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Than V, Doroud N, O’Brien L. Mental health service utilization and help seeking behaviours of adult Cambodians living in Western countries: A systematic scoping review. Int J Soc Psychiatry 2024; 70:778-791. [PMID: 38420918 PMCID: PMC11144358 DOI: 10.1177/00207640241230848] [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: 03/02/2024]
Abstract
BACKGROUND Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. AIMS To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. METHODS This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. RESULTS This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. CONCLUSION Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted.
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Affiliation(s)
- Vannaral Than
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Nastaran Doroud
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Lisa O’Brien
- Swinburne University of Technology, Hawthorn, VIC, Australia
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2
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Ekblad S, Gramatik O, Suprun Y. Increasing perceived health and mental health literacy among separated refugee Ukrainian families with urgent needs occasioned by invasion-a group intervention study with participatory methodology in Sweden. Front Public Health 2024; 12:1356605. [PMID: 38799690 PMCID: PMC11122463 DOI: 10.3389/fpubh.2024.1356605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background With the increasing numbers of refugees from Ukraine affected by the ongoing war, there is a high risk of trauma-related stress due to low local health and mental health literacy care. Perceived good health is a human right. Earlier studies show that intervention for refugees can reduce and prevent post-migration stress and anxiety. The present explorative study aimed to investigate the feasibility and effectiveness of a short, trauma-focused group intervention (in Swedish "hälsoskola") for Ukrainian-speaking refugees (EU's mass refugee directive). This intervention was part of an ESF project aiming to get the subjects closer to the labor market in Västernorrland County, Sweden. Materials and methods A mixed-methods design, a participatory methodology, and an evaluation were used. Data were obtained with a short questionnaire in Ukrainian. It included a visual analogue health-rating scale, an observation, and an oral evaluation in groups. For practical and ethical reasons, there was no control group. Each group met five times for 2 h, a total of 10 h excluding pre- and post-assessment. There were eight sets of five group sessions per set, a total of 40 sessions. Brief initial and concluding breathing exercises sought to reduce stress among the participants. Results Baseline data were obtained from 99 participants, mostly females. Data gathered directly after the group intervention from 57 participants who had filled in both the pre- and post-questionnaires showed that (1) perceived anxiety/stress was significantly reduced (chi-2 25,53, df = 4, p < 001). (2) The participants showed significantly better perceived health as assessed on a visual analogue scale (average change from 63.16 to 71.18, p < 0.001). This result was supported by the participants' questions, which were qualitatively evaluated using thematic content analysis. Five general themes stemmed from questions raised in dialogue with the participants plus observation with the respective local expert. The participants received answers to their questions, and their perceived negative attitudes to authorities changed to more positive ones. Conclusion By dialogue between the participants' needs of knowledge and direct answers by the local expert, respectively, was feasible and effective as they perceived trust and health and mental health literacy increased. Implications for primary prevention are discussed.
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Affiliation(s)
- Solvig Ekblad
- Cultural Medicine Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Kleinschmitt A. Research on psychotherapy for refugees in Germany: A systematic review on its transdisciplinary and transregional opening. Transcult Psychiatry 2024; 61:151-167. [PMID: 38234182 PMCID: PMC10996299 DOI: 10.1177/13634615231187255] [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: 01/19/2024]
Abstract
Recently, an increasing amount of research has focused on adapting psychotherapy concepts for refugees moving to Germany. For a long time, research from disciplines like anthropology and cultural studies has problematized the eurocentrism of psychology's theoretical premises and methodologies. Currently, scholarship around Global Mental Health and decolonization emphasizes how knowledge production from various disciplines and regions relates to this topic and could contribute to improving respective approaches. Consequently, this review aims at evaluating the actual transdisciplinary and transregional opening of studies on psychotherapeutic interventions for refugees in Germany. It provides a theoretically as well as empirically informed basis for looking at disciplinary premises, practices, and boundaries as well as the regional locatedness of respective research. Fourteen relevant studies, published between January 1, 2007 and March 4, 2022, were identified by systematically searching the databases PubPsych and Web of Science. The studies were reviewed regarding study design, choice and characterization of target groups, regional origin and target group specific adaptations of the therapeutic concepts, integration of elements from and connections to other disciplines, and use of references to scholarship from the Global South. The findings show a pronounced focus on the development of trauma therapy approaches and moreover a broad variety of concept adaptations in response to the assumed characteristics, situations, and needs of the target groups. While the findings reveal a complex transregional pattern of development and adaptation of the therapeutic concepts, transdisciplinary opening and reference to the Global South appear scarce.
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Fuhr K, Bender A, Wiegand A, Janouch P, Drujan M, Cyrny B, Schweizer C, Kreifelts B, Nieratschker V, Batra A. Hypnotherapy for agoraphobia-Feasibility and efficacy investigated in a pilot study. Front Psychol 2023; 14:1213792. [PMID: 37637902 PMCID: PMC10448829 DOI: 10.3389/fpsyg.2023.1213792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
A number of case studies describing hypnotherapy in the treatment of anxiety disorder patients have already been published. Only a few randomized controlled trials (RCTs) investigated the efficacy of hypnotherapy but focused mainly on symptoms rather than specific mental disorders. The goal of this study was to investigate whether hypnotherapy (HT) was superior to a waitlist control group (WL) in the reduction of agoraphobia-related symptoms. Further goals were to report the feasibility of hypnotherapy as well as attrition and completion rates and detect (epi-)genetic variables, which might play a role in treatment outcome. This pilot study was based on a monocentric two-armed randomized controlled rater-blind clinical trial that was conducted between 2018 and 2020 with a waitlist control group. A total of 36 patients diagnosed with agoraphobia were randomized to either HT or WL. Patients in HT received individual outpatient treatment with hypnotherapy with 8 to 12 sessions for a period of 3 months. Patients in WL received HT after 3 months. Agoraphobia-related symptoms were assessed at baseline, after the treatment, and 3 months later in both groups with a clinician rating. The primary hypothesis concerning the difference between groups in the individual percentage symptom reduction could be confirmed in the intention-to-treat, not the per-protocol sample. Additionally, we applied repeated-measures analyses of variance and found a higher symptom decrease in HT compared with WL patients in three of the five imputed datasets. The dropout rate was low, and satisfaction with the treatment was high. HT patients experienced a strong symptom reduction after receiving hypnotherapy. WL patients improved slightly during the waiting period. The COMT Val108/158Met genotype had an effect on the agoraphobia-related symptoms as well as on COMT DNA methylation levels. This is the first study to indicate that hypnotherapy performed better than a waitlist control group regarding the reduction in anxiety symptoms in an RCT. Future studies should confirm the efficacy of hypnotherapy and compare the treatment with a standard treatment for anxiety disorders in a larger trial. Future studies should also investigate whether hypnotic susceptibility is associated with COMT Val108/158Met genotype and could predict treatment success for HT. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT03684577, identifier: NCT03684577.
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Affiliation(s)
- Kristina Fuhr
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Annika Bender
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- Max Planck Fellow Group Precision Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Paul Janouch
- Outpatient Psychotherapy Practice, Bad Salzuflen, Germany
| | - Marta Drujan
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Barbara Cyrny
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Cornelie Schweizer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
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5
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P Iqbal M, Walpola R, Harris-Roxas B, Li J, Mears S, Hall J, Harrison R. Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches. Health Expect 2021; 25:2065-2094. [PMID: 34651378 PMCID: PMC9615090 DOI: 10.1111/hex.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well‐being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. Methods A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference‐management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. Results The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. Conclusion This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. Patient or Public Contribution Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.
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Affiliation(s)
- Maha P Iqbal
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ramesh Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,South Eastern Sydney Research Collaboration Hub (SEaRCH), Population and Community Health, South Eastern Sydney Local Health District, Darlinghurst, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, New South Wales, Australia
| | - John Hall
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation; Level 6, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Kim EY, Han SW. Development of Psychological First Aid Guidelines for People Who Have Experienced Disasters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010752. [PMID: 34682491 PMCID: PMC8535812 DOI: 10.3390/ijerph182010752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022]
Abstract
This study developed guidelines for psychological first aid. This guideline promotes core response and disaster capabilities for disaster mental-health professionals, such as mental-health nurses and counseling psychologists at disaster sites. A research team composed of a first-aid professor and counseling psychology professor developed this psychological first-aid guideline to promote the psychological response required at disaster sites. The team verified each question’s content adequacy at each guideline-development stage to determine the appropriateness of response to a disaster. The PFA performance stage and achievement objectives were moved to the next stage only when the research team fully agreed upon them. This guideline revised and supplemented the six steps suggested in the handbook to five steps through expert meetings. The modified part was made into one step, without separating the first rapport formation and safety check. The checklist for evaluation was developed after verification by a total of four people, including one emergency-rescue-department professor, one counseling psychology professor, one paramedic, and one health educator. Based on previous studies, the cutting point is 24 points. The final completed psychological first aid consists of five stages: rapport formation and safety verification, psychological stabilization, information collection, problem resolution, and recovery, with details to be carried out at each step. These guidelines contribute to the promotion of disaster-response capabilities of disaster psychologists. Continuous training and practical exercises based on the five stages will provide fundamental data for a disaster-simulation psychological-first-aid educational development.
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Affiliation(s)
- Eun-Young Kim
- Department of Counseling Psychology, Kyungil University, Gyeongsan 38428, Korea;
| | - Seung-Woo Han
- Department of Emergency Medical Technology, Kyungil University, Gyeongsan 38428, Korea
- Correspondence:
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Zehetmair C, Kaufmann C, Tegeler I, Klippel A, Nagy E, Kindermann D, Friederich HC, Nikendei C. Stabilisierungsgruppe für traumatisierte männliche
Geflüchtete in einer Erstaufnahmeeinrichtung des Landes
Baden-Württemberg: Konzept und Erfahrungen. Psychother Psychosom Med Psychol 2021; 71:473-476. [PMID: 34517421 DOI: 10.1055/a-1584-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungGeflüchtete erleben vielfach traumatisierende Ereignisse im Heimatland
und auf der Flucht, die in dieser Gruppe zu einer erhöhten
Prävalenz der Posttraumatischen Belastungsstörung
führen. Traumaorientierte stabilisierende Techniken können vor
allem in der frühen post-migratorischen Phase eine erste psychosoziale
Stabilisierung traumatisierter Geflüchteter bewirken. In diesem Beitrag
wird das klinische Konzept der offenen Stabilisierungsgruppe für
männliche, traumatisierte Geflüchtete im Erstaufnahme- und
Registrierungszentrum „Patrick-Henry Village“ des Landes
Baden-Württemberg vorgestellt. Die Stabilisierungsgruppe in englischer
Sprache folgt einem offenen Gruppenkonzept mit einer wiederkehrenden Struktur
bestehend aus Begrüßungsrunde, dem gemeinsamen Üben von
Achtsamkeits- und imaginativen Stabilisierungsübungen und einer
Abschlussrunde. Die bisherigen Erfahrungen zeigen, dass das Konzept einer
offenen Stabilisierungsgruppe im Kontext einer Erstaufnahme- und
Registrierungsstelle für Geflüchtete gut implementierbar ist.
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Affiliation(s)
- Catharina Zehetmair
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Claudia Kaufmann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Inga Tegeler
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Anne Klippel
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Ede Nagy
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - David Kindermann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Hans-Christoph Friederich
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Nikendei
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
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Zehetmair C, Zeyher V, Cranz A, Ditzen B, Herpertz SC, Kohl RM, Nikendei C. A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052275. [PMID: 33668936 PMCID: PMC7956492 DOI: 10.3390/ijerph18052275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022]
Abstract
Providing refugees with psychosocial support is particularly important considering the high level of mental health problems prevalent in this population. A psychosocial walk-in clinic operating within a state reception and registration center in Germany has been supporting mentally burdened refugees since 2016. This study focused on patients' perspectives on their mental health burden, the psychosocial walk-in clinic, and future help seeking. We conducted interviews with n = 22 refugees attending the walk-in clinic from March to May 2019. Qualitative analysis focused on the following four topics: (1) mental burden from the patients' perspective, (2) access to the psychosocial walk-in clinic, (3) perception of counseling sessions, and (4) perception of follow-up treatment. The results show that the majority of interviewees were burdened by psychological and somatic complaints, mostly attributed to past experiences and post-migratory stress. Therapeutic counseling and psychiatric medication were found to be particularly helpful. Most of the participants felt motivated to seek further psychosocial support. Key barriers to seeking psychosocial help included shame, fear of stigma, and lack of information. Overall, the psychosocial walk-in clinic is a highly valued support service for newly arrived refugees with mental health issues.
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Affiliation(s)
- Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
- Correspondence: ; Tel.: +49-6221-56-3873
| | - Valentina Zeyher
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Anna Cranz
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Sabine C. Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, 69115 Heidelberg, Germany;
| | - Rupert Maria Kohl
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
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Bækkelund H, Karlsrud I, Hoffart A, Arnevik EA. Stabilizing group treatment for childhood-abuse related PTSD: a randomized controlled trial. Eur J Psychotraumatol 2021; 12:1859079. [PMID: 33537118 PMCID: PMC7833018 DOI: 10.1080/20008198.2020.1859079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Patients with PTSD related to childhood-abuse often experience additional problems such as emotional dysregulation and interpersonal difficulties. Psychotherapy focused on stabilization of symptoms, emotion-regulation, and skills training has been suggested as a treatment for this patient population, either as preparation for further treatment or as a stand-alone intervention. Objective: The present study tests the efficacy of treatment using a group-protocol for stabilizing treatment delivered adjunct with conventional individual therapy. Methods: In a delayed-treatment design with switching replication, a clinically representative sample of 89 patients with PTSD and histories of childhood abuse were randomly assigned to either 20-week stabilizing group treatment or a corresponding waiting-period, both adjunct with conventional individual therapy. After the waiting-period, patients in the control condition were offered group treatment. The primary outcome was psychosocial functioning, measured with interview - assessed Global Assessment of Functioning (GAF), while secondary outcome was self-reported PTSD symptoms. These were measured before treatment, after treatment and at 6 months follow up. The trial was preregistered at Clinical Trials (NCT02450617). Results: We found large within-group effect sizes in both conditions on GAF and moderate effects on PTSD symptoms. Linear mixed-models did not indicate significant differences in treatment trajectories between conditions. Conclusion: Stabilizing group treatment focused on emotional-regulation and skills-training does not improve outcomes beyond individual-treatment alone, and should not be recommended as first-line treatment for this patient-group.
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad, Vikersund, Norway.,Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ida Karlsrud
- Research Institute, Modum Bad, Vikersund, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad, Vikersund, Norway
| | - Espen Ajo Arnevik
- Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
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10
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Zehetmair C, Nagy E, Leetz C, Cranz A, Kindermann D, Reddemann L, Nikendei C. Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study. J Med Internet Res 2020; 22:e17906. [PMID: 32965229 PMCID: PMC7542415 DOI: 10.2196/17906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees’ emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. Objective This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. Methods From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. Results At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique “The Inner Safe Place” was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. Conclusions The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, “The Inner Safe Place” technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.
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Affiliation(s)
- Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carla Leetz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Cranz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Luise Reddemann
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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11
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Stabilizing Techniques and Guided Imagery for Traumatized Male Refugees in a German State Registration and Reception Center: A Qualitative Study on a Psychotherapeutic Group Intervention. J Clin Med 2019; 8:jcm8060894. [PMID: 31234487 PMCID: PMC6617260 DOI: 10.3390/jcm8060894] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022] Open
Abstract
Refugees have an increased risk of developing mental health problems. Due to the unstable setting in refugee state registration and reception centers, recommended trauma-focused treatment approaches are often not applicable. For this purpose, we devised a suitable therapeutic approach to treat traumatized refugees in a German state registration and reception center: Group therapy, focusing on stabilizing techniques and guided imagery according to Reddemann (2017). From May 2017 to April 2018, we conducted semi-structured interviews with n = 30 traumatized refugees to assess their experiences with the stabilizing techniques and guided imagery in group sessions and self-practice. Participants mainly reported that they had more pleasant feelings, felt increasingly relaxed, and could better handle recurrent thoughts. Additionally, the participants noticed that their psychosocial functioning had improved. The main difficulties that participants encountered were feeling stressed, having difficulties staying focused, or concentrating on the techniques. During self-practice, the participants found it most challenging that they did not have any verbal guidance, were often distracted by the surroundings in the accommodation, and had recurrent thoughts about post-migratory stressors, such as insecurity concerning the future or the application for asylum. Our results show that stabilizing techniques and guided imagery according to Reddemann (2017) are a suitable approach to treat traumatized refugees living in volatile conditions.
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