Insecure and violent environments foster two different forms of aggressive behavior: reactive aggressive responding, such as fearful or angry impulsive behavior to perceived threats, and appetitive aggression, which encompasses violence-related feelings of power, excitement, and pleasure. We tested whether forensic offender rehabilitation narrative exposure therapy (FORNET; five sessions) would reduce involvement in everyday violence and produce beneficial effects for mental and physical health. In a Burundian residential center for former street children, we identified a subset of 32 male youths (mean age = 17 years) who scored highly in appetitive aggression. We conducted a randomized controlled trial by assigning matched pairs to receive either FORNET or treatment as usual. During the follow-up (4–7 months after completing treatment), the 16 youths who received FORNET reported having committed significantly fewer offenses (Hedges’s g = 0.62) and presented with fewer physical-health complaints (Hedges’s g = 0.56) than did their matched control participants.
CataniC.JacobN.SchauerE.KohilaM.NeunerF. (2008). Family violence, war, and natural disasters: A study of the effect of extreme stress on children’s mental health in Sri Lanka. BMC Psychiatry, 8, 33. Retrieved from http://www.biomedcentral.com/1471-244X/8/33/
6.
ConnerK. R.BeautraisA. L.ConwellY. (2003). Moderators of the relationship between alcohol dependence and suicide and medically serious suicide attempts: Analyses of Canterbury Suicide Project data. Alcoholism: Clinical and Experimental Research, 27, 1156–1161. doi:10.1097/01.alc.0000075820.65197.fd
7.
CrombachA.BambonyéM.ElbertT. (2014). Shattered by violence, poverty and insecurity: A study on reintegration of street children in Burundi. Manuscript submitted for publication.
8.
CrombachA.ElbertT. (2014). The benefits of aggressive traits: A study with street and former street children in Burundi. Child Abuse & Neglect. Advance online publication. doi:10.1016/j.chiabu.2013.12.003
9.
CrombachA.WeierstallR.HeckerT.SchalinskiI.ElbertT. (2013). Social status and the desire to resort to violence—A study on former child soldiers in Uganda. Journal of Aggression, Maltreatment & Trauma, 22, 559–575.
10.
ElbertT.HermenauK.HeckerT.WeierstallR.SchauerM. (2012). FORNET: Behandlung von traumatisierten und nicht-traumatisierten Gewalttätern mittels Narrativer Expositionstherapie [FORNET: Treatment of traumatized and nontraumatized violent offenders by means of narrative exposure therapy]. In EndrassJ.RosseggerA.UrbaniokF.BorchardB. (Eds.), Interventionen bei Gewalt- und Sexualstraftätern: Risk-Management, Methoden und Konzepte der forensischen Therapie (pp. 255–276). Berlin, Germany: Medizinisch Wissenschaftliche Verlagsgesellschaft.
11.
ElbertT.RockstrohB.KolassaI.-T.SchauerM.NeunerF. (2006). The influence of organized violence and terror on brain and mind: A co-constructive perspective. In BaltesP.Reuter-LorenzP.RöslerF. (Eds.), Lifespan development and the brain: The perspective of biocultural co-constructivism (pp. 326–349). New York, NY: Cambridge University Press.
12.
ElbertT.SchauerM. (2002). Burnt into memory. Nature, 419, 883.
13.
ElbertT.SchauerM.SchauerE.HuschkaB.HirthM.NeunerF. (2009). Trauma-related impairment in children—A survey in Sri Lankan provinces affected by armed conflict. Child Abuse & Neglect, 33, 238–246.
14.
ElbertT.WeierstallR.SchauerM. (2010). Fascination violence—On mind and brain of man hunters. European Archives of Psychiatry and Clinical Neuroscience, 260, 100–105.
15.
ErtlV.PfeifferA.SchauerE.ElbertT.NeunerF. (2011). Community-implemented trauma therapy for former child soldiers in Northern Uganda: A randomized controlled trial. Journal of the American Medical Association, 206, 503–512.
16.
FlanneryD. J.WesterK. L.SingerM. I. (2004). Impact of exposure to violence in school on child and adolescent mental health and behavior. Journal of Community Psychology, 32, 559–573.
17.
FontaineR. G. (2007). Disentangling the psychology and law of instrumental and reactive subtypes of aggression. Psychology, Public Policy, and Law, 13, 143–165.
18.
FordJ. D. (2002). Traumatic victimization in childhood and persistent problems with oppositional-defiance. Journal of Aggression, Maltreatment & Trauma, 6, 25–58.
19.
GumaM.HendaN. (2004). The socio-cultural context of child abuse: A betrayal of trust. In RichterL.DawesA.Higson-SmithC. (Eds.), Sexual abuse of young children in southern Africa (pp. 95–109). Cape Town, South Africa: Human Science Research Council Press.
20.
GunnarM.QuevedoK. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145–173.
21.
HartJ. L.O’TooleS. K.Price-SharpsJ. L.ShafferT. W. (2007). The risk and protective factors of violent juvenile offending: An examination of gender differences. Youth Violence and Juvenile Justice, 5, 367–384. doi:10.1177/1541204006297367
22.
HeckerT.HermenauK.MaedlA.ElbertT.SchauerM. (2012). Appetitive aggression in former combatants—Derived from the ongoing conflict in DR Congo. International Journal of Law and Psychiatry, 35, 244–249. doi:10.1016/j.ijlp.2012.02.016
23.
HeckerT.HermenauK.MaedlA.SchauerM.ElbertT. (2013). Aggression inoculates against PTSD symptom severity—Insights from armed groups in eastern DR Congo. European Journal of Psychotraumatology, 4, 2070. Retrieved from http://www.ejpt.net/index.php/ejpt/article/view/20070
24.
HedgesL. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6, 107–128.
25.
HermenauK.HeckerT.RufM.SchauerE.ElbertT.SchauerM. (2011). Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system. Child and Adolescent Psychiatry and Mental Health, 5, 29. Retrieved from http://www.capmh.com/content/5/1/29
26.
HermenauK.HeckerT.SchaalS.MaedlA.ElbertT. (2013). Addressing post-traumatic stress and aggression by means of narrative exposure—A randomized controlled trial with ex-combatants in the eastern DRC. Journal of Aggression, Maltreatment & Trauma, 22, 916–934. doi:10.1080/10926771.2013.824057
JacobN.NeunerF.MaedlA.SchaalS.ElbertT. (2014). Dissemination of psychotherapy for trauma-spectrum disorders in post-conflict settings: A randomized controlled trial in Rwanda. Manuscript submitted for publication.
29.
JacobsonN. S.TruaxP. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy-research. Journal of Consulting and Clinical Psychology, 59, 12–19.
30.
KempesM.MatthysW.de VriesH.van EngelandH. (2005). Reactive and proactive aggression in children—A review of theory, findings and the relevance for child and adolescent psychiatry. European Child & Adolescent Psychiatry, 14, 11–19.
31.
MarseeM. A. (2008). Reactive aggression and posttraumatic stress in adolescents affected by Hurricane Katrina. Journal of Clinical Child & Adolescent Psychology, 37, 519–529.
32.
McManusH. H.ThompsonS. J. (2008). Trauma among unaccompanied homeless youth: The integration of street culture into a model of intervention. Journal of Aggression, Maltreatment & Trauma, 16, 92–109.
33.
MillerK., E.RasmussenA. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70, 7–16. doi:10.1016/j.socscimed.2009.09.029
34.
MorettiM. M.ObsuthI.OdgersC. L.ReebyeP. (2006). Exposure to maternal vs. paternal partner violence, PTSD, and aggression in adolescent girls and boys. Aggressive Behavior, 32, 385–395.
35.
NandiC.CrombachA.BambonyéM.ElbertT.WeierstallR. (2014). Predictors of posttraumatic stress and appetitive aggression in active soldiers and former combatants in Burundi. Manuscript submitted for publication.
36.
NeunerF.CataniC.RufM.SchauerE.SchauerM.ElbertT. (2008). Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): From neurocognitive theory to field intervention. Child and Adolescent Psychiatric Clinics of North America, 17, 641–664.
37.
NeunerF.OnyutP. L.ErtlV.OdenwaldM.SchauerE.ElbertT. (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 686–694.
38.
NeunerF.SchauerM.KlaschikC.KarunakaraU.ElbertT. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72, 579–587.
39.
NsengiyumvaA. (2010). L’espace public urbain comme lieu de survie: Les Timbayi de Bujumbura [The urban public space as a place of survival: The Timbayi of Bujumbura] (Doctoral dissertation). Université Catholique de Louvain, Louvain-la Neuve, Belgium.
40.
PennebakerJ. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162–166.
41.
RobjantK.FazelM. (2010). The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review, 30, 1030–1039. doi:10.1016/j.cpr.2010.07.004
42.
SapolskyR. (2004). Why zebras don’t get ulcers. New York, NY: Owl Books.
43.
SchaalS.ElbertT.NeunerF. (2009). Narrative exposure therapy versus interpersonal psychotherapy: A pilot randomized controlled trial with Rwandan genocide orphans. Psychotherapy and Psychosomatics, 78(5), 298–306.
44.
SchauerM.NeunerF.ElbertT. (2011). Narrative exposure therapy: A short-term treatment for traumatic stress disorders. Toronto, Ontario, Canada: Hogrefe & Huber.
45.
ShawJ. A.HarrisJ. J. (2003). Children of war and children at war: Child victims of terrorism in Mozambique. In UrsanoR. J. (Ed.), Terrorism and disaster: Individual and community mental health interventions (pp. 41–57). New York, NY: Cambridge University Press.
46.
ShieldsA.CicchettiD. (1998). Reactive aggression among maltreated children: The contributions of attention and emotion dysregulation. Journal of Clinical Child Psychology, 27, 381–395.
47.
ShieldsA.CicchettiD. (2001). Parental maltreatment and emotion dysregulation as risk factors for bullying and victimization in middle childhood. Journal of Clinical Child Psychology, 30, 349–363.
48.
SommershofA.AichingerH.EnglerE.AdenauerH.CataniC.BonebergE. M.. . . KolassaI. T. (2009). Lack of naive and regulatory T cells in posttraumatic stress disorder patients. Brain, Behavior, and Immunity, 23, 1117–1124.
49.
SteinbergA. M.BrymerM. J.DeckerK. B.PynoosR. S. (2004). The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6, 96–100.
50.
SteudteS.KolassaI. T.StalderT.PfeifferA.KirschbaumC.ElbertT. (2011). Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology, 36, 1193–1200.
ThompsonS. J.McManusH.VossT. (2006). Posttraumatic stress disorder and substance abuse among youth who are homeless: Treatment issues and implications. Brief Treatment and Crisis Intervention, 6, 206–217.
53.
TurneraH. A.FinkelhorbD.OrmrodbR. (2006). The effect of lifetime victimization on the mental health of children and adolescents. Social Science & Medicine, 62, 13–27.
54.
UvinP. (2009). Life after violence: A people’s story of Burundi. New York, NY: Zed Books.
55.
WeaverC. M.BorkowskiJ. G.WhitmanT. L. (2008). Violence breeds violence: Childhood exposure and adolescent conduct problems. Journal of Community Psychology, 36, 96–112. doi:10.1002/jcop.20219
56.
WeierstallR.ElbertT. (2011). The Appetitive Aggression Scale: Development of an instrument for the assessment of human’s attraction to violence. European Journal of Psychotraumatology, 2, 8430. Retrieved from http://www.ejpt.net/index.php/ejpt/article/view/8430
57.
WeierstallR.ElbertT. (2012). Formen und Klassifikation von menschlicher Aggression [Subtypes and classification of human aggression]. In EndrassJ.RosseggerA.UrbaniokF.BorchardB. (Eds.), Interventionen bei Gewalt- und Sexualstarftätern (pp. 3–14). Berlin, Germany: Medizinisch Wissenschaftliche Verlagsgesellschaft.
58.
WeierstallR.HinsbergerM.KaminerD.HoltzhausenL.MadikaneS.ElbertT. (2013). Appetitive aggression and adaptation to a violent environment among youth offenders. Peace and Conflict: Journal of Peace Psychology, 19, 138–149. doi:10.1037/a0032489
59.
WeierstallR.SchaalS.SchalinskiI.ElbertT. (2011). The thrill of being violent as an antidote to posttraumatic stress disorder in Rwandese genocide perpetrators. European Journal of Psychotraumatology, 2, 6345. Retrieved from http://www.ejpt.net/index.php/ejpt/article/view/6345
60.
WeierstallR.SchalinskiI.CrombachA.HeckerT.ElbertT. (2012). When combat prevents PTSD symptoms: Results of a survey with former child soldiers in Northern Uganda. BMC Psychiatry, 12, 41. Retrieved from http://www.biomedcentral.com/1471-244X/12/41
61.
WoodJ.FoyD. W.LayneC.PynoosR.BoydJ. C. (2002). An examination of the relationships between violence exposure, posttraumatic stress symptomatology, and delinquent activity: An “ecopathological” model of delinquent behavior among incarcerated adolescents. Journal of Aggression, Maltreatment & Trauma, 6, 127–147.
