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Übersicht

Den transgenerationalen Kreislauf der Gewalt durchbrechen

Wie kann man aggressiven Jugendlichen mit Gewalterfahrungen helfen?

Published Online:February 26, 2018https://doi.org/10.1026/0942-5403/a000249

Abstract

Zusammenfassung. Die langfristigen Folgen des transgenerationalen Kreislaufs der Gewalt belegen die Notwendigkeit für evidenzbasierte Interventionen, um aggressiv-dissoziales Verhalten von Jugendlichen mit Misshandlungs- und Gewalterfahrungen abzubauen. Es erfolgt ein Überblick über solche Therapieansätze und ihre Wirksamkeit. Es werden etablierte Programme dargestellt, deren Wirksamkeit in randomisierten Kontrollgruppenstudien überprüft wurde. Es existieren wenige manualisierte Therapierogramme, die den Abbau aggressiven Verhaltens bei Jugendlichen mit Misshandlungs- und Gewalterfahrungen evaluieren. Solche Therapierogramme bauen aggressives Verhalten bei Jugendlichen mit traumatischen Erfahrungen effektiv ab. Ihre Effektivität wurde in sehr unterschiedlichen Kontexten beurteilt, was einen Vergleich erschwert. Komponenten, die wiederholt erfolgreich angewandt wurden, waren die Aufklärung und Sensibilisierung gegenüber dem Thema „Gewalt“ und die Aufarbeitung einer Narration, die darauf abzielt, die traumatische Erfahrung in das autobiographische Gedächtnis einzuordnen und eine Habituierung zu fördern. Daraus wird geschlossen, dass eine Bearbeitung von Traumata häufig im Vorfeld notwendig ist, um aggressiv-dissoziales Verhalten zu verringern oder abzubauen. Für einen langfristigen Erfolg im Rahmen des Abbaus von aggressiv-dissozialem Verhalten sind jedoch Therapieverfahren notwendig, die sich spezifisch auf aggressiv-dissoziales Verhalten als primäres und nicht sekundäres Ziel (neben der Traumabewältigung) beziehen.


Breaking the Cycle of Violence: How to Help Aggressive Adolescents Who Experienced Violence and Abuse

Abstract. Aggressive and antisocial behavior in adolescents who experienced violence and abuse can develop in isolation from or comorbid to posttraumatic stress disorder (PTSD). This transgenerational cycle of violence can have long-term consequences for the adolescents, for society, and for the health-care system. Therefore, it is important to implement effective evidence-based interventions. The aim of this study is to give an overview of interventions designed to break the cycle of violence and to reduce adolescents’ aggressive and antisocial behavior following violence and abuse. We considered interventions focusing on comorbid aggressive behavior and PTSD as well as interventions aiming at reducing aggressive behavior in abused adolescents independently from PTSD. The therapeutic approach and the efficacy of four interventions that were evaluated in randomized controlled trials are presented: trauma-focused cognitive behavior therapy, Forensic Offender Rehabilitation Narrative Exposure Therapy, the Youth Relationships Project, and the Life Story Intervention. The effect of trauma-focused cognitive behavior therapy on aggressive behavior was tested in four studies with two of them reporting significant reduction of externalizing symptoms in comparison with a wait list control group. Evaluating the Forensic Offender Rehabilitation Narrative Exposure Therapy in a study of former street children showed a significant reduction in the involvement of everyday violence but not of appetitive aggression. The third program – the Youth Relationships Project – could be effectively applied to reduce incidents of physical and emotional abuse in the partnerships of youth with a history of maltreatment. The last program was the Life Story Intervention, which is a mental health intervention for foster care children from methamphetamine-involved families. Adolescents taking part in the Life Story Intervention showed a modest decrease in externalizing symptoms, while in the wait list control group, externalizing symptoms increased over time. The results indicate that manualized interventions can significantly reduce aggressive behavior in adolescents with potentially traumatic experiences in randomized controlled trials. Given that the programs were based on very heterogeneous components as well as that the evaluation studies included heterogeneous samples and different approaches to operationalize aggression, the efficacy of the programs could not be compared. However, this overview gives important insights regarding settings, relevant components, and implementation difficulties of therapeutic approaches in clinical practice. The components that were applied in more than two effective interventions were psychoeducation as well as sensitizing toward violence and its consequences and completing a trauma narration that helps with embedding traumatic experiences in autobiographic memory. It could, therefore, be assumed that coping with trauma is often necessary in order to reduce aggressive and antisocial behavior. Interventions that focus on reducing aggressive and antisocial behavior as a primary goal and not as a secondary goal (besides coping with trauma) are still needed.

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