Research

The team of the Neuner and Catani working group at Bielefeld University (AE11) studies the causes and consequences of traumatic experiences with methods from clinical psychology, public health and neurosciences. Across single projects our specific view is characterized by four features:

Developmental life-span
perspective:

We study the interplay between risk factors, protective factors, adversities and outcomes at various stages of the human development
 
Contextual perspective:
The parameters of studies range across socio-ecological levels, from the molecular individual level (including neuronal activity) to the impact of family and community factors
 
Community perspective:
A key focus of our research is on field studies with individuals and groups that accumulate risk factors and adversities but receive little research attention, such as war survivors in conflict regions in Africa and Asia and refugees in Europe
Translational perspective:
Out of the findings of our basic research we develop and test evidence-based mental health interventions, such as Narrative Exposure Therapy, study new mental health structures and test innovative ways of dissemination including web-based technologies

 

Bücher-Icon klein  A publication list of the team can be found here

 

+   The psycho-physiology of social traumatization

Child maltreatment refers to various forms of abusive and potentially harmful parenting that threatens the healthy development of a child. Most of this research refers to the consequences of physical abuse, sexual abuse, physical neglect or combinations of these types of maltreatment. Second to traumatic events that involve a threat to life and limb, it is aversive social experiences that can be detrimental for mental health. Traumatic social experiences include emotional abuse and neglect by caretakers as well as relational peer victimization. Recently, there is a growing body of evidence that indicates that experiences of emotional maltreatment increase the risk of various forms of psychopathology.

In several studies it has been shown that the regulation of stress responses can be altered by psychopathology and adverse childhood experiences. However, research examining alterations in the physiological responses to stress in subjects with a history of emotional maltreatment is still scarce. Additionally, to date it is unknown whether the processing of threatening cues in emotional maltreated individuals underlies the same mechanisms as the information processing in victims of physical and sexual abuse where the formation of associative memory representations has been suggested.

In the current project we aim to disclose psycho-physiological consequences of emotional maltreatment and to reveal underlying mechanisms that may link emotional maltreatment to psychopathology. In particular, in a series of studies we investigate reactivity to social stressors on different physiological (EEG, ECG, SCL, EMG) and experiential parameters as a function of levels of child maltreatment and diagnostic status of various psychiatric disorders.

Contact person: Dr. Benjamin Iffland
+   Recent publications
  • Klein, F., Iffland, B., Schindler, S., Wabnitz, P., & Neuner, F. (2015). This person is saying bad things about you: The influence of physically and socially threatening context information on the processing of inherently neutral faces. Cognitive, Affective, & Behavioral Neuroscience , 1-13.
  • Sansen, L., Iffland, B., & Neuner, F. (2015) The trauma of peer victimization: Psychophysiological and emotional characteristics of memory imagery in subjects with social anxiety disorder, Psychophysiology, 52 (1), 107-116.
  • Iffland, B., Sansen, L., & Neuner, F., (2014) Rapid heartbeat, but dry palms: reactions of heart rate and skin conductance levels to social rejection, Frontiers in Psychology ,5: 956.
  • Iffland, B., Sansen, L., Catani, C., & Neuner, F., (2014) The trauma of peer abuse: Effects of relational peer victimization and social anxiety disorder on physiological and affective reactions to social exclusion, Frontiers in Psychiatry , 5:26.
  • Sansen, L., Iffland, B., & Neuner, F. (2014) Peer victimization predicts psychological symptoms beyond the effects of child maltreatment, Psychiatry Research , 220, 1051-1058.
  • Sansen, L., Iffland, B., Catani, C., & Neuner, F. (2013) Die Bedeutung aversiver sozialer Erfahrungen in Familie und Peergroup für die Entwicklung sozialer Ängste, Zeitschrift für Klinische Psychologie und Psychotherapie , 42, 34-44.
  • Iffland, B., Sansen, L., Catani, C., & Neuner, F. (2012). Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based Internet survey. BMC Psychiatry , 12:49.
  • Wabnitz, P., Martens, U., & Neuner, F. (2012). Cortical reactions to verbal abuse: Event-related brain potentials reflecting the processing of socially threatening words. NeuroReport . 23(13), 774-779.
+   Traumatized Refugee families in the Great Lakes Region in Africa

According to actual figures of the United Nations High Commissioner for Refugees (UNHCR), the number of refugees has reached an unprecedented number of 22.5 million over the half of whom are children and adolescents. Most refugees flee from war and conflict in their home countries to neighboring countries, which are relatively safe, yet struggle with economic hardships themselves. In these host countries, refugees are required to reside in refugee camps where they often face new stressors such as overcrowding and scarcity of resources. Despite this global reality of refugees` lives, research on mental health has focused on refugees in high-income settings of Europe and North America and little is known about refugees living in camps close to ongoing war and conflict. In particular, children`s psychological well-being, psychosocial and cognitive functioning has hardly been examined in this context. It remains unclear how family factors such as parental well-being and community factors such as family and community violence might relate to refugee children`s mental health and functioning. Tanzania provides a case in point of low to middle-income refugee hosting countries with currently three refugee camps providing shelter for more than 300 000 refugees mainly from neighboring Burundi and the Democratic Republic of Congo (DRC). Our research project seeks to investigate experiences of trauma and violence in refugee families in refugee camps and how these experiences relate to children`s mental health, psychosocial and cognitive functioning. A representative sample of 200 family triads (child, mother, father) will be assessed in three refugee camps in Tanzania. The project will be carried out in cooperation with the University of Zurich, Switzerland, and the Dar es Salaam University College of Education. Multi-methods will be used for data collection: Structural clinical interviews will be applied to assess experiences of trauma and violence, mental health and psychosocial functioning in children and parents. Neuropsychological tests of attention, memory and executive functioning will provide a measure of children`s cognitive functioning. A behavioral observation paradigm will be used to assess the interaction between mother and child. Hair sampling and buccal swab sampling are applied to obtain indicators of functioning of biological stress systems.


Project coordinator:
Dr. Tobias Hecker (Bielefeld University)
Project staff:
Florian Scharpf, MSc (Bielefeld University), Edna Kyaruzi, MA (Dar es Salaam University College of Education)

+   Recent publications
  • Ainamani, H. E., Elbert, T., Olema, D. K., & Hecker, T. (2017). PTSD symptom severity relates to cognitive and psycho-social dysfunctioning – a study with Congolese refugees in Uganda. European Journal of Psychotraumatology, 8, 1283086. doi: 10.1080/20008198.2017.1283086
  • Hecker, T., Ainamani, H. E., Hermenau, K., Haefele, E., & Elbert, T. (2017). Exploring the potential distinction between continuous traumatic stress and posttraumatic stress in an East-African refugee sample. Clinical Psychological Science, 5 (6), 964-973. doi: 10.1177/2167702617717023
+   E-KVT: Evaluation of a new approach for trauma therapy for young        adults

Sexual and/or physical abuse in childhood and adolescence can lead to the development of a variety of psychological diseases and problems. Recent studies especially highlight the connection between these types of abuse and posttraumatic stress disorder (PTSD). Even though it is known that PTSD leads to severe health problems, there are only few evidence-based psychotherapeutic interventions for adolescents and young adults who developed PTSD after the experience of sexual and/or physical abuse.

The aim of the E-KVT-project is the evaluation of a treatment manual which is particularly focused on the treatment of adolescents and young adults. The manual is based on the Cognitive Processing Therapy (CPT) – a therapeutical approach that has already been evaluated for adults.  Additional components of E-KVT are aspects of emotional and behavioral training (Verhaltensmanagement?) as well as skill training for coping with typical developmental tasks. The treatment consists of reliable elements and has already been audited in a pilot study. The results showed an improvement for almost all participating patients.

Beside the evaluation of this treatment procedure, our multicenter trial investigates other aspects, such as neuronal correlates of PTSD, epigenetic markers etc. The study administration is represented by Prof. Rita Rosner (KU Eichstätt-Ingolstadt).

The subproject in Bielefeld is supervised by Prof. Frank Neuner. We are trying to find neuronal correlates for information processing in adolescents and young adults with PTSD and would like to find out about how E-KVT influences this information processing. For questions upon the project, please contact the project coordinator for Bielefeld, Dr. Benjamin Iffland.

Further information (in German) upon the therapy and the multicenter trial can be found here
+   Transformation to War and Barbarism – Sources of Violence and
       Mental Health in Syrian and Iraqi Refugees

Frank Neuner , Bielefeld University, Bielefeld, Germany, Hawkar Ibrahim Hussin, Koya University, Koya, Iraq, Azad Ali Ismael, Koya University, Koya, Iraq

The Arab Spring movement has resulted in a disastrous civil war. Half of the Syrian population is now on the flight, the majority still within the country. It is well documented that civil wars bring about psychological traumas in significant proportions of the affected populations. However, studies in Middle East and North Africa are scarce. Beyond the individual level, war trauma is associated with increased levels of violence within families. Observers have noted widespread domestic violence in Syrian refugee camps. Here, we aim to study sources of violence (war, community and family violence) in relation to mental health (posttraumatic stress disorder and depression). The study is carried out by Koya University in Iraq in cooperation with Bielefeld University. The study region of northern Iraq is unique as it hosts displaced war victims with an Arab as well as Kurdish background and Syran as well as Iraq nationality. In a large scale survey with 1200 respondents we will determine predictors of mental health impairment as well as domestic violence, with a specific consideration of ethnicity, nationality, gender and the interaction of these factors.
+   Trauma, alcohol use and the transmission of violence in post-
       conflict societies

In todays post-conflict areas the majority of the civilian population is repeatedly exposed to events of extreme violence. While most attention is drawn to post-traumatic stress disorder and closely related conditions, there has been little recognition of hazardous and dependent alcohol use as both, a cause and consequence of mental health problems and violence in these settings. Alcohol may serve a self-medication purpose in the absence of other means to mitigate symptoms. However, excessive drinking may also be an influential causal and perpetuating factor for the evident transmission of violence across contexts and social relationships in conflict-affected populations (e.g. from war-violence to community-violence or from being a victim of war or intimate partner violence to being a perpetrator of violence against children).
A first line of projects in this area consists of cross-sectional, epidemiological studies, with the overall aim to build and investigate complex models to reveal some of the processes underlying the transmission of violence. By using multi-informant strategies we take the whole family system into account. We aim to identify influencing factors according to the strength of their impact on family violence, in order to mark them as promising targets for interventions.
Generally, interventions targeting alcohol abuse and addiction are recognized as being both, lacking and underevaluated among conflict-affected civilian populations, particularly in low and middle income countries. As alcohol consumption may promote the exertion of family violence to a significant extent, alcohol-related interventions should - apart from their intended curative effect on alcohol use disorders - be in the focus of evaluation as possible first-line strategies when targeting family violence. Consequently, a second line of projects investigates whether a change in alcohol consumption leads to a reduction of intimate partner violence and violence against children. For this purpose we evaluate the effects of already existing inpatient treatment approaches targeting alcohol addiction. We additionally work on adaptations of evidence-based brief interventions for the hazardous and harmful use of alcohol for implementation in a group format in post-conflict settings.
+   Mental health in refugees who have been allocated to Bielefeld

The United Nations High Commissioner for Refugees reported 21.3 million refugees worldwide in 2015; the prevalence rates of trauma related disorders as well as other psychological problems is high among refugees. However, representative studies concerning prevalence rates as well as the different causes and their influence on the development of psychological issues and mental disorders do not yet exist.
In the context of a pilot study adolescent and adult refugees allocated to Bielefeld will be screened for stressors and traumatic events they have experienced before, during, and after flight. In addition, their mental health status will be assessed. In this way, we will get a first impression regarding stressors experienced, and the mental health status of the refugees who are currently living in Bielefeld.
Subsequently, we will use the knowledge gained to conduct a larger study where the refugees will be interviewed in more detail.

For questions upon the pilot study, please contact PD Dr. Claudia Catani.
+   Evaluating Interaction Competencies with Children – for        teachers (ICC-T) - An approach to reduce harsh and violent
       punishment by teachers in school settings

Despite the negative consequences associated with harsh and violent punishment, it has remained legal in schools in many countries. The high prevalence rates of corporal punishment by teachers further emphasize the need for interventions to reduce this practice. Yet, existing prevention programs are rarely evaluated and often difficult to implement due to limited resources. In this project, we aim to implement and scientifically evaluate ICC-T. The preventive intervention approach Interaction Competencies with Children (ICC) aims at preventing maltreatment and improving the adult-child relationship by introducing essential interaction competencies in the work with children and is available for different target groups. The training concept follows the childcare guidelines of the American Academy of Pediatrics (The American Academy of Pediatrics, 1999). Key principles are: (a) a participative approach, (b) a trustful atmosphere, (c) practice orientation, and (d) sustainability. Five core components form the ICC-T training program: 1) teacher-student interactions, 2) self-reflection and maltreatment prevention, 3) effective non-violent discipline strategies, 4) identifying & supporting burdened students, 5) implementation into daily work. ICC-T aims at reducing violence by teachers in school settings and may contribute to less exposure to violence and improved psychological well-being of many students. We have already pretested ICC-T in a Tanzanian school (Kaltenbach et al., submitted). In a cluster randomized trials (CRT), we will involve both students and teachers. In a first phase (baseline study) the prevalence, nature and consequences of harsh and violent punishment in school settings will be assessed in randomly selected secondary schools in Tanzania. In the second phase, we will implement and evaluate the efficacy of ICC-T. In the CRT, the schools will be randomly assigned to an intervention group (that will receive the ICC-T intervention training) or a control group (that will receive no training). Data will be collected during the pre-assessment (T1, directly before intervention) and during follow-up assessment (T2, three months after the training). Furthermore, reports and feedback from the trained participants will be elicited in the beginning and the end of the training workshop to investigate demand and motivation for and satisfaction and feasibility of ICC-T. We are considering to conduct a second CRT in Southwestern Uganda implementing a similar design as in the first trial.

Project coordinators:
Dr. Tobias Hecker (Bielefeld University) & Dr. Katharin Hermenau (University of Konstanz)

Project staff:
Mabula Nkuba, MA (Dar es Salaam University College of Education & University of Konstanz) & Dr. Joseph Ssenyonga (Mbarara University of Science and Technology & University of Konstanz)

Supported by the Katholischer Akademischer Austauschdienst (KAAD), Alexander von Humboldt Foundation, Misereor, vivo international and the Young Scholar Fund of the University of Konstanz.
+   Recent publications
  • Hecker, T., Goessmann, K., Nkuba, M., & Hermenau, K. (2018). Teachers’ stress intensifies violent disciplining in Tanzanian secondary schools. Child Abuse and Neglect, 76, 173–183. doi: 10.1016/j.chiabu.2017.10.019
  • Kaltenbach, E., Hermenau, K., Nkuba, M., Goessmann, K. & Hecker, T. (2017). Improving interaction competencies with children - A pilot feasibility study to reduce school corporal punishment. Journal of Aggression, Maltreatment and Trauma. Advance Online Publication. doi: 10.1080/10926771.2017.1357060
  • Hecker, T., Hermenau, K., Salmen, C., Teicher, M., & Elbert, T. (2016). Harsh discipline relates to internalizing problems and cognitive functioning: Findings from school children in Tanzania. BMC Psychiatry , 16, 118. doi: 10.1186/s12888-016-0828-3
  • Hecker, T., Hermenau, K., Isele, D., & Elbert, T. (2014). Corporal punishment and children’s externalizing problems: A cross-sectional study of Tanzanian primary school students. Child Abuse and Neglect , 38, 884-892. doi: 10.1016/j.chiabu.2013.11.007
+   Evaluating  Interaction Competencies with Children – for
       caregivers (ICC-C) - An approach to reduce harsh and violent
       punishment by caregivers in institutional care settings

Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. As maltreatment occurs in all alternative care settings, we emphasize that improving care quality may be more important than the type of care. Although basic nutrition, sanitation, and medical care are essential, interactions with responsive nonviolent caregivers are crucial to the children’s physical and behavioral development. Therefore, we advocate for focusing on the prevention of maltreatment and violence in institutional care and other care settings in Sub-Saharan Africa. The preventive intervention approach Interaction Competencies with Children (ICC) aims at preventing maltreatment and improving the adult-child relationship by introducing essential interaction competencies in the work with children and is available for different target groups. ICC-C has been inspired by the parenting guidelines of the American Academy of Pediatrics (The American Academy of Pediatrics, 1999) and the FairstartGlobal training concept (Rygaard, 2010). It is designed for caregivers caring for children of pre-school to primary school age and early adolescence (4 to 14 years). ICC-C offers a basic introduction to the essential interaction competencies in the work with children focusing mainly on warm, sensitive, and reliable caregiver-child relationships and non-violent, warm, and sensitive caregiving strategies. ICC-C is guided by the following key principles: (a) a participative approach, (b) a trustful atmosphere, (c) practice orientation, (d) teambuilding and new ideas for games, and (e) sustainability. Seven core components form the content of ICC-C: 1) child development, 2) caregiver-child relationship, 3) effective non-violent caregiving strategies, 4) self-reflection and maltreatment prevention, 5) supporting burdened children, 6) child-centered institutional care, and 7) teamwork and supervision. In a first pilot study, ICC-C proved its feasibility and showed first promising results with caregivers in Tanzanian orphanages. These promising findings call for further studies testing the efficacy and sustainability of ICC-T approach using scientifically rigorous designs, e.g. randomized cluster trials.

Project coordinators:
Dr. Tobias Hecker (Bielefeld University) & Dr. Katharin Hermenau (University of Konstanz)

Supported by vivo international and Misereor
+   Recent publications
  • Hecker, T., Mkinga, G., Ssenyonga, J., & Hermenau, K. (2017). Interaction Competencies with Children (ICC) – An approach for preventing violence, abuse and neglect in institutional care in Sub-Saharan Africa. In A. V. Rus, S. R. Parris, & E. Stativa (Eds.), Child Maltreatment in Residential Care-History, Research, and Current Practice. Cham, Switzerland: Springer International Publishing, pp. 357-378. doi: 10.1007/978-3-319-57990-0_17
  • Hermenau, K., Kaltenbach, E., Mkinga, G., & Hecker, T. (2015). Improving care quality and preventing maltreatment in institutional care – A feasibility study with caregivers in Tanzania. Frontiers in Psychology, 6, 937. doi: 10.3389/fpsyg.2015.00937
  • Hermenau, K., Eggert, I., Landolt, M., & Hecker, T. (2015).  Neglect and perceived stigmatization impact psychological distress of orphans in Tanzania. European Journal of Psychotraumatology , 6, 28617. doi: 10.3402/ejpt.v6.28617
  • Hermenau, K., Hecker, T., Elbert, T., & Ruf-Leuschner, M. (2014). Maltreatment and mental health in institutional care – comparing early- and late-institutionalized children in Tanzania. Infant Mental Health Journal, 35 (2), 102-110. doi: 10.1002/imhj.21440.
  • Hermenau, K., Hecker, T., Ruf, M., Schauer, E., Elbert, T., & Schauer, M. (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(1), 29. doi: 10.1186/1753-2000-5-29
  • Crombach, A., Wilker, S., Hermenau, K., Wieling, E., & Hecker, T. (2017). Treating and preventing psychological trauma of children and adolescents in post-conflict settings. In M. A. Landolt, M. Cloitre, & U. Schnyder (Eds.), Evidence-based Treatments for Trauma-Related Disorders in Children and Adolescents. Cham, Switzerland: Springer International Publishing, 483-504. doi: 10.1007/978-3-319-46138-0_23
+   ECQAT – online course trauma therapy

The department of Clinical Psychology and Psychotherapy headed by Prof. Dr. Frank Neuner is developing an internet-based further education program for trauma therapy. This project is subsidized by the BMBF (the German Ministry for Education and Research). The aim is to provide future and licensed psychotherapists with in-depth information on trauma therapy that is based on the newest insights from research. The course consists of modules on diagnostics and psychoeducation, disease models and evidence-based interventions, that can be used for the treatment of PTSD (imaginative exposure, exposure in vivo, cognitive restructuring) as well as information for coping with difficulties in therapy such as dissociation or suicidality. Through presentations, texts, expert interviews and video materials, the course participants will gain background knowledge and practical competences alike. Different experts in the field of trauma therapy demonstrate concrete therapeutic strategies as well as coping strategies for difficult situations during therapy using example cases. Next to practical exercises of the different interventions, the course also offers the opportunity for self-reflection and self-experience as well as information on the promotion of self-care and mental hygiene.

Contact:
Dr. Lisa Sansen
Dipl.psych. Laura Bebra Saupe
+   SHELTER (Safety & Help for Early adverse Life events and
       Traumatic Experiences in minor Refugees)

SHELTER is a BMBF-funded Project for the development and evaluation of an e-Learning course addressing clinical and educational professionals as well as lay personnel working with minor refugees.
The course aims at imparting theoretical knowledge about traumatic life events and their potential aftereffects. Theoretical input will be supported by case-examples and interviews with important stakeholders in the various disciplines.
Also, participants will learn practical competences in dealing with unexpected or difficult situations in contact with traumatized refugee-clients and administrative barriers. A special focus lies on self-care and the ability to build inter-disciplinary networks to improve given work-conditions.

For further information, please contact shelter-projekt@uni-bielefeld.de
+   Growing up in a transforming post-conflict society:
       Adolescents in Northern Uganda

A rise in family and intimate partner violence is one of the many long-term consequences of violent conflicts that heavily affect children growing up in post-conflict societies.
A multi-generational, cross-sectional study with school children and their primary guardians conducted in 2010 in Northern Uganda showed that after nearly two decades of war, families were suffering at multiple levels from a rise in experienced as well as committed violent acts.
Intimate partner violence against Northern Ugandan women was at an alarming high, with 70-80% of women reporting at least one type of experienced violence against them (Saile, Neuner, Ertl, & Catani,2013). Furthermore, strong links were found between aggressive parenting behaviours and guardians’ own experienced childhood maltreatment, as well as between male guardians’ PTSD symptoms and alcohol abuse and female guardians’ victimization experiences in their intimate relationships (Saile, Ertl, Neuner, & Catani, 2013). Children’s psychopathological symptoms were independently mediated by a higher exposure to traumatic events, witnessed or experienced violence within the family as well as lower child-reported care from female guardians (Saile, Ertl, Neuner, & Catani, 2015).
On the basis of these cross-sectional studies, this project aims at exploring long-term affects of war and post-war traumatic experiences on the ability of children to transition into healthy adults in a longitudinal design.
The participants of the above-mentioned studies have been interviewed in 2010, 2012 and 2016 with a focus on psychopathology, experienced and witnessed traumatic events and domestic violence as well as the adolescents’ experiences with intimate and sexual relationships and risky behaviours such as alcohol and drug use. An additional objective of the dissertation project is to explore adolescents’ sense of belonging and perceived support within their communities as well as their future expectations.
The results of the project will be used to develop trainings and community-based interventions addressing adolescents’ risky behaviours as well as effective, non-violent parenting techniques.

Contact person: Dipl. psych. Laura B. Saupe

Literature:
Saile, R., Ertl, V., Neuner, F., & Catani, C. (2015). Children of the postwar years: A two-generational multilevel risk assessment of child psychopathology in northern Uganda. Development and Psychopathology, FirstView (November), 1–14. doi:10.1017/S0954579415001066

Saile, R., Ertl, V., Neuner, F., & Catani, C. (2013). Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda. Child Abuse & Neglect . doi:10.1016/j.chiabu.2013.10.007

Saile, R., Neuner, F., Ertl, V., & Catani, C. (2013). Prevalence and predictors of partner violence against women in the aftermath of war: a survey among couples in Northern Uganda. Social Science & Medicine (1982), 86, 17–25. doi:10.1016/j.socscimed.2013.02.046