1
|
Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees. Eur J Psychotraumatol 2023; 14:2180707. [PMID: 37052105 PMCID: PMC9987726 DOI: 10.1080/20008066.2023.2180707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background: Many refugees report high levels of psychopathology. As a countermeasure, some psychological interventions aim at targeting mental health difficulties in refugees transdiagnostically. However, there is a lack of knowledge about relevant transdiagnostic factors in refugee populations.Objective: To inform intervention efforts empirically, we investigated whether self-efficacy and locus of control are transdiagnostically associated with symptoms of depression, anxiety, somatisation, psychological distress, and a higher-order psychopathology factor ('p') in Middle Eastern refugees residing in Germany.Method: In total, 200 Middle Eastern refugees took part in this cross-sectional study, comprising 160 male and 40 female refugees. Participants were, on average, 25.56 years old (SD = 9.19), and 182 (91%) originally came from Syria, while remaining refugees were from Iraq or Afghanistan. They completed measures of depression, anxiety, somatisation, self-efficacy, and locus of control.Results: In multiple regression models adjusting for demographic factors (gender and age), self-efficacy and external locus of control were transdiagnostically related to depression, anxiety, somatic symptoms, psychological distress, and a higher-order psychopathology factor. Internal locus of control had no detectable effect in these models.Conclusions: Self-efficacy and external locus of control appear critical in the mental health of refugees and may be important mechanisms in overcoming posttraumatic stress and resettlement stressors. Our findings support the need to target self-efficacy and external locus of control as transdiagnostic factors of general psychopathology in Middle Eastern refugees.
Collapse
|
2
|
Schippert ACSP, Dahl-Michelsen T, Grov EK, Sparboe-Nilsen B, Silvola J, Bjørnnes AK. Torture survivors' experiences of receiving surgical treatment indicating re- traumatization. PLoS One 2023; 18:e0287994. [PMID: 37847719 PMCID: PMC10581467 DOI: 10.1371/journal.pone.0287994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/18/2023] [Indexed: 10/19/2023] Open
Abstract
Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.
Collapse
Affiliation(s)
- Ana Carla S. P. Schippert
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Oslo, Norway
| | | | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Sparboe-Nilsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Juha Silvola
- Akershus University Hospital, Oslo, Norway
- Institute of Clinical medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
3
|
Bakke SL, Winer ES, Brown AD. Recalling Self-efficacious Memories Reduces COVID-19-Related Fear. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-8. [PMID: 37363751 PMCID: PMC10153042 DOI: 10.1007/s10608-023-10377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
Purpose Manipulating perceived self-efficacy can mitigate the negative impact of trauma and increase ability to adapt to stress. It is possible that a similar domain-based manipulation aimed at anxiety around the pandemic might mitigate the negative mental health impact of COVID-19. The current experimental study assessed whether a self-efficacy induction would be effective in reducing COVID-19 distress. Methods Participants were randomized to a self-efficacy autobiographical memory induction or control condition. We hypothesized that individuals in the self-efficacy group would exhibit lower levels of fear on an implicit measure of emotional states following exposure to COVID-19-related stimuli. Results A significant increase in general self-efficacy and self-confidence was found in the self-efficacy group from pre- to post-induction. Individuals in the self-efficacy group had significantly lower levels of fear counts on the implicit measure of emotional states than the control group following exposure to COVID-19-related stimuli. Conclusions Results suggest that (1) self-efficacy can be increased among individuals with high levels of COVID-19-related distress using an autobiographical memory induction and (2) doing so reduces fear processing among these individuals when exposed to COVID-19 stimuli. This is relevant for future intervention as it reveals a possible mechanism for reducing and recovering from COVID-19-related distress. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10377-6.
Collapse
Affiliation(s)
- Samantha L. Bakke
- Department of Psychology, The New School for Social Research, 66 W 12th Street, New York, NY 10011 USA
| | - E. Samuel Winer
- Department of Psychology, The New School for Social Research, 66 W 12th Street, New York, NY 10011 USA
| | - Adam D. Brown
- Department of Psychology, The New School for Social Research, 66 W 12th Street, New York, NY 10011 USA
| |
Collapse
|
4
|
Strupf M, Wiechers M, Bajbouj M, Böge K, Karnouk C, Goerigk S, Kamp-Becker I, Banaschewski T, Rapp M, Hasan A, Falkai P, Jobst-Heel A, Habel U, Stamm T, Heinz A, Hoell A, Burger M, Bunse T, Hoehne E, Mehran N, Kaiser F, Hahn E, Plener P, Übleis A, Padberg F. Predicting treatment outcomes of the Empowerment group intervention for refugees with affective disorders: Findings from the MEHIRA project. J Affect Disord 2023; 323:241-250. [PMID: 36427652 DOI: 10.1016/j.jad.2022.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research on outcome predictors in the field of transcultural treatment for refugees and asylum seekers (RAS) is scarce. We aimed to evaluate predictors of outcome of a group intervention (Empowerment) for RAS with affective disorders which was incorporated at level three of the stratified stepped-care model within the Mental Health in Refugees and Asylum Seekers (MEHIRA) project. METHODS A predictor analysis was performed at level three of the MEHIRA project, where 149 refugees with moderate depressive symptoms were treated either with Empowerment or Treatment-as-usual (TAU). Outcome measures were depression severity as assessed by patient-rated Patient Health Questionnaire 9 (PHQ-9) and clinician-rated Montgomery Asberg Depression Rating Scale (MADRS). Regression models with change scores (T1-T0) of PHQ-9 and MADRS as dependent variables were fit. Predictor selection was a mixed-method approach combining testing of literature-based hypotheses and explorative hypothesis-generating analyses of multiple baseline variables. RESULTS Intention-to-treat (ITT) analyses revealed significant linear relationships between change in PHQ-9 and baseline depression severity (β = -0.35, t = -3.27, p = .002) and perceived self-efficacy (β = -0.24, t = -2.26, p = .027) in the treatment (verum) condition. MADRS change scores were predicted by baseline depression severity (β = -0.71, t = -8.65, p < .001) in the treatment (verum) condition. LIMITATIONS Due to small cell numbers, single predictors could not be evaluated reliably. CONCLUSIONS Severity of depression and self-efficacy at baseline were predictors of symptom improvement at level three (Empowerment) of the MEHIRA project. Comorbidity and trauma indicators did not predict outcomes in the treatment (verum) condition, pointing towards broad applicability of the Empowerment intervention in refugee populations.
Collapse
Affiliation(s)
- Michael Strupf
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
| | - Maren Wiechers
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany; Charlotte Fresenius Hochschule, University of Applied Sciences, Munich, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Andrea Jobst-Heel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Ute Habel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | | | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Max Burger
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Tilmann Bunse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Edgar Hoehne
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nassim Mehran
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Franziska Kaiser
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Aline Übleis
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| |
Collapse
|
5
|
Eltanamly H, Leijten P, van Roekel E, Mouton B, Pluess M, Overbeek G. Strengthening parental self-efficacy and resilience: A within-subject experimental study with refugee parents of adolescents. Child Dev 2023; 94:187-201. [PMID: 36069393 PMCID: PMC10087555 DOI: 10.1111/cdev.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Post-migration stress and parenting adolescents can reduce parental self-efficacy. This study tested the effects of strengthening parental self-efficacy in refugee parents of adolescents and whether this makes parental self-efficacy less impacted by post-migration stressors. Using a within-subject experimental design, experience sampling data were collected in 2019 from 53 refugee parents of adolescents (Mage = 39.7, SDage = 5.59, 73% Syrian, 70% mothers) in the Netherlands. Data were analyzed by dynamic structural equation modeling using interrupted time-series analysis. The single-session personalized intervention strengthened parental self-efficacy (small effect: between case standardized mean difference = 0.09) and made refugee parents less vulnerable to post-migration stressors. Findings suggest that parental self-efficacy is malleable and strengthening it fosters refugee parents' resilience. Replications with longer-term follow-ups are needed.
Collapse
Affiliation(s)
| | | | | | - Benedicte Mouton
- University of Amsterdam, Amsterdam, The Netherlands.,Universite Libre de Bruxelles, Bruxelles, Belgium
| | | | | |
Collapse
|
6
|
An Interaction Effect of Life-Threatening Experience, Self-Efficacy, and Financial Resources on Quality of Life Among Chinese Middle-Aged and Older Women. AGEING INTERNATIONAL 2023; 48:231-246. [PMID: 34658463 PMCID: PMC8503864 DOI: 10.1007/s12126-021-09439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/09/2022]
Abstract
The current study explores the interaction effect of adversities and self-efficacy at baseline on quality of life (QoL) at follow-up among middle-aged and older Chinese women. 531 women were interviewed in 2008 and 226 of them were re-interviewed a year later using Quality of Life Ladder (QoLL), General Self-Efficacy Scale (GSE), List of Threatening Experiences (LTE), Somatic Complaint Scale, and self-rated health. Respondents' mean age at baseline was 55.7 (SD = 4.7, range: 50-78). Over a year's time, respondents had a decline in quality of life and self-rated health (p < .001), experienced more life-threatening events (p < .05) and somatic complaints. The hierarchical multiple regression model, employed in the study, identifies three predictors of future quality of life after adding the interaction term 'Previous LTE × Previous GSE × Previous household income' - previous quality of life (β = .492, p < .001), previous LTE (β = -.292, p < .001), and the interaction term (β = .221, p < .05). This model explains 34.1% of the variance of future quality of life (Adjusted R2 = .341, p < .001). The findings suggests that respondents' good self-appraisal of coping resources could moderate the impact of adversities on their future quality of life. Interventions for promoting positive psychological growth among middle-aged and older adults should cover four domains, i.e. event-related factors, environmental factors, personal factors, and cognitive and coping responses. Traditional Chinese wisdom emphasizes the importance of understanding the bad ('Yin'-the shady side) and the good ('Yang'-the sunny side) aspect of life events. Future research may explore the Yin Yang perspective on life-threatening experiences and its applications in cross-cultural quality of life studies in the era of globalization.
Collapse
|
7
|
Al-Adhami M, Berglund E, Wångdahl J, Salari R. A cross-sectional study of health and well-being among newly settled refugee migrants in Sweden-The role of health literacy, social support and self-efficacy. PLoS One 2022; 17:e0279397. [PMID: 36534679 PMCID: PMC9762600 DOI: 10.1371/journal.pone.0279397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants. However, these barriers remain largely unresolved and unaddressed. Thus, there is a need to better understand how other factors, such as individual-level health resources, may influence health and mitigate ill health in the early post-migration phase. In this study, we aimed to explore the relationship between health outcomes and individual health resources including health literacy, social support, and self-efficacy in newly settled refugee migrants. Survey data was collected from 787 refugee migrants in Sweden. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. Demographic variables such as gender, education, and type of residence permit were not as imperative. Individual-level health resources may play an important role in the general and psychological well-being of newly settled migrants. Promoting health literacy and facilitating the attainment of social support may buffer for structural challenges in the establishment phase and enhance the prospects of later health and social integration.
Collapse
Affiliation(s)
- Maissa Al-Adhami
- Research and Learning for Sustainable Development and Global Health (SWEDESD) Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Erik Berglund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Josefin Wångdahl
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Raziye Salari
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
Nickerson A, Hoffman J, Keegan D, Kashyap S, Tricesaria D, Pestalozzi Z, Argadianti Rachmah R, Nandyatama R, Khakbaz M, Nilasari N, Liddell BJ. Context, coping, and mental health in refugees living in protracted displacement. J Trauma Stress 2022; 35:1769-1782. [PMID: 36268717 DOI: 10.1002/jts.22885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
There is currently an unprecedented number of forcibly displaced people worldwide. Little is known, however, about how external stressors and internal coping strategies intersect to influence mental health in displaced refugees, particularly whether specific types of coping strategies are more or less effective across different levels of external stress. This study aimed to understand whether positive and negative internal coping strategies were differentially associated with mental health across high and low levels of external stressors in displaced refugees. Participants were 1,216 refugees living in Indonesia who completed an online survey indexing demographic characteristics, exposure to ongoing stressors, positive psychological coping strategies (i.e., cognitive flexibility, self-efficacy, and hope), negative psychological coping strategies (i.e., rumination and intolerance of uncertainty), psychological symptoms (i.e., posttraumatic stress disorder, depression, and anxiety) and mental health-related quality of life. Participants (27.3% female, Mage = 30.52 years) were from Arabic-, Farsi-, Tamil-, Somali-, Dari-, and English-speaking backgrounds. Results of latent moderated structural equation modeling indicated that the association between negative psychological coping strategies and poorer mental health was stronger at higher levels of stress, whereas the association between positive psychological coping strategies and better quality of life was stronger at lower levels of stress. These findings provide evidence in support of tailored approaches that integrate interventions addressing external stressors and internal coping strategies to support positive mental health and enhanced quality of life in displaced refugees.
Collapse
Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Joel Hoffman
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Shraddha Kashyap
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Zico Pestalozzi
- SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Rizka Argadianti Rachmah
- HOST International, Parramatta, Australia.,SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Jakarta, Indonesia
| | - Randy Nandyatama
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nindita Nilasari
- School of International Relations, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
| |
Collapse
|
9
|
Wang L, Jiang N. Managing Students' Creativity in Music Education - The Mediating Role of Frustration Tolerance and Moderating Role of Emotion Regulation. Front Psychol 2022; 13:843531. [PMID: 35496233 PMCID: PMC9045781 DOI: 10.3389/fpsyg.2022.843531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Artificial intelligence (AI) era challenges the use and functions of emotion in college students and the students' college life is often experienced as an emotional rollercoaster, negative and positive emotion can affect the emotional outcomes, but we know very little about how students can ride it most effectively to increase their creativity. We introduce frustration tolerance as a mediator and emotion regulation as a moderator to investigate the mechanism of creativity improvement under negative emotion. Drawing on a sample of 283 students from professional music colleges or music major in normal universities, we find that negative emotion are generally associated with a lower creativity, while frustration tolerance can mediate the relationship between negative emotion and creativity, but these effects depend on the emotion regulation. Cognitive reappraisal exerts a negative effect on the relationship between negative emotion and creativity, while expressive suppression has the opposite effect. Our study contributes to the literatures on student's emotions and creativity in music education and to the emotion regulation literature.
Collapse
Affiliation(s)
- Lei Wang
- School of Music, Liaoning Normal University, Dalian, China
| | - Na Jiang
- Changchun Humanities and Sciences College, Changchun, China
| |
Collapse
|
10
|
|
11
|
Spaaij J, Schick M, Bryant RA, Schnyder U, Znoj H, Nickerson A, Morina N. An exploratory study of embitterment in traumatized refugees. BMC Psychol 2021; 9:96. [PMID: 34112232 PMCID: PMC8193876 DOI: 10.1186/s40359-021-00599-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. METHODS A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. RESULTS Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. CONCLUSION The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.
Collapse
Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
| | | | | | - Hansjörg Znoj
- Department of Psychology, University of Bern, Bern, Switzerland
| | | | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich (USZ), University of Zurich (UZH), Culmannstrasse 8, 8091, Zurich, Switzerland
| |
Collapse
|
12
|
Heyen JM, Weigl N, Müller M, Müller S, Eberle U, Manoliu A, Vetter S, Brown AD, Berger T, Kleim B. Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders. JMIR Form Res 2021; 5:e28055. [PMID: 33999835 PMCID: PMC8189283 DOI: 10.2196/28055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. OBJECTIVE This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. METHODS We developed COVID-19-specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19-related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. RESULTS In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. CONCLUSIONS Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms.
Collapse
Affiliation(s)
- Janna Marie Heyen
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Noé Weigl
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
| | | | - Urs Eberle
- Zurich Schutz und Rettung, Zürich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
- McLean Hospital Belmont, Harvard Medical School, Boston, MA, United States
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
| | - Adam D Brown
- Department of Psychology, New School for Social Research, New York, NY, United States
- Department of Psychiatry, New York University, New York, NY, United States
| | - Thomas Berger
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zürich, Switzerland
- Department of Psychology, University of Zurich, Zürich, Switzerland
| |
Collapse
|
13
|
The power of appraisals in predicting PTSD symptom improvement following cognitive rehabilitation: A randomized clinical trial. J Affect Disord 2021; 282:561-573. [PMID: 33440301 DOI: 10.1016/j.jad.2020.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/03/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with PTSD often voice concern over their perceived change in cognitive functioning. However, these negative appraisals do not always align with objective neuropsychological performance, yet are strongly predictive of PTSD symptom severity and self-reported functional impairment. METHODS The present study involves a secondary analysis examining the role of appraisals of a subsample of 81 adults with full or subthreshold PTSD on treatment outcomes in a randomized controlled trial investigating the effectiveness of a cognitive rehabilitation treatment, Strategic Memory and Reasoning Training (n = 38), compared to a psychoeducation control arm, the Brain Health Workshop (n = 43). Neither condition addressed PTSD symptoms, focusing instead on cognitive skills training and psychoeducation about the brain. RESULTS Intent-to-treat models showed statistically significant improvements for both groups on composite scores of executive functioning and memory. Additionally, both groups experienced clinically significant reductions in PTSD symptoms (assessed via the Clinician-Administered PTSD Interview) and the SMART group showed fewer negative appraisals about cognitive functioning following training. Change in appraisals of cognitive functioning was associated with change in PTSD as well as change in quality of life, with no differential associations based on group status. In contrast, neurocognitive test score changes were not associated with change in symptoms or functional outcomes. LIMITATIONS We did not collect data on other appraisals (e.g., self-efficacy), which could have further elucidated pathways of change. CONCLUSIONS Our findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.
Collapse
|
14
|
van Heemstra HE, Scholte WF, Nickerson A, Boelen PA. Can Circumstances Be Softened? Self-Efficacy, Post-Migratory Stressors, and Mental Health among Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041440. [PMID: 33557018 PMCID: PMC7913747 DOI: 10.3390/ijerph18041440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Post-migratory stressors (PS) are a risk factor for mental health problems among resettled refugees. There is a need to identify factors which can reduce this burden. Self-efficacy (SE) is associated with refugees' mental health. The current study examined whether SE can protect this group from the impact of PS on mental wellbeing. Higher levels of PS were expected to be associated with higher levels of mental health problems. In addition, we expected this linkage to be moderated by lower SE. Questionnaires were administered to a non-clinical refugee sample (N = 114, 46% female, average age 35 SD = 10.42 years) with various backgrounds. The following questionnaires were used: the Self-Reporting Questionnaire-20 (SRQ-20) to assess mental health problems, the General Self-Efficacy Scale (SGES) to measure SE, and an adapted version of the Post-Migration Living Difficulties Checklist (PMLD) to measure PS. Bivariate correlations and multiple linear regression analysis were performed. No significant contribution was found for SE or the interaction of SE and daily stressors, above and beyond the significant contribution of daily stressors to mental health problems. The findings reinforce that PS affects mental health and suggest that SE had a limited impact on mental health in this non-clinical sample of refugees.
Collapse
Affiliation(s)
- Henriëtte E. van Heemstra
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands; (W.F.S.); (P.A.B.)
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Correspondence:
| | - Willem F. Scholte
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands; (W.F.S.); (P.A.B.)
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Paul A. Boelen
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE Diemen, The Netherlands; (W.F.S.); (P.A.B.)
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| |
Collapse
|
15
|
Kashyap S, Keegan D, Liddell BJ, Thomson T, Nickerson A. An Interaction Model of Environmental and Psychological Factors Influencing Refugee Mental Health. J Trauma Stress 2021; 34:257-266. [PMID: 33314393 DOI: 10.1002/jts.22636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
In this paper, we draw on empirical research and theoretical models of refugee and posttrauma mental health to propose the "Psychological Interaction with Environment (PIE) Matrix Model" of refugee mental health. This model focuses on the mental health of adult refugees and proposes that psychological factors and the external environment interact to influence mental health outcomes and functioning for individuals with refugee backgrounds. Environmental factors include adversity faced before, during, and after the migration journey, including adversity faced in a resettlement or postdisplacement environment. Psychological factors refer to psychological (i.e., cognitive and emotional) mechanisms that individuals may use to cope with adversity. We posit that individuals from refugee backgrounds are likely to show individual differences in psychological processes that may protect against or underpin the development and maintenance of psychopathology following exposure to trauma and displacement. The PIE Matrix Model proposes a framework to guide intervention by identifying key pathways by which psychological and environmental factors impact one another. We suggest that psychological interventions can be targeted according to the kind and level of support different individuals may require, based on individualized and context-driven assessments of the interaction between environmental and psychological factors at any given point in time. This model draws on existing models of refugee adaptation and highlights the need for longitudinal and experimental research to explain the interaction between these factors and their causal impact on refugee mental health.
Collapse
Affiliation(s)
- Shraddha Kashyap
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| |
Collapse
|
16
|
Tabibnia G. An affective neuroscience model of boosting resilience in adults. Neurosci Biobehav Rev 2020; 115:321-350. [DOI: 10.1016/j.neubiorev.2020.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022]
|
17
|
Kiselev N, Morina N, Schick M, Watzke B, Schnyder U, Pfaltz MC. Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view. BMC Psychiatry 2020; 20:378. [PMID: 32680485 PMCID: PMC7366894 DOI: 10.1186/s12888-020-02783-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.
Collapse
Affiliation(s)
- Nikolai Kiselev
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
18
|
Lacour O, Morina N, Spaaij J, Nickerson A, Schnyder U, von Känel R, Bryant RA, Schick M. Prolonged Grief Disorder Among Refugees in Psychological Treatment-Association With Self-Efficacy and Emotion Regulation. Front Psychiatry 2020; 11:526. [PMID: 32581893 PMCID: PMC7291948 DOI: 10.3389/fpsyt.2020.00526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND While Prolonged Grief Disorder (PGD) among refugees has recently started to attract scientific attention, knowledge regarding associated psychological factors remains limited. Given the multifactorial context of persecution, trauma, displacement, and exile-related difficulties, obtaining a better understanding of PGD in refugees is crucial because PGD may affect psychological well-being, level of functioning, and social integration. METHODS In a sample of refugees receiving psychological treatment in Switzerland (N = 88), we examined the relationship between severity of PGD and potentially associated factors such as emotion regulation, perceived self-efficacy, as well as potentially traumatic events and post-migration living difficulties. RESULTS In a regression analysis, difficulties in emotion regulation and lower perceived self-efficacy were associated with greater severity of PGD, while post-migration living difficulties and potentially traumatic events did not emerge as significant factors. CONCLUSION These findings suggest that emotion regulation and perceived self-efficacy are associated with PGD in refugees in psychological treatment and are thus potential targets for treatment interventions.
Collapse
Affiliation(s)
- Oriane Lacour
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Starck A, Gutermann J, Schouler-Ocak M, Jesuthasan J, Bongard S, Stangier U. The Relationship of Acculturation, Traumatic Events and Depression in Female Refugees. Front Psychol 2020; 11:906. [PMID: 32528358 PMCID: PMC7247808 DOI: 10.3389/fpsyg.2020.00906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/14/2020] [Indexed: 12/31/2022] Open
Abstract
Recent research has identified significant correlations between traumatic events and depression in refugees. However, few studies have addressed the role of acculturation strategies in this relationship. This study explored the relationship between cultural orientation, traumatic events and depression in female refugees from Syria, Afghanistan, Eritrea, Iran, Iraq, and Somalia living in Germany. We expected acculturation strategies to moderate the effect of traumatic experiences on depression. The sample included 98 female refugees in Germany. The depression scale of the Hopkins Symptom Checklist (HSCL) represented the dependent measure. The trauma checklists derived from the Post-traumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ) as well as the Frankfurt Acculturation Scale (FRACC) were used as independent measures for traumatic events and orientation toward the host culture as well as orientation toward the culture of origin, respectively. A moderation analysis was conducted to examine whether the relationship between the number of traumatic events and depression was influenced by the women's orientation toward the culture of origin and the host culture. We identified a significant model explaining 26.85% of the variance in depressive symptoms (Cohen's f2 = 0.37). The number of traumatic events and the orientation toward the host culture exerted significant effects on depressive symptoms. The moderating effect was not significant, indicating that the effect of the number of traumatic events was not influenced by cultural orientation. Based on our results, orientation toward the host culture as well as traumatic experiences exert independent effects on depressive symptoms in refugees.
Collapse
Affiliation(s)
- Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Stephan Bongard
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| |
Collapse
|
20
|
Raeder F, Karbach L, Struwe H, Margraf J, Zlomuzica A. Low Perceived Self-Efficacy Impedes Discriminative Fear Learning. Front Psychol 2019; 10:1191. [PMID: 31275188 PMCID: PMC6591439 DOI: 10.3389/fpsyg.2019.01191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/06/2019] [Indexed: 11/29/2022] Open
Abstract
Perceived self-efficacy refers to a subject’s expectation about the outcomes his/her behavior will have in a challenging situation. Low self-efficacy has been implicated in the origins and maintenance of phobic behavior. Correlational studies suggest an association between perceived self-efficacy and learning. The experimental manipulation of perceived self-efficacy offers an interesting approach to examine the impact of self-efficacy beliefs on cognitive and emotional functions. Recently, a positive effect of an experimentally induced increased self-efficacy on associative learning has been demonstrated. Changes in associative learning constitute a central hallmark of pathological fear and anxiety. Such alterations in the acquisition and extinction of conditioned fear may be related to cognitive and neurobiological factors that predict a certain vulnerability to anxiety disorders. The present study builds on previous own work by investigating the effect of an experimentally induced low perceived self-efficacy on fear acquisition, extinction and extinction retrieval in a differential fear conditioning task. Our results suggest that a negative verbal feedback, which leads to a decreased self-efficacy, is associated with changes in the acquisition of conditioned fear. During fear acquisition, the negative verbal feedback group showed decreased discrimination of fear responses between the aversive and safe conditioned stimuli (CS) relative to a group receiving a neutral feedback. The effects of the negative verbal feedback on the acquisition of fear discrimination learning were indexed by an impaired ability to discriminate the probability of receiving a shock during acquisition upon presentation of the aversive (CS+) relative to the safe stimuli (CS−). However, the effects of low self-efficacy on discrimination learning were limited to fear acquisition. No differences between the groups were observed during extinction and extinction retrieval. Furthermore, analysis of other outcome measures, i.e., skin conductance responses and CS valence ratings, revealed no group differences during the different phases of fear conditioning. In conclusion, lower perceived self-efficacy alters cognitive/expectancy components of discrimination during fear learning but not evaluative components and physiological responding. The pattern of findings suggests a selective, detrimental role of low(er) self-efficacy on the subject’s ability to learn the association between ambiguous cues and threat/safety.
Collapse
Affiliation(s)
- Friederike Raeder
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Lioba Karbach
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Helena Struwe
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Jürgen Margraf
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Armin Zlomuzica
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| |
Collapse
|
21
|
Raeder F, Woud ML, Schneider S, Totzeck C, Adolph D, Margraf J, Zlomuzica A. Reactivation and Evaluation of Mastery Experiences Promotes Exposure Benefit in Height Phobia. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10018-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
22
|
van Heemstra HE, Scholte WF, Haagen JFG, Boelen PA. 7ROSES, a transdiagnostic intervention for promoting self-efficacy in traumatized refugees: a first quantitative evaluation. Eur J Psychotraumatol 2019; 10:1673062. [PMID: 31681464 PMCID: PMC6807946 DOI: 10.1080/20008198.2019.1673062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Due to traumatic experiences and highly prevalent post-migration stressors, refugees are vulnerable for developing psychopathology. To date, research has mainly evaluated trauma-focused therapies, targeting post traumatic stresss symptoms. Treatments targeting post-migration stressors are relatively understudied. The present cohort study evaluated the potential effectiveness of 7ROSES, a transdiagnostic intervention that aims to increase self-efficacy among treatment-seeking refugees in dealing with post-migration stressors. Because it can be applied by non-specialist health care workers, it can be disseminated on a large scale, thereby increasing options for psychosocial support for refugees. Method: Forty-nine refugees (65% male, average age: 36.02 years, SD = 8.52) with psychopathology were included. Before and after participation in 7ROSES, self-efficacy was measured using the General Self-Efficacy Scale (GSES), and general psychopathology using the Brief Symptom Inventory (BSI). Results: Completers analysis yielded a significant increase in GSES scores (Z = -2.16, p = .03) and significant decrease in BSI scores (Z = -2.05, p = .04) with medium-small effects (both r = -.28). Intent-to-treat analysis, using predictive mean matching imputation, yielded significant results for the GSES (p = .012) but not for the BSI (p = .14) with small effects (GSES r = .14, BSI r = .12). Reliable change indices established negative change in 3%, no change in 70%, and positive change in 27% based on the GSES; percentages were 11.5%, 65.5%, and 23%, respectively, based on the BSI. Conclusion: Findings provide preliminary evidence that 7ROSES could improve self-efficacy and general mental health in refugees with psychopathology.
Collapse
Affiliation(s)
- Henriette E van Heemstra
- ARQ Centrum'45, Diemen, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - W F Scholte
- ARQ Centrum'45, Diemen, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J F G Haagen
- ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,Impact, Dutch Knowledge and Advice Center for Psychosocial Care and Safety Concerning Critical Incidents, Diemen, Netherlands
| | - P A Boelen
- ARQ National Psychotrauma Centre, Utrecht University, Diemen, Netherlands.,department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
23
|
Titcombe-Parekh RF, Chen J, Rahman N, Kouri N, Qian M, Li M, Bryant RA, Marmar CR, Brown AD. Neural circuitry changes associated with increasing self-efficacy in Posttraumatic Stress Disorder. J Psychiatr Res 2018; 104:58-64. [PMID: 29982083 DOI: 10.1016/j.jpsychires.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/06/2018] [Accepted: 06/08/2018] [Indexed: 01/03/2023]
Abstract
Cognitive models suggest that posttraumtic stress disorder (PTSD) is maintained, in part, as a result of an individual's maladaptive beliefs about one's ability to cope with current and future stress. These models are consistent with considerable findings showing a link between low levels of self-efficacy and PTSD. A growing body of work has demonstrated that perceptions of self-efficacy can be enhanced experimentally in healthy subjects and participants with PTSD, and increasing levels of self-efficacy improves performance on cognitive, affective, and problem-solving tasks. This study aimed to determine whether increasing perceptions of self-efficacy in participants with PTSD would be associated with changes in neural processing. Combat veterans (N = 34) with PTSD were randomized to either a high self-efficacy (HSE) induction, in which they were asked to recall memories associated with successful coping, or a control condition before undergoing resting state fMRI scanning. Two global network measures in four neural circuits were examined. Participants in the HSE condition showed greater right-lateralized path length and decreased right-lateralized connectivity in the emotional regulation and executive function circuit. In addition, area under receiver operating characteristics curve (AUC) analyses found that average connectivity (.71) and path length (.70) moderately predicted HSE group membership. These findings provide further support for the importance of enhancing perceived control in PTSD, and doing so may engage neural targets that could guide the development of novel interventions.
Collapse
Affiliation(s)
| | - Jingyun Chen
- Department of Psychiatry, New York University School of Medicine, USA
| | - Nadia Rahman
- Department of Psychiatry, New York University School of Medicine, USA
| | - Nicole Kouri
- Department of Psychiatry, New York University School of Medicine, USA
| | - Meng Qian
- Department of Psychiatry, New York University School of Medicine, USA
| | - Meng Li
- Department of Psychiatry, New York University School of Medicine, USA
| | | | - Charles R Marmar
- Department of Psychiatry, New York University School of Medicine, USA
| | - Adam D Brown
- Department of Psychiatry, New York University School of Medicine, USA; Department of Psychology, Sarah Lawrence College, USA
| |
Collapse
|