Islamic Trauma Healing: Integrating Faith and Empirically Supported Principles in a Community-Based Program

Family functioning in the context of current and historical stressors: Exploring the buffering role of social support

BACKGROUND

Adverse Childhood Experiences (ACEs) can be passed onto future generations through complex biopsychosocial mechanisms. However, social support in caregivers who have experienced adversity may lead to adaptation. Most research on the intergenerational consequences of ACEs has focused on mental health in subsequent generations, while overlooking family functioning as an outcome.

OBJECTIVE

This pre-registered study addresses this gap by examining a hypothesized association between caregiver ACEs and caregiver-perceived family functioning, and the moderating role of social support. It was expected that high levels of social support would attenuate the association between caregiver ACEs and family functioning, controlling for contemporaneous stressors in the context of the COVID-19 pandemic.

PARTICIPANTS AND SETTING

Data come from a multinational non-clinical sample (n = 310).

METHODS

Caregivers completed self-report measures to assess caregiver ACEs, social support, COVID stressors, and family dysfunction.

RESULTS

Multiple regression analyses revealed that the ACEs-by-social support interaction was not significant. Exploratory analyses revealed a significant three-way interaction between COVID stressors, ACEs, and social support (b = 0.001, SE < 0.001, p = .008). For lower adversity, social support protected against the association between COVID stressors and family dysfunction; however, for higher adversity, social support was only protective when COVID stressors were low.

CONCLUSIONS

Social support is protective against concurrent stressors during the pandemic in relation to family functioning, though this buffering depends on historical levels of adversity. Findings are interpreted through a trauma-informed lens and provide support for family-focused interventions and policies to mitigate the impact of stress on caregivers with high ACEs.

Islamic trauma healing (ITH): A scalable, community-based program for trauma: Cluster randomized control trial design and method

Background

Somalia has long been in a state of humanitarian crisis; trauma-related mental health needs are extremely high. Access to state-of-the-art mental health care is limited. Islamic Trauma Healing (ITH) is a manualized mosque-based, lay-led group intervention aimed at healing the individual and communal mental wounds of war and refugee trauma. The 6-session intervention combines Islamic principles with empirically-supported exposure and cognitive restructuring principles for posttraumatic stress disorder (PTSD). ITH reduces training time, uses a train the trainers (TTT) model, and relies on local partnerships embedded within the strong communal mosque infrastructure.

Methods

We will conduct a hybrid effectiveness-implementation randomized control trial (RCT) in the Somaliland, with implementation in the cities of Hargeisa, Borama, and Burao. In this study, a lay-led, mosque-based intervention, Islamic Trauma Healing (ITH), to promote mental health and reconciliation will be examined in 200 participants, randomizing mosques to either immediate ITH or a delayed (waitlist; WL) ITH conditions. Participants will be assessed by assessors masked to condition at pre, 3 weeks, 6 weeks, and 3-month follow-up. Primary outcome will be assessor-rated posttraumatic stress symptoms (PTSD), with secondary outcomes of depression, somatic symptoms, and well-being. A TTT model will be tested, examining the implementation outcomes. Additional measures include potential mechanisms of change and cost effectiveness.

Conclusion

This trial has the potential to provide effectiveness and implementation data for an empirically-based principle trauma healing program for the larger Islamic community who may not seek mental health care or does not have access to such care.

Clinical trial registration number

ClinicalTrials.gov NCT05890482.

World health organization trial registration data set information

See Supplemental Appendix 1.

Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims

Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

Mental health training programs for non-health professionals and volunteers working with asylum-seekers and refugees: scoping review

OBJECTIVE

To identify and describe the mental health training programs for non-health professionals and volunteers who work, have worked, or would work with asylum seekers and/or refugees.

METHOD

Scoping review following JBI methodology. Search carried out in MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, and websites of Clinical Trials, UNHCR, International Organization for Migration, WHO, Save the Children, International Migration, Integration and Social Cohesion in Europe, and International Federation of Red Cross and Red Crescent Societies. Studies written in English, Portuguese, French, Spanish and Swedish.

RESULTS

Of the 8954 articles identified, 16 were included reporting on 11 training programs: Mind-Spring, PM+, MHFA, Cognitive-Behavioral Training for Community and Religious Leaders, EmpaTeach, Suicide Prevention Education Program, Teaching Recovery Techniques, Handbook for Teachers of Vietnamese Refugee Students, PFA, Psychosocial support of volunteers and CBP&MHPSS.

CONCLUSION

Training programs from scientific literature focus on mental health disorders, while non-governmental organizations' documents focus on resilience and self-care. The current mental health training programs might be insufficient.

Understanding ethnic minority service user experiences of being invited to and attending group pain programmes: A qualitative service evaluation

Introduction

Health inequalities continue to exist for individuals from an ethnic minority background who live with chronic pain. There is a growing recognition that an individual's experience of pain is shaped by their cultural beliefs, which may influence their decisions about managing their pain.

Aims

This service evaluation aimed to (a) understand experiences of service users from a Black, Asian or other ethnic minority background of being invited to and attending a group pain programme in one secondary care pain rehabilitation service. (b) Provide recommendations to develop culturally grounded services to better meet the diverse needs of all service users living with chronic pain.

Method

Semi-structured interviews were conducted with five service users who had been offered a place on a group pain programme within the last 3 years. The interviews were recorded and transcribed verbatim. An interpretative phenomenological analysis was used to identify themes in the data.

Results

The analysis produced three themes (1) Pain, Ethnicity and Coping: Perceptions of pain and coping in relation to ethnicity and intersectional factors, alignment to a self-management approach. (2) Communication for Decisions: Experiences of ethnicity and culture in relation to health professional communication about group pain programmes, participants' expectations and fears. (3) Feeling Included: Experiences of feeling included or excluded in group pain programme, relationships and empowerment during the group pain programme.

Discussion

The five service users shared a range of perspectives on how they felt ethnicity shaped their experience of the group pain programme. The findings suggest that adaptations to group pain programmes can make a meaningful difference for service users from ethnic minority backgrounds. 10 recommendations are suggested, including greater exploration of cultural beliefs during assessment, improving accessibility of information about the service and engaging more diverse attendees and facilitators.

WhatsApp supervision for a lay-led Islamic trauma-focused intervention in Somaliland: Qualitative content analysis

Clinical supervision is critical for the uptake of psychotherapy but difficult to facilitate in countries with limited providers, resources, and internet infrastructure. Innovative supervision approaches are needed to increase access to mental health treatments in low-to-middle income countries (LMICs). This study examined the content and feasibility of remote WhatsApp text supervision conducted as part of an open clinical trial in Somaliland. Islamic Trauma Healing ITH) is a brief, group, lay-lead, trauma-focused, mosque-based intervention that has demonstrated initial efficacy in pilot studies in the United States and Somaliland. After a 2-day, in-person training, lay leaders led four groups of five to seven members focused on trauma-related psychopathology and community reconciliation. Somali lay leaders trained in ITH (n = 9) and the research team (n = 6) attended weekly WhatsApp supervision during the intervention. Content was logged and subjected to qualitative analysis by two coders. Comments related to intervention implementation indicated that lay leaders understood the treatment rationale, adhered to treatment procedures, and believed the intervention components to be helpful and culturally relevant. Themes related to engagement suggested perfect attendance across groups and high levels of participation. Lay leader psychoeducation and skill development; supervisor praise, support, and encouragement; and supervisee gratitude emerged as additional themes. Remote text supervision conducted via WhatsApp was technologically feasible and may have facilitated skill development and the effective implementation of this lay-led intervention. When tailored to the local context, remote supervision approaches hold promise for increasing access to services in LMICs with limited resources.

Adapting narrative exposure therapy with a tribal community: A community-based approach

OBJECTIVE

American Indian (AI) individuals are at increased risk for present-day trauma exposure and associated negative outcomes, as well as ongoing effects of intergenerational trauma exposure and adversity. However, few empirically supported treatments exist that are specifically tailored and/or tested with AI communities. This study describes the process of selecting, adapting, and implementing narrative exposure therapy (NET) with an AI community.

METHODS

A community and academic partnership was formed and worked together to make culturally mindful changes to NET to best fit the needs of the community. The partnership incorporated community leaders/Elders (n = 7), providers (n = 11), and participants seeking treatment (n = 50) to implement an iterative process of adapting and implementing the adapted form of NET.

RESULTS

Key adaptions included addressing historical and intergenerational trauma, greater protections for confidentiality in a small community, and incorporation of cultural customs and traditions. Overall, the adapted form of NET was favorably received by the participants, and the implementation appeared to be feasible, with improved retention over past trials of adapted trauma-focused treatments with this community and with highly positive satisfaction ratings and feedback.

CONCLUSIONS

NET was shown to be an appropriate approach for this AI community and should be considered as a treatment option for other AI communities. Future work should consider strategies outlined in this adaption as well as following a similar process for working with AI communities to implement culturally appropriate interventions for trauma-related symptoms.

"Whatever you hide, also hides you": A discourse analysis on mental health and service use in an American community of Somalis

After decades of refugee displacement, Somalis are at increased risk for poor mental health. However, uptake of treatment referrals in primary care is low among Somalis compared to other refugee groups. The objective of this analysis was to understand specific resistances to US mental health care contributing to this gap in coverage. One hundred and sixty-eight Somali men and women over the age of 14, participated in 28 focus group from October 2017 to November 2018 discussing wellbeing and healthcare in the US. Transcripts were analyzed based on critical discourse theory, informed by the theoretical work of Michel Foucault. This study identified two primary discourses, one biomedical and the other driven by Somali community mental health knowledge and social practice. Mental health as an object of Muslim faith, nosological fusion of psychiatric illness terms, and stigmatization and internal social control to limit disclosure were discussed. US mental health services were described as giving off a bad vibe, and represented external institutions of power, exacerbated by perceived discrimination. Somali youth occupied social bridging positions between cultural vs. US knowledge and practice. Three negotiating discourses emerged wherein participants created discursive solutions to these sites of resistance, including 1) how the social acceptability of seeking psychological care might be increased while maintaining Somali emotional resilience, 2) stressing the need to seek medical care as a practical supplement to spiritual care, and 3) highlighting the need for Somali youth to enter health fields. Findings suggest that intervention strategies not only ensure that services are culturally appropriate and sensitive to religion, but also consider that services are potentially seen as both an extension of US institutional power and an affront to Somali identity making. Overcoming these challenges may involve nurturing the negotiating discourses taken up by communities.

Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War

Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors (N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD (g = 1.91), depression (g = 2.00), somatic symptoms (g = 2.73), and well-being (g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs. ClinicalTrials.gov Identifier: NCT03761732.