Culturally modified cognitive processing therapy for Karen refugees with posttraumatic stress disorder: A pilot study

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

Fostering cultural resilience: assessing the success of a locally engaged and adapted mental health intervention in Gaza

In ongoing-conflict-affected regions like Gaza, the prevalence of complex and intersecting post-traumatic stress disorders (PTSDs) necessitates innovative interventions. Our study explores a mental health care approach that has been culturally adapted for 15 years to address the complex landscape of PTSD in the Gaza Strip. Tarkiz was initially developed as 'Focusing', a metacognitive approach founded by Eugene Gendlin in 1950s Chicago. Tarkiz has been iteratively adapted and implemented for over a decade in Gaza by a team of local practitioners. The program's unique emphasis lies in its engagement approach, which relies on community participation and partnership building. The aim of this study was to qualitatively explore the perceived success of the program from the perspectives of the practitioners who adapted and delivered the program and the clients who participated in it. Data collection was driven by a multicultural research team, and prioritized capacity-building opportunities for Palestinian practitioners who lead on the development of research questions defining success. This exemplifies a successful science diplomacy model, emphasizing a collaborative approach, cultural sensitivity, and adaptable partnerships essential in global public health.

Psychological Interventions for PTSD, Depression, and Anxiety in Child, Adolescent and Adult Forced Migrants: A Systematic Review and Frequentist and Bayesian Meta-Analyses

OBJECTIVE

The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants.

DESIGN AND DATA SOURCES

Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis.

RESULTS

We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen's d) ranged from -1.03 to -0.26 for PTSD, from -0.91 to -0.11 for depression and from -0.91 to -0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type.

CONCLUSION

Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.

Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies

Introduction

The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors.

Methods

We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample.

Results

Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test (p = 0.127).

Discussion

Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.

Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons

Sleep difficulty is a recognized hallmark symptom of post-traumatic stress disorder (PTSD) yet often remains an enduring and neglected problem post-treatment. Around 4.4%- 88.0% of refugees, asylum seekers, and internally displaced persons report PTSD, of which 39%- 99% report sleep difficulties. These percentages substantially exceed those of the general population. Yet there has been a lack of research examining evidence-based stand-alone and add-on treatments for PTSD and related sleep disturbances among this population. Barriers to treatment encountered by this population often vary by their legal status or location, but generally include lack of access due to insufficient evidence-based treatments or mental health practitioner shortages, lack of psychoeducation on mental health, cultural stigma, language barriers, situational instability, and racial bias. The refugee population has been on the rise over the past 10 years, and the United Nations estimated the recent Ukraine-Russia conflict would lead to an additional 12 million people needing humanitarian assistance inside Ukraine and more than 6.9 million refugees fleeing to neighboring countries in the coming months. Given that refugees, asylum seekers, and internally displaced persons repeatedly encounter barriers to mental health care specific to their predicament, interventions designed to accommodate their situation are imperative for improving their sleep and mental health. We therefore call for there to be more research on integrative programs incorporating evidence-based treatments that allow for scalability, adaptability, and rapid dissemination to maximize impact in this population. Further, we encourage trainings among clinicians and researchers to increase knowledge and confidence in working with this population.

A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women

Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, M_age (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.

Die Cognitive Processing Therapy zur Behandlung Geflüchteter mit einer Posttraumatischen Belastungsstörung: Eine Machbarkeitsstudie

<b><i>Hintergrund:</i></b> Metaanalysen zeigen die Wirksamkeit traumafokussierter Verfahren für Geflüchtete. Für die Cognitive Processing Therapy (CPT) liegt bei dieser Population in Deutschland bisher keine empirische Machbarkeitsprüfung vor. <b><i>Patient</i></b>*<b><i>innen und Methoden:</i></b> Im Rahmen einer Machbarkeitsstudie erhielten 16 Geflüchtete mit einer Posttraumatischen Belastungsstörung (PTBS) unter klinischen Routinebedingungen drei diagnostische Vorgespräche, fünf probatorische Sitzungen, zwölf Doppelsitzungen (100 Minuten) CPT sowie bis zu vier optionale Krisensitzungen. Vor und nach der Therapie wurde die PTBS-Symptomatik erhoben. Qualitative Nachbefragungen mit Patient*innen und Therapeut*innen wurden durchgeführt. <b><i>Ergebnisse:</i></b> Insgesamt neun von 16 Patient*innen brachen die Therapie vorzeitig ab. Innerhalb der Completer-Stichprobe (Per-protocol-Analyse) zeigten sich mittelgroße, aber nicht signifikante Effekte auf die PTBS-Symptomatik (<i>d</i> = 0,75; M[CAPS_prä] = 39,33 [SD = 10,89]; M[CAPS_post] = 22,50 [SD = 15,16]). Patient*innen und Therapeut*innen berichteten eine Reihe von Hürden in der Therapiedurchführung. <b><i>Diskussionen:</i></b> Die vorliegende Machbarkeitsstudie verzeichnete eine für die CPT ungewöhnlich hohe Abbruchquote. Diese lässt sich möglicherweise auf die mangelnde Passung des Verfahrens für Patient*innen mit geringer Schreib- und Lesekompetenz oder hoher psychosozialer Belastung zurückführen. Implikationen für die Behandlung Geflüchteter bezüglich der Wahl des Behandlungsverfahrens, der Motivationsklärung und der Rahmenbedingungen werden diskutiert. <b><i>Schlussfolgerungen:</i></b> Während breite empirische Evidenz für traumafokussierte Verfahren bei Geflüchteten vorliegt, ist die Standard-CPT möglicherweise nur für Subgruppen dieser Population geeignet. Eine Vereinfachung der CPT-Materialien und eine vorherige Motivationsklärung erscheinen notwendig.