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Tay AK, Mohsin M, Foo CYS, Rees S, Silove D. Long-term efficacy of brief psychological treatments for common mental disorders in Myanmar refugees in Malaysia: 12-month follow-up of a randomized, active-controlled trial of integrative adapt therapy v. cognitive behavioral therapy. Psychol Med 2023; 53:6055-6067. [PMID: 36330832 DOI: 10.1017/s0033291722003245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term efficacy of brief psychotherapies for refugees in low-resource settings is insufficiently understood. Integrative adapt therapy (IAT) is a scalable treatment addressing refugee-specific psychosocial challenges. METHODS We report 12-month post-treatment data from a single-blind, active-controlled trial (October 2017-August 2019) where 327 Myanmar refugees in Malaysia were assigned to either six sessions of IAT (n = 164) or cognitive behavioral treatment (CBT) (n = 163). Primary outcomes were posttraumatic stress disorder (PTSD), depression, anxiety, and persistent complex bereavement disorder (PCBD) symptom scores at treatment end and 12-month post-treatment. Secondary outcome was functional impairment. RESULTS 282 (86.2%) participants were retained at 12-month follow-up. For both groups, large treatment effects for common mental disorders (CMD) symptoms were maintained at 12-month post-treatment compared to baseline (d = 0.75-1.13). Although participants in IAT had greater symptom reductions and larger effect sizes than CBT participants for all CMDs at treatment end, there were no significant differences between treatment arms at 12-month post-treatment for PTSD [mean difference: -0.9, 95% CI (-2.5 to 0.6), p = 0.25], depression [mean difference: 0.1, 95% CI (-0.6 to 0.7), p = 0.89), anxiety [mean difference: -0.4, 95% CI (-1.4 to 0.6), p = 0.46], and PCBD [mean difference: -0.6, 95% CI (-3.1 to 1.9), p = 0.65]. CBT participants showed greater improvement in functioning than IAT participants at 12-month post-treatment [mean difference: -2.5, 95% CI (-4.7 to -0.3], p = 0.03]. No adverse effects were recorded for either therapy. CONCLUSIONS Both IAT and CBT showed sustained treatment gains for CMD symptoms amongst refugees over the 12-month period.
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Affiliation(s)
- Alvin Kuowei Tay
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Cheryl Yunn Shee Foo
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York City, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Rees
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
| | - Derrick Silove
- The Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine, Sydney, Australia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Spanhel K, Hovestadt E, Lehr D, Spiegelhalder K, Baumeister H, Bengel J, Sander LB. Engaging Refugees With a Culturally Adapted Digital Intervention to Improve Sleep: A Randomized Controlled Pilot Trial. Front Psychiatry 2022; 13:832196. [PMID: 35280163 PMCID: PMC8905517 DOI: 10.3389/fpsyt.2022.832196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023] Open
Abstract
Refugees are exposed to multiple stressors affecting their mental health. Given various barriers to mental healthcare in the arrival countries, innovative healthcare solutions are needed. One such solution could be to offer low-threshold treatments, for example by culturally adapting treatments, providing them in a scalable format, and addressing transdiagnostic symptoms. This pilot trial examined the feasibility, acceptance, and preliminary effectiveness of a culturally adapted digital sleep intervention for refugees. Sixty-six refugees participated, with 68.2% of them seeking psychological help for the first time. Only three participants did not show clinically significant insomnia severity, 93.9% reported past traumatic experiences. Participants were randomly assigned to the intervention group (IG) or the waitlist control group (CG). Insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, fear of sleep, fatigue, depression, wellbeing, mental health literacy) were assessed at baseline, 1 and 3 months after randomization. The self-help intervention included four modules on sleep hygiene, rumination, and information on mental health conditions associated with sleep disturbances. 66.7% of the IG completed all modules. Satisfaction with the intervention and its perceived cultural appropriateness were high. Linear multilevel analyses revealed a small, non-significant intervention effect on insomnia severity of Hedge's g = 0.28 at 3-months follow-up, comparing the IG to the CG [F 2, 60 = 0.88, p = 0.421]. This non-confirmatory pilot trial suggests that low-threshold, viable access to mental healthcare can be offered to multiple burdened refugees by culturally adapting an intervention, providing it in a scalable format, and addressing a transdiagnostic symptom.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Eva Hovestadt
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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Sudheer N, Banerjee D. The Rohingya refugees: a conceptual framework of their psychosocial adversities, cultural idioms of distress and social suffering. Glob Ment Health (Camb) 2021; 8:e46. [PMID: 35003755 PMCID: PMC8715339 DOI: 10.1017/gmh.2021.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/17/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
Rohingya refugees, a group of religious and ethnic minorities, primarily reside in the South Asian nations. With decades of displacement, forced migration, limited freedom of movement, violence and oppression, they have been termed by the United Nations (UN) as the 'most persecuted minority group' in world history. Literature shows an increased prevalence of psychiatric disorders such as depression, anxiety, post-traumatic stress, insomnia, etc., in this population. However, beyond 'medicalisation', the psychosocial challenges of the Rohingyas need to be understood through the lens of 'social suffering', which results from a complex interplay of multiple social, political, environmental and geographical factors. Lack of essential living amenities, poverty, unemployment, overcrowding, compromised social identity, and persistent traumatic stressors lead to inequality, restricted healthcare access, human rights deprivation and social injustice in this group. Even though the United Nations High Commission for Refugees (UNHCR) has taken a renewed interest in Rohingya re-establishment with well-researched standards of care, there are several pragmatic challenges in their implementation and inclusion in policies. This paper reviews these multi-dimensional psychosocial challenges of the Rohingyas by synthesising various intersecting conceptual models including minority stress, health-stigma-discrimination framework, refugee ecological model and capability approach. Furthermore, it highlights multidisciplinary interventions to mitigate these adversities, improve their living situation and eventually foster healing via means which are culturally relevant and contextually appropriate. These interventions need to involve various stakeholders from a human rights and dignity based lens, including the voices of the Rohingyas and supported by more research in this area.
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Affiliation(s)
- Nivedita Sudheer
- Department of Psychiatry, Christian Medical College, Vellore, India
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Jannesari S, Lotito C, Turrini G, Oram S, Barbui C. How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review. Int J Ment Health Syst 2021; 15:80. [PMID: 34702334 PMCID: PMC8546788 DOI: 10.1186/s13033-021-00501-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) host the majority of the world's refugees. Evidence suggests that refugees and asylum seekers have high mental health needs compared to the host country population. However, they face many social, economic and culture barriers to receiving mental health care and benefitting from mental health interventions. This paper examines how these contextual factors affect the implementation of mental health interventions for refugees and asylum seekers in LMICs. METHODS We conducted a qualitative systematic review searching 11 databases and 24 relevant government and non-governmental organisation (NGO) websites. We spoke with academic experts and NGO professionals for recommendations, and conducted forwards and backwards citation tracking. RESULTS From 2055 records in abstract and title screening, and then 99 in full-text screening, 18 eligible studies were identified. Qualitative thematic synthesis was conducted on eligible papers. Three main thematic clusters were identified around: (1) support during a time of pressure and insecurity, and the need for intervention flexibility through facilitator and participant autonomy; (2) different cultural conceptions of mental health, and how interventions negotiated these differences; and (3) the importance of facilitator skills, knowledge, characteristics and relationships to intervention implementation. CONCLUSION Evidence suggests that intervention coordinators and developers should continue to: (1) think broadly about the range of social influences on mental health, addressing structural issues where possible; (2) offer flexibility with intervention style, content and timings; and (3) encourage building research capacity in LMICs while acknowledging pre-existing mental health knowledge and practice.
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Affiliation(s)
- Sohail Jannesari
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Claudia Lotito
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Siân Oram
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
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Tay AK, Miah MAA, Khan S, Mohsin M, Alam AM, Ozen S, Mahmuda M, Ahmed HU, Silove D, Ventevogel P. A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh. EClinicalMedicine 2021; 38:100999. [PMID: 34505027 PMCID: PMC8413262 DOI: 10.1016/j.eclinm.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh. Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience. Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17). Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency. Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
- Correspondence: Alvin Kuowei Tay, : School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.
| | | | - Sanjida Khan
- Independent Researcher, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - A.N.M. Mahmudul Alam
- Mental Health and Psychosocial Support Subunit, Public Health & Nutrition Unit, United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh
| | - Sanem Ozen
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | | | - Helal U. Ahmed
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Peter Ventevogel
- National Institute of Mental Health, Dhaka, Bangladesh
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Tay AK, Khat Mung H, Badrudduza M, Balasundaram S, Fadil Azim D, Arfah Zaini N, Morgan K, Mohsin M, Silove D. Psychosocial mechanisms of change in symptoms of Persistent Complex Bereavement Disorder amongst refugees from Myanmar over the course of Integrative Adapt Therapy. Eur J Psychotraumatol 2020; 11:1807170. [PMID: 33062211 PMCID: PMC7534324 DOI: 10.1080/20008198.2020.1807170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: The ability to adapt to the psychosocial disruptions associated with the refugee experience may influence the course of complicated grief reactions. Objective: We examine these relationships amongst Myanmar refugees relocated to Malaysia who participated in a six-week course of Integrative Adapt Therapy (IAT). Method: Participants (n = 170) included Rohingya, Chin, and Kachin refugees relocated to Malaysia. At baseline and six-week post-treatment, we applied culturally adapted measures to assess symptoms of Prolonged Complex Bereavement Disorder (PCBD) and adaptive capacity to psychosocial disruptions, based on the Adaptive Stress Index (ASI). The ASI comprises five sub-scales of safety/security (ASI-1); bonds and networks (ASI-2); injustice (ASI-3); roles and identity (ASI-4); and existential meaning (ASI-5). Results: Multilevel linear models indicated that the relationship between baseline and posttreatment PCBD symptoms was mediated by the ASI scale scores. Further, ASI scale scores assessed posttreatment mediated the relationship between baseline and posttreatment PCBD symptoms. Mediation of PCBD change was greatest for the ASI II scale representing disrupted bonds and networks. Conclusion: Our findings are consistent with the informing model of IAT in demonstrating that changes in adaptive capacity, and especially in dealing with disrupted bonds and networks, may mediate the process of symptom improvement over the course of therapy.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
| | - Hau Khat Mung
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mohammad Badrudduza
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Darlina Fadil Azim
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Nur Arfah Zaini
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Kuala Lumpur, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Psychiatry Research and Teaching Unit, Liverpool Hospital, NSW Health, Sydney, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Tay AK, Mung HK, Miah MAA, Balasundaram S, Ventevogel P, Badrudduza M, Khan S, Morgan K, Rees S, Mohsin M, Silove D. An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLoS Med 2020; 17:e1003073. [PMID: 32231364 PMCID: PMC7108685 DOI: 10.1371/journal.pmed.1003073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience. METHODS AND FINDINGS We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up. CONCLUSIONS Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings. TRIAL REGISTRATION The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Selangor, Malaysia
| | - Hau Khat Mung
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | | | - Susheela Balasundaram
- Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia
| | - Peter Ventevogel
- Public Health Section/ Division of Programme Support & Management, United Nations High Commissioner for Refugees (UNHCR), Geneva, Switzerland
| | - Mohammad Badrudduza
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Sanjida Khan
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Susan Rees
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
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Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees. Epidemiol Psychiatr Sci 2019; 29:e47. [PMID: 31441397 PMCID: PMC8061213 DOI: 10.1017/s2045796019000416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. METHODS A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. RESULTS The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. CONCLUSIONS IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
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Miah MA, Mahmuda M, Elshazly M, Khan S, Tay A, Ventevogel P. Contextual adaptation and piloting of Group Integrative Adapt Therapy (IAT-G) amongst Rohingya refugees living in Bangladesh. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2019. [DOI: 10.4103/intv.intv_48_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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