Cognitive Behaviour Therapy with Refugees and Asylum Seekers Experiencing Traumatic Stress Symptoms

2007 ◽  
Vol 36 (1) ◽  
pp. 3-19 ◽  
Author(s):  
Nick Grey ◽  
Kerry Young
Keyword(s):  
Traumatic Stress ◽  
Clinical Pathway ◽  
Asylum Seekers ◽  
Behaviour Therapy ◽  
Mass Violence ◽  
Multicultural Issues ◽  
Stress Symptoms ◽  
Cognitive Behaviour ◽  
Prolonged Duration ◽  
Refugees And Asylum Seekers

AbstractThis paper describes the nature of the difficulties faced by asylum seekers and refugees who present with traumatic stress symptoms and uses existing cognitive models to better understand theoretical issues in these cases. The focus is on those people for whom traumatic stress symptoms are their main problem/pre-occupation. It is acknowledged that these people may only form a small proportion of those who have experienced such events. This paper does not focus on the important multicultural issues integral to this work. A possible clinical pathway is presented, including the role of exposure/reliving, and how it may be adapted where necessary for people who have experienced multiple traumatic events, often of prolonged duration. Discussion of possible psychosocial understandings of torture and mass violence may be important in this work. A case example is presented that demonstrates how this clinical pathway might unfold in practice.

Successfully treating refugees’ post-traumatic stress symptoms in a Ugandan settlement with group cognitive behaviour therapy

2020 ◽  
pp. 1-15
Author(s):  
Elsa J. Goninon ◽  
Lee Kannis-Dymand ◽  
Robi Sonderegger ◽  
Doddy Mugisha ◽  
Geoff P. Lovell
Keyword(s):  
Traumatic Stress ◽  
Cognitive Behaviour Therapy ◽  
Sociodemographic Factors ◽  
Developing Nations ◽  
Post Traumatic Stress ◽  
Behaviour Therapy ◽  
Stress Symptoms ◽  
Cognitive Behaviour ◽  
Post Traumatic ◽  
Sensitive Group

Abstract Background: High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations. Aims: To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees’ post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes. Method and Results: Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes. Discussion: A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees’ PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.

scholarly journals Asylum-Seekers' Experiences of Trauma-Focused Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder: A Qualitative Study

2012 ◽  
Vol 41 (5) ◽  
pp. 579-593 ◽  
Author(s):  
Felicity Vincent ◽  
Helen Jenkins ◽  
Michael Larkin ◽  
Sue Clohessy
Keyword(s):  
Therapeutic Relationship ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Asylum Seekers ◽  
Stress Disorder ◽  
Special Importance ◽  
Post Traumatic Stress ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Post Traumatic

Background: Trauma-focused CBT (TFCBT) is an evidence-based treatment for post-traumatic stress disorder (PTSD), but little is known about whether it is an acceptable and effective treatment for asylum-seekers presenting with PTSD. Aims: This study considers the acceptability of TFCBT for asylum-seekers with PTSD by exploring their experiences of this treatment. Method: Seven asylum-seekers who had received CBT involving a TFCBT component were interviewed using a semi-structured schedule. The transcribed interviews were analysed using interpretative phenomenological analysis (IPA). Interpretative themes were developed iteratively to closely reflect participants’ common and distinct experiences. Results: Six super-ordinate interlinking themes are discussed: Staying where you are versus engaging in therapy; Experiences encouraging engagement in therapy; Experiences impeding engagement in therapy; Importance of the therapeutic relationship; “Losing oneself” and “Regaining life”. Conclusions: Participants described their ambivalence about engaging in TFCBT. Such treatment was experienced as very challenging, but most participants also reported finding it helpful. Various experiences that appeared to encourage or impede engagement are outlined. These preliminary findings suggest that fear of repatriation can impede engagement in TFCBT, but that some asylum-seekers with PTSD still report finding TFCBT beneficial. The clinical implications are discussed, including the special importance of the therapeutic relationship.

scholarly journals Cognitive–behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial

2016 ◽  
Vol 47 (1) ◽  
pp. 43-51 ◽  
Author(s):  
C. Steel ◽  
A. Hardy ◽  
B. Smith ◽  
T. Wykes ◽  
S. Rose ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Cognitive Restructuring ◽  
Post Traumatic Stress ◽  
Behaviour Therapy ◽  
Current Trial ◽  
Randomized Controlled ◽  
Stress Symptoms ◽  
Cognitive Behaviour ◽  
Post Traumatic ◽  
Secondary Outcomes

BackgroundThere is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia.MethodA multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive–behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale.ResultsBoth the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes.ConclusionsThe current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder

2007 ◽  
Vol 38 (4) ◽  
pp. 555-561 ◽  
Author(s):  
R. A. Bryant ◽  
K. Felmingham ◽  
A. Kemp ◽  
P. Das ◽  
G. Hughes ◽  
...  
Keyword(s):  
Treatment Response ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Cognitive Behaviour Therapy ◽  
Stress Disorder ◽  
Anterior Cingulate ◽  
Post Traumatic Stress ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Post Traumatic

BackgroundAlthough cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.MethodFunctional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion.ResultsSeven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces.ConclusionsExcessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.

scholarly journals Long-distance migration was associated with increased prevalence of post-traumatic stress disorder in Syrian refugees

2021 ◽  
Author(s):  
Andreas Halgreen Eiset ◽  
Michaelangelo P Aoun ◽  
Monica Stougaard ◽  
Annemarie Graa Gottlieb ◽  
Ramzi S Haddad ◽  
...  
Keyword(s):  
Health Care ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Asylum Seekers ◽  
Stress Disorder ◽  
Syrian Refugees ◽  
Post Traumatic Stress ◽  
Long Distance ◽  
Post Traumatic ◽  
Refugees And Asylum Seekers

Background: Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a knowledge gap on how this may affect refugee' health and health care needs. We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health. Methods: Included from 2016-2019 were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arrived up to 12 months prior. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed. Results: After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point). Discussion: We found that long-distance migration was associated with an increase in the prevalence of PTSD suggesting that long-distance migration may be a factor to consider when assessing refugees' and asylum seekers' health. To secure timely and appropriate health care for this vulnerable group we need to remedy the current knowledge gap regarding the health effects of migration. This study is the first step in doing so.

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