The treatment of posttraumatic stress symptoms and aggression in female former child soldiers using adapted Narrative Exposure therapy – a RCT in Eastern Democratic Republic of Congo

Highlights

• Former female child soldiers in DR Congo have high levels of PTSD and aggression.

• Brief psychotherapeutic interventions reduce trauma related mental health problems.

• Interventions that reduce PTSD and aggression concurrently reduce ongoing conflict.

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.