this issue) evaluated Narrative Exposure Therapy (NET) as an example of a short-term treatment for posttraumatic stress disorder that is applied in low and middle income, post conflict settings. They concluded that it is premature to recommend NET as a treatment approach. In this response, the clinicians and researchers who developed NET argue that the paper by Mundt et al. does not correctly represent the rationale of NET and that the methodological critique of the NET trials in the article is biased. Compared to other types of psychotherapy and psychosocial interventions in post conflict settings, the evidence base of NET is strong, and the application of NET within a sustainable mental healthcare system can be recommended.

Research has shown the harmful potential of institutional care on young children; however, little is known about the consequences of institutional care on infants in Sub-Saharan Africa. We compared 35 Tanzanian children who were institutionalized at birth to 4 years of age with a matched group of 35 children who were institutionalized at 5 to 14 years of age. We examined adverse childhood experiences over the course of their entire lives, in their family of origin and in institutional care, and mental health problems at primary school age, such as depressive symptoms, aggressive behavior, and internalizing and externalizing problems. Results showed that early institutionalized children reported more adverse experiences during their time in institutional care and a greater variety of mental health problems than did late institutionalized children. Moreover, maltreatment in institutional care was positively related to mental health problems only in early institutionalized children. We conclude that adverse experiences in institutional care play an important role for early institutionalized children who need special care from adequately educated caregivers. Therefore, training concepts focusing on the needs of the youngest children have to be developed, tested, and established. Countries such as Tanzania need policies that apply to all orphanages to ensure an adequate standard of quality in childcare.

Background: Previous research reveals an association between traumatic stress and an increased risk for numerous diseases, including cancer. At the molecular level, stress may increase carcinogenesis via increased DNA damage and impaired DNA repair mechanisms. We assessed DNA breakage in peripheral blood mononuclear cells from individuals with post-traumatic stress disorder (PTSD) and measured the cellular capacity to repair single-strand breaks after exposure to ionizing X-radiation. We also investigated the effect of psychotherapy on both DNA breakage and DNA repair. Methods: In a first study we investigated DNA breakage and repair in 34 individuals with PTSD and 31 controls. Controls were subdivided into 11 trauma-exposed subjects and 20 individuals without trauma exposure. In a second study, we analysed the effect of psychotherapy (Narrative Exposure Therapy) on DNA breakage and repair. Thirty-eight individuals with PTSD were randomly assigned to either a treatment or a waitlist control condition. Follow-up was performed 4 months and 1 year after therapy. Results: In study 1 we found higher levels of basal DNA breakage in individuals with PTSD and trauma-exposed subjects than in controls, indicating that traumatic stress is associated with DNA breakage. However, single-strand break repair was unimpaired in individuals with PTSD. In study 2, we found that psychotherapy reversed not only PTSD symptoms, but also DNA strand break accumulation. Conclusion: Our results show - for the first time in vivo - an association between traumatic stress and DNA breakage; they also demonstrate changes at the molecular level, i.e., the integrity of DNA, after psychotherapeutic interventions., publishedVersion

Background The Neural Cell Adhesion Molecule 1 (NCAM-1) has been implicated in several brain-related biological processes, including neuronal migration, axonal branching, fasciculation, and synaptogenesis, with a pivotal role in synaptic plasticity. Here, using an interdisciplinary approach we investigated the evolutionary conserved role of Neural Cell Adhesion Molecule 1 (NCAM-1) in learning and memory. Methods First, we examined the temporal transcriptome profiles during C. elegans aversive olfactory long-term memory in a large-scale gene expression study (up to 24 hours upon conditioning). We observed sustained changes in NCAM-1 expression and thus we further investigated its association with aversive memory by using molecular genetics methods. Following, we examined the link between molecular signatures of the NCAM-1 gene and aversive memory in two independent human samples of European descent, by using genome-wide expression and methylation profiling. Finally, in a population of genocide survivors of African descent we investigated the link between NCAM-1 promoter DNA methylation and PTSD. Results NCAM-1 expression showed sustained expression changes up to 24 hours upon aversive olfactory conditioning. Loss of NCAM-1 function selectively impaired long-term memory in a negative but not in positive olfactory associative memory paradigm, without causing acquisition, sensory, motor or short-term memory deficits. Finally, both C. elegans and human NCAM-1 expression in nematodes rescued loss of C. elegans NCAM-1 gene function. Considering the conserved role of NCAM-1 in higher complex organisms, we next expanded our C. elegans findings in human. In two samples of European descent, we showed a negative correlation between DNA methylation of the NCAM-1 promoter and aversive memory (i.e., recognition of negative pictures) as well as a strong positive correlation between NCAM-1 expression and the same recognition performance. In the second sample, we could also show a strong correlation between NCAM-1 expression and long-delayed recall of negative pictures. Finally, in a population of genocide survivors DNA methylation at NCAM-1 gene promoter was inversely correlated with intrusive memories symptoms and Posttraumatic Stress Disorder (PTSD) risk. Discussion Taken together, our results support a conserved role of NCAM-1 in negative associative memory from nematodes to humans and might, ultimately, prove to be helpful in elucidating diagnostic markers and suggest novel therapy targets for memory-related disorders, like PTSD.

Appetitive aggression – a rewarding perception of the perpetration of violence – seems to be an adaptation common to adverse conditions. Children raised within armed groups may develop attitudes and values that favour harming others when socialized within a combat force. Combatants who joined an armed force early in their lives should, therefore, perceive aggression in a more appetitive way than those who were recruited later. We interviewed 95 former members of armed groups operating in the eastern part of the Democratic Republic of the Congo. Those combatants that were having higher levels of appetitive aggression were those who joined a rebel force earlier in life. Surprisingly, neither the amount of military training nor the amount of time spent in the forces had a significant effect on the level of appetitive aggression. Our results show that when civil socialization is replaced by socialization within an armed group early in life, self-regulation of appetitive aggression may become deficient, leading to a higher propensity towards cruelty.

Posttraumatic stress disorder (PTSD) arises as a long-term result of exposure to trauma and brings with it an altered autonomic response to potentially threatening stimuli. The present study investigates the dynamic sequence of cardiac defense in women with and without PTSD. An acoustic noise of 0.5-s duration and 105 dB was used to elicit the cardiac defense reaction. The stimulus was repeated three times. Within the PTSD sample, respondents who suffered from more severe PTSD showed a higher heart rate at rest, a higher baseline, and a greater response. Compared to the healthy subjects, the PTSD group showed an elevated heart rate from 6 s to 25 s following the presentation of the first stimulus. There was evidence of habituation in the PTSD group and hints of differential effects on the cardiac defense of traumatic experiences with a high proximity of danger.

Previous research has demonstrated that those who perpetrate violence and report aggression to be appetitive are less vulnerable to developing posttraumatic stress disorder (PTSD). The current study examined the hypothesis that, among youth offenders living in a high-violence community, an attraction to violence is associated with improved psychosocial functioning and less concern about future threats. A sample of 69 male youth offenders living in two high-violence communities in Cape Town, South Africa, completed measures of trauma exposure, PTSD symptoms, appetitive aggression, reactive aggression, psychosocial functioning, and concerns about future threats. Higher PTSD symptoms predicted lower psychosocial functioning as well as more concern about future threats. However, participants high in appetitive aggression showed better functioning and fewer concerns about future threat. By contrast, reactive aggression was a significant predictor of reduced functioning and increased concerns about threat. These findings suggest that, for youth offenders living in contexts of ongoing violence exposure, appetitive aggression may serve a psychologically self-protective function. Implications for interventions with youth offenders living in high-violence communities are considered. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

As a consequence of the ongoing conflict in the Democratic Republic of the Congo (DRC), combatants are constantly involved in various forms of violence. Findings concerning the impact of perpetrating violence on mental health are contradictory, ranging from increasing to buffering the risk for mental ill health. The present study investigated the impact of perpetrating violence on mental health. In total, 204 forcibly recruited and voluntary male combatants (mean age = 24.61 years) from different armed groups in the eastern DRC took part in the study. In a semistructured interview, respondents were questioned about appetitive aggression and posttraumatic stress disorder (PTSD) as well as self-experienced violence and self-perpetrated violent offending. A multivariate analysis of variance (η(2) = .23) revealed that voluntary combatants perpetrated more violent acts (η(2) = .06) and showed higher appetitive aggression η(2) = .03). A moderated multiple regression analysis (R(2) = .20) showed that perpetrating violence was positively related to PTSD in forcibly recruited combatants, but not in voluntary combatants. Thus, perpetrating violence may not necessarily qualify as a traumatic stressor. Further studies might consider assessing the combatant's perception of committing violent acts. Language: en

Background: Posttraumatic stress disorder (PTSD) results from the formation of a strong memory for the sensory-perceptual and affective representations of traumatic experiences, which is detached from the corresponding autobiographical context information. Because WWC1, the gene encoding protein KIBRA, is associated with long-term memory performance, we hypothesized that commonWWC1 alleles influence the risk for a lifetime diagnosis of PTSD.Methods: Traumatic load and diagnosis of current and lifetime PTSD were assessed in two independent African samples of survivors from conflict zones who had faced severe trauma (n ¼ 392, Rwanda, and n ¼ 399, Northern Uganda, espectively). Array-based single nucleotide polymorphism (SNP) genotyping was performed. The influence of WWC1 tagging SNPs and traumatic load on lifetime PTSDwas estimated by means of logistic regression models with correction for multiple comparisons in the Rwandan sample. Replication analysis was performed in the independent Ugandan sample.Results: An association of two neighboring SNPs in almost complete linkage disequilibrium, rs10038727 and rs4576167, with lifetime PTSD was discovered in the Rwandan sample. Although each traumatic event added to the probability of lifetime PTSD in a dosedependent manner in both genotype groups, carriers of the minor allele of both SNPs displayed a diminished risk (p ¼ .007, oddsratio ¼ .29 [95% confidence interval ¼ .15–.54]). This effect was confirmed in the independent Ugandan sample.Conclusions: This study reveals an association between two WWC1 SNPs and the likelihood of PTSD development, indicating that this memory-related gene might be involved in processes that occur in response to traumatic stress and influence the strengthening of fear memories.

This work examines the effectiveness of two training programs (teacher-assisted versus computer-based) to enhance the visual perception of mild intellectually disabled children native Arabic children in Egypt. Subjects were randomly assigned to three groups: control group with treatment as usual (n=12), traditional/teacher-assisted training (n=12) and a computerized training (n=12). Groups were matched for socio-demographic variables controlling for age, gender, and the education of parents. The success of the different training procedures was evaluated by Frosting Developmental Test of Visual Perception and its transfer to other skills in the same modality (List of Reading Readiness Skills) and general improvement in cognitive abilities (The Stanford-Binet Test). Both programs significantly improved performances of the experimental groups compared to the control group. Yet, no significant differences were found between the two active training groups, suggesting that a computerized trainings may be an option to assist challenged children, particularly when there are no specialized teachers available for the highly time consuming trainings. These findings are discussed in terms of neurological plasticity as well as recommendations for integrated training programs. © 2016 Published by Future Academy www.FutureAcademy.org.uk

The Female Genital Mutilation (FGM) is still practiced in many countries and mainly performed for traditional reasons. In this study, the relationship of the FGM type (type I and type III) with anxiety, depression, and posttraumatic stress disorder as well as the attitude toward FGM was analyzed. For this purpose the data of N=109 of FGM type I and III affected women from Ethiopia were collected. Analyses show moderation effects. It was found that the symptoms of depression and PTSD were less pronounced with a positive attitude towards the FGM in the sample of severely mutilated women (type III). It seems that the attitude toward FGM plays a major role in enhancing social recognition of those affected, thus better coping can take place. As well, this study shows the importance of the attitude of FGM tradition in the population to protect young girls prone for FGM.