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      Treating Traumatized Offenders and Veterans by Means of Narrative Exposure Therapy

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          Abstract

          Violent offenders and soldiers are at high risk of developing appetitive aggression and trauma-related disorders, which reduce successful integration into societies. Narrative exposure therapy (NET) for forensic offender rehabilitation (FORNET) aims at reducing symptoms of traumatic stress (e.g., posttraumatic stress disorder) and controlling readiness for aggressive behavior. It follows the logic of the evidence-based trauma-focused NET with special emphasis on violent acts in past and future behavior. In NET, the therapist guides the client by means of exposure through his traumatic experiences in chronological order linking the negative emotions, such as fear, shame, and disgust, to the past context and integrating the traumatic experiences into the autobiographical memory. During FORNET, we also encourage verbalization of any positive emotions and experiences linked to past violent and aggressive behaviors. This recall of positive emotions (linked to the there and then) is contrasted with feelings that emerge during the narration process ( here and now). In this way, the therapist helps the client to anchor the whole range of sensory and bodily experiences, cognitions, and emotions to the contextual cues. Over the process of the therapy, we support the client to begin the role change from a violent offender to a citizen, who is capable of living a non-violent and socially adjusted life. Finally, the client develops visions and wishes for the future to support a successful integration into society. Several studies with veterans and violent youths have proven the feasibility of FORNET, found evidence of a positive outcome (recovered mental health, fewer offenses committed, less drug intake, and improved integration into civil society), and highlighted the importance of addressing the whole range of experiences while treating violent offenders or veterans.

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          Most cited references58

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          Human aggression.

          Research on human aggression has progressed to a point at which a unifying framework is needed. Major domain-limited theories of aggression include cognitive neoassociation, social learning, social interaction, script, and excitation transfer theories. Using the general aggression model (GAM), this review posits cognition, affect, and arousal to mediate the effects of situational and personological variables on aggression. The review also organizes recent theories of the development and persistence of aggressive personality. Personality is conceptualized as a set of stable knowledge structures that individuals use to interpret events in their social world and to guide their behavior. In addition to organizing what is already known about human aggression, this review, using the GAM framework, also serves the heuristic function of suggesting what research is needed to fill in theoretical gaps and can be used to create and test interventions for reducing aggression.
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            Adverse childhood experiences and the risk of depressive disorders in adulthood.

            Research examining the association between childhood abuse and depressive disorders has frequently assessed abuse categorically, thus not permitting discernment of the cumulative impact of multiple types of abuse. As previous research has documented that adverse childhood experiences (ACEs) are highly interrelated, we examined the association between the number of such experiences (ACE score) and the risk of depressive disorders. Retrospective cohort study of 9460 adult health maintenance organization members in a primary care clinic in San Diego, CA who completed a survey addressing a variety of health-related concerns, which included standardized assessments of lifetime and recent depressive disorders, childhood abuse and household dysfunction. Lifetime prevalence of depressive disorders was 23%. Childhood emotional abuse increased risk for lifetime depressive disorders, with adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI), 2.3-3.2] in women and 2.5 (95% CI, 1.9-3.2) in men. We found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P<0.0001). This relationship was attenuated slightly when a history of growing up with a mentally ill household member was included in the model, but remained significant (P<0.001). The number of ACEs has a graded relationship to both lifetime and recent depressive disorders. These results suggest that exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.
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              Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study.

              This study examined the prevalence of a history of various combinations of childhood maltreatment types (physical abuse, sexual abuse, and witnessing of maternal battering) among adult members of a health maintenance organization (HMO) and explored the relationship with adult mental health of the combinations of types of childhood maltreatment and emotional abuse in the childhood family environment. A total of 8,667 adult members of an HMO completed measures of childhood exposure to family dysfunction, which included items on physical and sexual abuse, witnessing of maternal battering, and emotional abuse in the childhood family environment. The adults' current mental health was assessed by using the mental health scale of the Medical Outcomes Study 36-item Short-Form Health Survey. The prevalences of sexual abuse, physical abuse, and witnessing of maternal violence were 21.6%, 20.6%, and 14.0%, respectively, when the maltreatment types were considered separately. Among respondents reporting any of the maltreatment types, 34.6% reported more than one type of maltreatment. Lower mean mental health scores were associated with higher numbers of abuse categories (mean=78.5, 75.5, 72.8, and 69.9 for respondents with no, one, two, and three abuse types, respectively). Both an emotionally abusive family environment and the interaction of an emotionally abusive family environment with the various maltreatment types had a significant effect on mental health scores. Childhood physical and sexual abuse, as well as witnessing of maternal battering, were common among the adult members of an HMO in this study. Among those reporting any maltreatment, more than one-third had experienced more than one type of maltreatment. A dose-response relation was found between the number of types of maltreatment reported and mental health scores. In addition, an emotionally abusive family environment accentuated the decrements in mental health scores. Future research examining the effects of childhood maltreatment on adult mental health should include assessments of a wide range of abusive experiences, as well as the family atmosphere in which they occur.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                22 June 2015
                2015
                : 6
                : 80
                Affiliations
                [1] 1Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich , Zurich, Switzerland
                [2] 2Vivo International ( www.vivo.org)
                [3] 3Department of Psychology, Division of Clinical Neuropsychology, University of Konstanz , Konstanz, Germany
                Author notes

                Edited by: Michael Noll-Hussong, Ulm University, Germany

                Reviewed by: Casimiro Cabrera Abreu, Queen’s University and Providence Care, Canada; Karl Bechter, Ulm University, Germany

                *Correspondence: Tobias Hecker, Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Binzmuehlestr 14/17, Zurich 8050, Switzerland, t.hecker@ 123456psychologie.uzh.ch

                Specialty section: This article was submitted to Affective Disorders and Psychosomatic Research, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2015.00080
                4475792
                26157395
                4722b9e1-d1b8-40c8-aef9-41116368f3c5
                Copyright © 2015 Hecker, Hermenau, Crombach and Elbert.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 08 April 2015
                : 14 May 2015
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 84, Pages: 13, Words: 11125
                Funding
                Funded by: Deutsche Forschungsgemeinschaft and the European Research Council
                Categories
                Psychiatry
                Hypothesis and Theory

                Clinical Psychology & Psychiatry
                trauma,violent offenders,veterans,narrative exposure,ptsd,aggression
                Clinical Psychology & Psychiatry
                trauma, violent offenders, veterans, narrative exposure, ptsd, aggression

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