NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence

New paper by Katy Robjant, Sabine Schmitt, Samuel Carleial, Thomas Elbert, Liliana Abreu, Amani Chibashimba, Harald Hinkel, Anke Hoeffler, Anja C. Rukundo Zeller, Brigitte Rockstroh, Anke Koebach.

Link to paper

Background: War and crises cause tremendous suffering and hardship and contribute to wider problems in our globalized world (e.g., mass migration, modern slavery, poverty). Yet theoretically anchored, evidence-based tools to mitigate the negative effects and restore resilience in affected communities have remained scarce, despite costly international programs.

Significance: Against this background, this article presents a longitudinal trial building on evidence from psychological trauma treatment and peacebuilding. Using trauma-focused individual treatment combined with a community-based intervention, we show that ignominious social norms and attitudes can be addressed effectively with the community-based intervention and thus indirectly reduce ongoing violence.

Case and method: With decades of armed conflict, the Democratic Republic of Congo is an example of crisis-induced long-term instability, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). We tested changes in mental health outcomes as well as change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members.

Results: In comparison to NET alone, NETfacts health system reduced rape myth acceptance more effectively and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.

Katy Robjant (corresponding author), Sabine SchmittSamuel CarleialThomas ElbertLiliana Abreu,
 Amani Chibashimba, Harald Hinkel, Anke HoefflerAnja C. Rukundo Zeller, Brigitte Rockstroh, Anke Koebach (corresponding author). 2022. PNAS 119 (44). DOI.