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Eskici HS, Hinton DE, Jalal B, Yurtbakan T, Acarturk C. Culturally adapted cognitive behavioral therapy for Syrian refugee women in Turkey: A randomized controlled trial. Psychol Trauma 2023; 15:189-198. [PMID: 34618479 DOI: 10.1037/tra0001138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to determine for Syrian refugee women in Turkey the effectiveness, feasibility, and acceptability of culturally adapted cognitive behavioral therapy (CA-CBT). METHOD Participants were randomly allocated to receive either CA-CBT (n = 12) or treatment-as-usual (TAU; n = 11). We used the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist-25 (HSCL) to assess posttraumatic stress symptoms and anxious-depressive distress. CA-CBT was delivered through seven weekly group sessions. RESULTS CA-CBT had a large effect on PTSD (HTQ d = 1.17) and nearly medium effect sizes for anxious-depressive distress (HSCL d = .40). There were also low drop-out rates and an absence of adverse events. CONCLUSIONS Because CA-CBT greatly reduced PTSD symptoms as compared with TAU and had a low drop-out rate, no adverse events, and was deliverable in a short treatment frame (seven sessions) and in a group format, we conclude that the treatment is effective, acceptable, and feasible and has the potential for scalability. Clinical Impact Statement: A Syrian version of CA-CBT was effective (large effect sizes for the HTQ), feasible, and potentially scalable (easy application, conducted with trained facilitators, short-term therapy, group format), and acceptable (as evidenced by very low drop out and no adverse events). Thus, the Syrian version of CA-CBT appears to be a valuable psychological intervention for traumatized Syrian refugees, particularly given the lack of effective treatments for this group. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Figge CJ, Martinez-Torteya C, Taing S, Chhim S, Hinton DE. Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention. Transcult Psychiatry 2022; 59:492-505. [PMID: 32178597 DOI: 10.1177/1363461520906008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
More than half of all children in Cambodia experience direct abuse and over 70% experience other traumatic events, which significantly increase their risks for a range of physical and mental health problems. Additionally, Cambodian children face longstanding sociopolitical, intergenerational, and cultural factors that compound the impact of other trauma. As a result, rates of posttraumatic stress symptoms among Cambodian youth are high. However, care providers often rely on Western-based nosology that does not account for culturally specific expressions of trauma. A greater understanding of culturally-salient expressions of distress can help inform diagnostic assessment accuracy and treatment effectiveness and monitoring. The current study utilized a qualitative design to interview 30 Cambodian caregivers of children with trauma experiences and 30 Cambodian children (ages 10-13 years) with trauma experiences to identify key local expressions of trauma. Findings reveal certain PTSD symptoms and culturally-specific frequent and severe trauma-related problems for Cambodian children and domains of functioning impacted by trauma. Certain symptoms seem particularly important to evaluate in this group, such as anger, physical complaints (e.g., headache and palpitations), and cognitive-focused complaints (in particular, "thinking too much"). All caregivers and children reported physical health as impacted by trauma-related problems, highlighting a particularly salient domain of functioning for this population. Expressions of distress explored in the current study are discussed in the context of assessment and intervention development to inform diagnostic and clinical efforts for those working with trauma-exposed Cambodian children.
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Affiliation(s)
- Caleb J Figge
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | | | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia, Phnom Penh, Cambodia
| | - Sotheara Chhim
- Transcultural Psychosocial Organization (TPO) Cambodia, Phnom Penh, Cambodia
| | - Devon E Hinton
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Figge CJ, Martinez-Torteya C, Taing S, Chhim S, Hinton DE. Local clinician perspectives on cause, impact, and treatment of key expressions of distress in Cambodian children. Transcult Psychiatry 2022; 59:506-521. [PMID: 32116154 DOI: 10.1177/1363461520905995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Child trauma and posttraumatic stress in Cambodia is highly prevalent, perpetuated within a postwar sociocultural context. The examination of locally meaningful expressions of distress is needed to provide culturally sensitive assessment and treatment of trauma-affected Cambodian children. The acceptable, feasible, and sustainable incorporation of expressions of distress into assessment and intervention development relies on key mental health professionals operating in Cambodia, who can provide invaluable perspectives on child trauma experiences in this particular sociocultural context. In this study, qualitative interviews were conducted with 15 Cambodian mental health professionals (MHPs) who work directly with trauma-affected Cambodian children. MHPs were presented with seven key posttraumatic problems derived from previous qualitative interviews with Cambodian children and caregivers, and discussed 1) the causes of these problems, 2) the impact of the problem on the child or those around them, 3) the current treatment for the problem in Cambodia, and 4) recommended treatment. MHPs provided unique insights and perspectives of trauma-affected children in the Cambodian context regarding key target problems, including palpitations, difficulties in school, headache, and thinking too much, and highlighted future directions for assessment and intervention. Recommendations are discussed in regard to programming design and organizational training development to promote culturally salient, feasible, and sustainable mental health service provision in Cambodia.
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Affiliation(s)
| | | | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia
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Trang K, Jovanovic T, Hinton DE, Sullivan P, Worthman CM, Lam LX, Chi NK, Thanh NC, Ha TV, Go V, Hoffman I, Giang LM. Elevated trauma exposure and mental health burden among men who have sex with men in Vietnam. Transcult Psychiatry 2022; 59:362-379. [PMID: 35072562 DOI: 10.1177/13634615211058348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n = 12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.
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Hinton DE. Auditory Hallucination Among Traumatized Cambodian Refugees: PTSD Association and Biocultural Shaping. Cult Med Psychiatry 2021; 45:727-750. [PMID: 33386575 DOI: 10.1007/s11013-020-09701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
At a psychiatric refugee clinic for survivors of the Khmer Rouge genocide, a survey revealed that 42% (38/90) had auditory hallucinations (AHs) in the last month. Of those with AHs, 87% (33/38) had PTSD, whereas of those without AHs, 31% (16/52) had PTSD, giving a chi square of 27.8, p < .001, odds ratio 14.8 (4.8-45). Most AHs were of a "ghost summoning" (khmaoch hao), considered an exhortation to go with a ghost (e.g., hearing "Please come with me, younger sister"), experienced by 73% percent of patients with AHs. The voices were always exterior and usually loud and clear. AHs were heard most often during hypnagogia (i.e., upon falling asleep or awakening), experienced by 72% of patients with AHs, whereas 42% of patients with AHs experienced AHs when fully awake. AHs were almost always attributed to a ghost, giving rise to great fear: of having the "soul" called away or of being frightened to death. AH episodes almost always triggered trauma recall. AHs caused patients to undertake certain actions to address acute episodes and to prevent further ones. To illustrate these processes, cases are provided. AH appears to be a key part of the Cambodian bioculturally shaped trauma subjectivity.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital, Harvard Medical School, Center for Anxiety and Traumatic Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
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Abstract
The present study examined explanations of sleep paralysis (SP) in Turkey. The participants were 59 college students recruited in İstanbul, Turkey, who had experienced SP at least once in their lifetime. Participants were administered the Sleep Paralysis Experiences and Phenomenology Questionnaire (SP-EPQ) in an interview. When asked whether they had heard of a name for SP, the vast majority (88%) mentioned the "Karabasan"-a spirit-like creature rooted in Turkish folk tradition. Seventeen percent of the participants believed that their SP might have been caused by this supernatural creature. Thirty-seven percent of participants applied various supernatural and religious methods to prevent future SP attacks such as dua (supplicating to God), reciting the Quran, and wearing a musqa (a type of talisman inscribed with Quranic verses). Case studies are presented to illustrate these findings. The Karabasan constitutes a culturally specific, supernatural interpretation of the phenomenology of SP in Turkey.
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Hinton DE, McNally RJ, Fairfax RCE, Harachi TW. A network analysis of culturally relevant anxiety sensitivity and posttraumatic stress disorder symptoms in Cambodians. Transcult Psychiatry 2021; 58:440-452. [PMID: 32148188 DOI: 10.1177/1363461520906005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Anxiety Sensitivity Index (ASI) measures fears of anxiety-related symptoms based on respondent beliefs about their harmfulness. This is the first network analysis of anxiety sensitivity and PTSD, and the first to explore an addendum of culturally salient fears in such an analysis. The purpose of our study was to test whether relations among PTSD symptoms and facets of anxiety sensitivity, observed clinically, can be visualized by this approach. Using network analysis, we examined in a Cambodian population the relationship of PTSD symptoms to the standard Anxiety Sensitivity Index (ASI) and to an ASI Cambodian Addendum (ASICA) that taps culturally salient fears of somatic symptoms among Cambodians not assessed in the standard ASI. Computing relative importance networks, we found that the ASI subscales, ASICA, and PTSD subscales were strongly interconnected, with the ASICA having the strongest outstrength centrality. In the network analysis of the ASI subscales, disaggregated ASICA, and PTSD subscales, several of the ASICA items had very high outstrength. The results show that fear of mental and physical symptoms of anxiety should be a key part of the evaluation of trauma-related disorder, and that those fears should be targeted. It also suggests the need for ASI addenda to assess concerns about anxiety symptoms salient for certain cultures that are not assessed by the standard ASI: among Cambodian populations, fear of cold hands and feet, "out of energy in the arms and legs," neck soreness, tinnitus, and dizziness on standing.
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Figge CJ, Martinez-Torteya C, Dixon S, Santoro S, Taing S, Chhim S, Hinton DE. Adaptive Functioning Behaviors for Trauma-Affected Children in the Cambodian Context. Journal of Cross-Cultural Psychology 2020. [DOI: 10.1177/0022022120966786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Across contexts, the roles and responsibilities for children are shaped by a range of sociocultural factors; thus, a contextually specific exploration of adaptive functioning norms is important in optimizing the acceptability, effectiveness, and sustainability of mental health intervention and community programming. The current study aimed to examine child adaptive functioning behaviors for children in Cambodia, a country faced with continuing recovery efforts from war and genocide, intergenerational trauma transmission, poverty, and minimal access to health and mental health services. Qualitative interviews were conducted with 30 children (ages 10–13, 16 girls) and 30 caregivers (ages 30–62, 24 females) in the Battambang province of Cambodia receiving mental health services related to caregiver intimate partner violence. Results reveal trauma-affected children in Cambodia engage in a range of familial, occupational, social, religious, and academic functioning domains. Children in this sample reported behaviors that reflect policy and community level priorities of development of children as a societal and economic resource, distress management strategies of self and others informed by mental health therapy and local healing strategies, and engagement in religio-cultural Khmer Buddhist practices and ceremonies. Findings highlight the importance of contextually specific conceptualizations of functional impairment in guiding assessment and community program design and identifying areas for monitoring intervention effectiveness.
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Affiliation(s)
- Caleb J. Figge
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Sopheap Taing
- The Transcultural Psychosocial Organization Cambodia, Phnom Penh, Cambodia
| | - Sotheara Chhim
- The Transcultural Psychosocial Organization Cambodia, Phnom Penh, Cambodia
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Abstract
Ghost encounters were found to be a key part of the trauma ontology among Cambodian refugees at a psychiatric clinic, a key idiom of distress. Fifty-four percent of patients had been bothered by ghost encounters in the last month. The severity of being bothered by ghosts in the last month was highly correlated to PTSD severity (r = .8), and among patients bothered by ghosts in the last month, 85.2% had PTSD, versus among those not so bothered, 15.4%, odds ratio of 31.8 (95% confidence level 11.3-89.3), Chi square = 55.0, p < .001. Ghost visitations occurred in multiple experiential modalities that could be classified into three states of consciousness: full sleep (viz., in dream), hypnagogia, that is, upon falling asleep or awakening (viz., in sleep paralysis [SP] and in non-SP hallucinations), and full waking (viz., in hallucinations, visual aura, somatic sensations [chills or goosebumps], and leg cramps). These ghost visitations gave rise to multiple concerns-for example, of being frightened to death or of having the soul called away-as part of an elaborate cosmology. Several heuristic models are presented including a biocultural model of the interaction of trauma and ghost visitation. An extended case illustrates the article's findings.
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Affiliation(s)
- Devon E Hinton
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
| | - Ria Reis
- Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Joop de Jong
- Center for Anxiety and Related Disorders, Boston University, Boston, USA
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Wróbel-Knybel P, Karakuła-Juchnowicz H, Flis M, Rog J, Hinton DE, Boguta P, Jalal B. Prevalence and Clinical Picture of Sleep Paralysis in a Polish Student Sample. Int J Environ Res Public Health 2020; 17:ijerph17103529. [PMID: 32443518 PMCID: PMC7277803 DOI: 10.3390/ijerph17103529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Sleep paralysis (SP) is a psychobiological phenomenon caused by temporary desynchrony in the architecture of rapid eye movement (REM) sleep. It affects approximately 7.6% of the general population during their lifetime. The aim of this study was to assess (1) the prevalence of SP among Polish students in Lublin (n = 439) using self-reported online surveys, (2) the frequency of SP-related somatic and psychopathologic symptoms, and (3) the factors potentially affecting the occurrence of symptoms among people experiencing SP. We found that the incidence of SP in the Polish student population was slightly higher (32%) than the average prevalence found in other student populations (28.3%). The SP clinical picture was dominated by somatic symptomatology: 94% of respondents reported somatic symptoms (most commonly tachycardia, 76%), 93% reported fear (most commonly fear of death, 46%), and 66% reported hallucinations (most commonly visual hallucinations, 37%). The number of SP episodes was related to sleep duration and supine position during sleep. The severity of somatic symptoms correlated with lifestyle variables and anxiety symptomatology. Our study shows that a significant proportion of students experience recurrent SP and that this phenomenon is associated with fear and physical discomfort. The scale of the phenomenon requires a deeper analysis.
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Affiliation(s)
- Paulina Wróbel-Knybel
- Ist Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-059 Lublin, Poland; (H.K.-J.); (M.F.); (J.R.)
- Correspondence:
| | - Hanna Karakuła-Juchnowicz
- Ist Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-059 Lublin, Poland; (H.K.-J.); (M.F.); (J.R.)
- Department of Clinical Neuropsychiatry, Medical University of Lublin, 20-059 Lublin, Poland
| | - Michał Flis
- Ist Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-059 Lublin, Poland; (H.K.-J.); (M.F.); (J.R.)
| | - Joanna Rog
- Ist Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-059 Lublin, Poland; (H.K.-J.); (M.F.); (J.R.)
| | - Devon E. Hinton
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Piotr Boguta
- Locum Pharmacy for Well and Lloyds in Berkshire, Devon, Dorset, Hampshire, Oxfordshire, West Sussex, Wilthshire RG30 2BT, UK;
| | - Baland Jalal
- Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Cambridge CB2 0QQ, UK;
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Trang K, Sullivan PS, Hinton DE, Worthman CM, Le MG, Jovanovic T. Feasibility, acceptability, and design of a mobile health application for high-risk men who have sex with men in Hanoi, Vietnam. The Lancet Global Health 2020. [DOI: 10.1016/s2214-109x(20)30155-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Acarturk ZC, Alyanak B, Cetinkaya M, Gulen B, Jalal B, Hinton DE. Adaptation of Transdiagnostic CBT for Turkish Adolescents: Examples From Culturally Adapted Multiplex CBT. Cognitive and Behavioral Practice 2019. [DOI: 10.1016/j.cbpra.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hinton DE, Seponski DM, Khann S, Armes SE, Lahar CJ, Kao S, Schunert T. Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation. Transcult Psychiatry 2019; 56:643-666. [PMID: 31169469 DOI: 10.1177/1363461519851609] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered "quite a bit" or "extremely" by "thinking a lot" (vs. 27.5% without caseness); 53.8% were bothered by "standing up and feeling dizzy" (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: "weak heart," "thinking a lot," dizziness, "khyâl hitting up from the stomach," and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as "thinking a lot," "weak heart," "blurry vision," and "dizziness upon standing up."
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Abstract
This article outlines key dimensions of culturally sensitive cognitive-behavioral therapy (CBT), and examines the application to Southeast Asian populations. Our treatment, culturally adapted (CA) multiplex CBT, was initially developed to treat traumatized Southeast Asian refugees, and has been shown to be efficacious for those and other groups. As described in the article, CA multiplex CBT is based on the multiplex model of distress generation and our conceptualization of key dimensions of culturally sensitive and effective treatment. We will describe why our CA-CBT may have applicability to Asian populations more generally, for example, due to its emphasis on mindfulness, contextual sensitivity (viz., flexibility), somatic complaint, and somatic-focused emotion regulation (e.g., applied stretching). We illustrate key dimensions of CA treatment, giving examples from how these principles are employed in CA multiplex CBT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Kohrt BA, Lu FG, Wu EY, Hinton DE, Aggarwal NK, Parekh R, Rousseau C, Lewis-Fernández R. Caring for Families Separated by Changing Immigration Policies and Enforcement: A Cultural Psychiatry Perspective. Psychiatr Serv 2018; 69:1200-1203. [PMID: 30122136 PMCID: PMC6382597 DOI: 10.1176/appi.ps.201800076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.
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Affiliation(s)
- Brandon A Kohrt
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Francis G Lu
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Emily Y Wu
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Devon E Hinton
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Neil Krishan Aggarwal
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Ranna Parekh
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Cécile Rousseau
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
| | - Roberto Lewis-Fernández
- Dr. Kohrt is with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Lu is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Wu is with the Department of Child and Adolescent Psychiatry and Dr. Hinton is with the Department of Psychiatry, both at Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Aggarwal and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, and with New York State Psychiatric Institute, New York. Dr. Parekh is with the Division of Diversity and Health Equity, American Psychiatric Association, Washington, D.C. Dr. Rousseau is with the Department of Psychiatry, McGill University, Montreal. The authors are members or guests of the Cultural Psychiatry Committee of the Group for the Advancement of Psychiatry. Dr. Kohrt is the project coordinator and Dr. Lewis-Fernández is the committee chair. Dr. Lewis-Fernández is also editor of this column
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Shaw SA, Ward KP, Pillai V, Hinton DE. A group mental health randomized controlled trial for female refugees in Malaysia. Am J Orthopsychiatry 2018; 89:665-674. [PMID: 30035560 DOI: 10.1037/ort0000346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Forcibly displaced persons confront multiple stressors while awaiting permanent asylum or resettlement and often experience high levels of emotional distress. This study assessed an 8-week somatic-focused culturally adapted cognitive-behavioral therapy (CBT) group intervention with 39 female refugees from Afghanistan living in Kuala Lumpur, Malaysia. Twenty-nine participants were randomly assigned to treatment conditions, resulting in 20 participants in two separate treatment groups and 9 in a waitlist control group. An additional 10 participants were not randomly assigned and therefore were treated as an additional treatment group and analyzed separately. A three-group piecewise linear growth model was specified in Mplus using Bayesian estimation. Dependent variables included emotional distress, anxiety, depression, posttraumatic stress, and social support. From baseline to posttreatment assessments, initial intervention participants experienced significant declines in emotional distress (b = -16.90, p < .001), anxiety (b = -.80, p < .001), depression (b = -.59, p < .001), and posttraumatic stress (b = -.24, p < .05). Gains were maintained three months posttreatment, with similar trends observed among nonrandomized participants. Subsequent to receiving treatment, the waitlist control participants also showed significant declines in emotional distress (b = -20.88, p < .001), anxiety (b = -1.10, p < .001), depression (b = -.79, p < .001), and posttraumatic stress scores (b = -.82, p < .001). Comparing the treatment groups to the waitlist control group revealed large effect sizes: Cohen's d was 2.14 for emotional distress, 2.31 for anxiety, 2.42 for depression, and 2.07 for posttraumatic stress. Relevant public health findings include low drop out, group format, and facilitation by a trained community member. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Veena Pillai
- Centre of Excellence for Research in AIDS, University of Malaya Medical Centre, Malaysia Social Research Institute
| | - Devon E Hinton
- Department of Global Health and Social Medicine, Harvard Medical School
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Abstract
The present study investigated what complaints are prominent in psychologically distressed Vietnamese in Vietnam beyond standard symptoms assessed by Western diagnostic instruments for anxiety and depression. To form the initial Vietnamese Symptom and Cultural Syndrome Addendum (VN SSA), we reviewed the literature, consulted experts, and conducted focus groups. The preliminary VN SSA was then used in a general survey (N = 1004) of five provinces in Vietnam. We found that the VN SSA items were highly and significantly correlated with a measure of anxious-depressive psychopathology (a composite measure of the General Anxiety Disorder-7; Posttraumatic Diagnostic Scale; and Patient Health Questionnaire-9). The VN SSA item most highly correlated to anxious-depressive psychopathology was "thinking a lot" ( r = .54), reported by 15.8% of the sample. Many other symptoms in the addendum also were prominent, such as orthostatic dizziness (i.e., dizziness upon standing up; r = .41), reported by 22.9% of the sample. By way of comparison, somatic complaints more typically assessed to profile Western anxious-depressive distress, such as palpitations, were less prominent, as evidenced by being less strongly correlated to Western psychiatric symptoms and being less frequent (e.g., palpitations: r = .31, 7.1% of the sample). Study results suggest that to avoid category truncation when profiling anxious-depressive distress among Vietnamese that items other than those in standard psychopathology measures should also be assessed.
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Abstract
In increasingly multicultural societies, cognitive behavioral therapy (CBT) must be made appropriate for diverse groups. This article examines cultural adaptations of CBT, focusing on anxiety and depressive disorders. The article presents a culturally informed, transdiagnostic model of how anxious-depressive distress is generated and culturally shaped. Guided by this model, it discusses how interventions can be designed to decrease anxiety-type and depressive-type psychopathology in a culturally sensitive way. It describes such concepts as explanatory model bridging, cultural grounding, and contextual sensitivity.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 812, Boston, MA 02114, USA.
| | - Anushka Patel
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
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Abstract
Theories of healing have attempted to identify general mechanisms that may work across different modalities. These include altering expectations, remoralization, and instilling hope. In this paper, we argue that many forms of healing and psychotherapy may work by inducing positive psychological states marked by flexibility or an enhanced ability to shift cognitive sets. Healing practices may induce these states of cognitive and emotional flexibility through specific symbolic interventions we term "flexibility primers" that can include images, metaphors, music, and other media. The flexibility hypothesis suggests that cognitive and emotional flexibility is represented, elicited, and enacted through multiple modalities in healing rituals. Identifying psychological processes and cultural forms that evoke and support cognitive and emotional flexibility provides a way to understand the cultural specificity and potential efficacy of particular healing practices and can guide the design of interventions that promote resilience and well-being.
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Ghazal YA, Hinton DE. Platzschwindel, agoraphobia and their influence on theories of anxiety at the end of the nineteenth century: theories of the role of biology and 'representations' (Vorstellungen). Hist Psychiatry 2016; 27:425-442. [PMID: 27450798 DOI: 10.1177/0957154x16657710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
During the 1860s, Berlin's exterior physiognomy transformed radically. The city eroded the surrounding rural areas, and the frontiers of the old city centre were abolished. These transformations led to the disappearance of the visible frontiers that once demarcated the limits of the old residential Prussian city. In this context, the description of the clinical picture of agoraphobia by the Berlin psychiatrist Carl Westphal in 1872 marked a turning point, not only in psychiatric theories on anxiety but also in the conceptualization of our experience of space. In this paper, the authors trace the emergence of a new psychology-neurology episteme during the last third of the nineteenth century; and they argue that such an episteme became possible once the relations between anxiety and modern city-scape had been clearly articulated.
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Hinton DE, Barlow DH, Reis R, de Jong J. A Transcultural Model of the Centrality of "Thinking a Lot" in Psychopathologies Across the Globe and the Process of Localization: A Cambodian Refugee Example. Cult Med Psychiatry 2016; 40:570-619. [PMID: 27085706 DOI: 10.1007/s11013-016-9489-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present a general model of why "thinking a lot" is a key presentation of distress in many cultures and examine how "thinking a lot" plays out in the Cambodian cultural context. We argue that the complaint of "thinking a lot" indicates the presence of a certain causal network of psychopathology that is found across cultures, but that this causal network is localized in profound ways. We show, using a Cambodian example, that examining "thinking a lot" in a cultural context is a key way of investigating the local bio-cultural ontology of psychopathology. Among Cambodian refugees, a typical episode of "thinking a lot" begins with ruminative-type negative cognitions, in particular worry and depressive thoughts. Next these negative cognitions may induce mental symptoms (e.g., poor concentration, forgetfulness, and "zoning out") and somatic symptoms (e.g., migraine headache, migraine-like blurry vision such as scintillating scotomas, dizziness, palpitations). Subsequently the very fact of "thinking a lot" and the induced symptoms may give rise to multiple catastrophic cognitions. Soon, as distress escalates, in a kind of looping, other negative cognitions such as trauma memories may be triggered. All these processes are highly shaped by the Cambodian socio-cultural context. The article shows that Cambodian trauma survivors have a locally specific illness reality that centers on dynamic episodes of "thinking a lot," or on what might be called the "thinking a lot" causal network.
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Affiliation(s)
- Devon E Hinton
- Center for Anxiety and Traumatic, Massachusetts General Hospital, Harvard Medical School, Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
| | - David H Barlow
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Ria Reis
- Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Joop de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- Boston University School of Medicine, Boston, MA, USA
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Jalal B, Hinton DE. Lifetime presence and rates of sleep paralysis in Denmark of ethnic Danes and non-ethnic Danes. Psychiatry Clin Neurosci 2016; 70:253. [PMID: 26940006 DOI: 10.1111/pcn.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Baland Jalal
- Behavioural and Clinical Neuroscience Institute, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Department of Psychology, Harvard University, Massachusetts, USA
| | - Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Massachusetts, USA
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Kaiser BN, Haroz EE, Kohrt BA, Bolton PA, Bass JK, Hinton DE. "Thinking too much": A systematic review of a common idiom of distress. Soc Sci Med 2015; 147:170-83. [PMID: 26584235 PMCID: PMC4689615 DOI: 10.1016/j.socscimed.2015.10.044] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 12/16/2022]
Abstract
Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.
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Affiliation(s)
- Bonnie N Kaiser
- Department of Anthropology and Department of Epidemiology, Emory University, 1557 Dickey Drive, Atlanta, GA 30322, USA; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27701, USA.
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Brandon A Kohrt
- Department of Psychiatry & Behavioral Sciences, Duke Global Health Institute, and Department of Cultural Anthropology, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Paul A Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Broadway, Baltimore, MD 21205, USA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, WACC 812, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Abstract
The current study examines cultural explanations regarding sleep paralysis (SP) in Italy. The study explores (1) whether the phenomenology of SP generates culturally specific interpretations and causal explanations and (2) what are the beliefs and local traditions associated with such cultural explanations. The participants were Italian nationals from the general population (n = 68) recruited in the region of Abruzzo, Italy. All participants had experienced at least one lifetime episode of SP. The sleep paralysis experiences and phenomenology questionnaire were orally administered to participants. We found a multilayered cultural interpretation of SP, namely the Pandafeche attack, associated with various supernatural beliefs. Thirty-eight percent of participants believed that this supernatural being, the Pandafeche-often referred to as an evil witch, sometimes as a ghost-like spirit or a terrifying humanoid cat-might have caused their SP. Twenty-four percent of all participants sensed the Pandafeche was present during their SP. Strategies to prevent Pandafeche attack included sleeping in supine position, placing a broom by the bedroom door, or putting a pile of sand by the bed. Case studies are presented to illustrate the study findings. The Pandafeche attack thus constitutes a culturally specific, supernatural interpretation of the phenomenology of SP in the Abruzzo region of Italy.
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Affiliation(s)
- Baland Jalal
- Center for Brain and Cognition, University of California at San Diego, San Diego, CA, USA.
| | - Andrea Romanelli
- Department of General Psychology, University of Padua, Padua, Italy
| | - Devon E Hinton
- Massechustest General Hospital and Harvard Medical School, Boston, MA, USA
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Hinton DE, Reis R, de Jong J. The “Thinking a Lot” Idiom of Distress and PTSD: An Examination of Their Relationship among Traumatized Cambodian Refugees Using the “Thinking a Lot” Questionnaire. Med Anthropol Q 2015; 29:357-80. [DOI: 10.1111/maq.12204] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center Amsterdam Institute for Social Science Research, University of Amsterdam; The Children's Institute, University of Cape Town
| | - Joop de Jong
- Amsterdam Institute for Social Science Research; University of Amsterdam
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Arnold MC, Lindberg TT, Liu YT, Porter KA, Hsu-Kim H, Hinton DE, Di Giulio RT. Bioaccumulation and speciation of selenium in fish and insects collected from a mountaintop removal coal mining-impacted stream in West Virginia. Ecotoxicology 2014; 23:929-938. [PMID: 24723096 DOI: 10.1007/s10646-014-1236-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 06/03/2023]
Abstract
A major contaminant of concern for mountaintop removal/valley fill (MTR/VF) coal mining is selenium (Se), an essential micronutrient that can be toxic to fish. Creek chubs (Semotilus atromaculatus), green sunfish (Lepomis cyanellus), and composite insect samples were collected in March-July, 2011-2013 at two sites within the Mud River, West Virginia. One site (MR7) receives MTR/VF coal mining effluent, while the reference site (LFMR) does not. MR7 water had significantly higher concentrations of soluble Se (p < 0.01) and conductivity (p < 0.005) compared to LFMR. MR7 whole insects contained significantly higher concentrations of Se compared to LFMR insects (p < 0.001). MR7 creek chubs had significantly higher Se in fillets, liver, and ovary tissues compared to LFMR samples (p < 0.0001, p < 0.0001, and p < 0.02, respectively). MR7 green sunfish fillets contained significantly higher Se (p < 0.0001). Histological examination showed LFMR creek chub gills contained a typical amount of parasitic infestations; however MR7 gills contained minimal to no visible parasites. X-ray absorption spectroscopic analyses revealed that MR7 whole insects and creek chub tissues primarily contained organic Se and selenite. These two species of Mud River fish were shown to specifically accumulate Se differently in tissues compartments. Tissue-specific concentrations of Se may be useful in determining potential reproductive consequences of Se exposure in wild fish populations.
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Affiliation(s)
- M C Arnold
- Nicholas School of the Environment, Duke University, Box 90328, LSRC A350, Durham, NC, 27708, USA,
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Heimberg RG, Hofmann SG, Liebowitz MR, Schneier FR, Smits JAJ, Stein MB, Hinton DE, Craske MG. Social anxiety disorder in DSM-5. Depress Anxiety 2014; 31:472-9. [PMID: 24395386 DOI: 10.1002/da.22231] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/09/2013] [Accepted: 11/28/2013] [Indexed: 11/09/2022] Open
Abstract
With the publication of DSM-5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues.
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Affiliation(s)
- Richard G Heimberg
- Department of Psychology, Adult Anxiety Clinic, Temple University, Philadelphia, Pennsylvania
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Abstract
A person's cultural background influences the experience and expression of emotions. In reviewing the recent literature on cross-cultural aspects of anxiety disorders, we identified some culturally related ethnopsychology/ethnophysiology factors (the culture's conceptualizations of how the mind and body function) and contextual factors that influence anxiety disorders. Ethnopsychology/ethnophysiology factors include the person's ideas about the mental and bodily processes (and their interaction), whereas contextual factors are associated with the social norms and rules that may contribute to anxiety, including individualism vs. collectivism and self-construals. From the perspective of ethnopsychology/ethnophysiology and contextual factors, we will discuss "khyâl cap" ("wind attacks"), taijin kyofusho, and ataques de nervios, three prominent examples of culture-specific expressions of anxiety disorders that have all been included in the DSM-5 list of cultural concepts of distress.
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Affiliation(s)
| | - Devon E. Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
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Jalal B, Simons-Rudolph J, Jalal B, Hinton DE. Explanations of sleep paralysis among Egyptian college students and the general population in Egypt and Denmark. Transcult Psychiatry 2014; 51:158-75. [PMID: 24084761 DOI: 10.1177/1363461513503378] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross-cultural study compared explanations of sleep paralysis (SP) in two countries and two groups with different levels of education in one country. Comparisons were made between individuals having experienced SP at least once in a lifetime from Cairo, Egypt (n = 89), Copenhagen, Denmark (n = 59), and the American University in Cairo, Egypt (n = 44). As hypothesized, participants from the general Egyptian population were more likely to endorse supernatural causal explanation of their SP compared to participants from Denmark; participants from the American University in Cairo were less likely to endorse supernatural causes of their SP compared to participants from the general Egyptian population. Moreover, participants from the American University in Cairo were marginally significantly more likely to endorse supernatural causes of their SP compared to participants from Denmark. Additionally, we explored which culturally bound explanations and beliefs about SP existed in Egypt and Denmark. We found that nearly half (48%) of the participants from the general Egyptian population believed their SP to be caused by the Jinn, a spirit-like creature with roots in Islamic tradition, which constitutes a culturally bound interpretation of the phenomenology of SP in this region of the world. Case studies are presented to illustrate these findings.
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Kohrt BA, Rasmussen A, Kaiser BN, Haroz EE, Maharjan SM, Mutamba BB, de Jong JTVM, Hinton DE. Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology. Int J Epidemiol 2013; 43:365-406. [PMID: 24366490 DOI: 10.1093/ije/dyt227] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Burgeoning global mental health endeavors have renewed debates about cultural applicability of psychiatric categories. This study's goal is to review strengths and limitations of literature comparing psychiatric categories with cultural concepts of distress (CCD) such as cultural syndromes, culture-bound syndromes, and idioms of distress. METHODS The Systematic Assessment of Quality in Observational Research (SAQOR) was adapted based on cultural psychiatry principles to develop a Cultural Psychiatry Epidemiology version (SAQOR-CPE), which was used to rate quality of quantitative studies comparing CCD and psychiatric categories. A meta-analysis was performed for each psychiatric category. RESULTS Forty-five studies met inclusion criteria, with 18 782 unique participants. Primary objectives of the studies included comparing CCD and psychiatric disorders (51%), assessing risk factors for CCD (18%) and instrument validation (16%). Only 27% of studies met SAQOR-CPE criteria for medium quality, with the remainder low or very low quality. Only 29% of studies employed representative samples, 53% used validated outcome measures, 44% included function assessments and 44% controlled for confounding. Meta-analyses for anxiety, depression, PTSD and somatization revealed high heterogeneity (I(2) > 75%). Only general psychological distress had low heterogeneity (I(2) = 8%) with a summary effect odds ratio of 5.39 (95% CI 4.71-6.17). Associations between CCD and psychiatric disorders were influenced by methodological issues, such as validation designs (β = 16.27, 95%CI 12.75-19.79) and use of CCD multi-item checklists (β = 6.10, 95%CI 1.89-10.31). Higher quality studies demonstrated weaker associations of CCD and psychiatric disorders. CONCLUSIONS Cultural concepts of distress are not inherently unamenable to epidemiological study. However, poor study quality impedes conceptual advancement and service application. With improved study design and reporting using guidelines such as the SAQOR-CPE, CCD research can enhance detection of mental health problems, reduce cultural biases in diagnostic criteria and increase cultural salience of intervention trial outcomes.
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Affiliation(s)
- Brandon A Kohrt
- Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA, Department of Psychology, Fordham University, New York, USA, Department of Anthropology, Department of Epidemiology, Emory University, Atlanta, GA, USA, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Psychology, Tribhuvan University, Kirtipur, Nepal, Butabika National Referral Mental and Teaching Hospital, Kampala, Uganda, AISSR, University of Amsterdam, The Netherlands and Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Lewis-Fernández R, Raggio GA, Gorritz M, Duan N, Marcus S, Cabassa LJ, Humensky J, Becker AE, Alarcón RD, Oquendo MA, Hansen H, Like RC, Weiss M, Desai PN, Jacobsen FM, Foulks EF, Primm A, Lu F, Kopelowicz A, Hinton L, Hinton DE. GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications. J Nerv Ment Dis 2013; 201:860-71. [PMID: 24080673 PMCID: PMC4324559 DOI: 10.1097/nmd.0b013e3182a5c184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.
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Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Greer A. Raggio
- Department of Psychology, Drexel University, Philadelphia, PA
| | | | - Naihua Duan
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Sue Marcus
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Leopoldo J. Cabassa
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- School of Social Work, Columbia University
| | - Jennifer Humensky
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Anne E. Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Renato D. Alarcón
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - María A. Oquendo
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Helena Hansen
- Departments of Psychiatry and Anthropology, New York University, New York, NY
| | - Robert C. Like
- Department of Family Medicine and Community Health, UMDNJ–Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Mitchell Weiss
- Department of Epidemiology and Public Health, Swiss Tropical Institute, and University of Basel, Switzerland
| | | | - Frederick M. Jacobsen
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC
| | | | - Annelle Primm
- American Psychiatric Association, Arlington, VA; Department of Psychiatry, Johns Hopkins Medical School, Baltimore, MD
| | - Francis Lu
- Department of Psychiatry, University of California, Davis
| | - Alex Kopelowicz
- Department of Psychiatry, University of California, Los Angeles
| | - Ladson Hinton
- Department of Psychiatry, University of California, Davis
| | - Devon E. Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
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Abstract
This article provides an introduction to the thematic issue of Transcultural Psychiatry on local responses to trauma. To illustrate how local responses to trauma may be therapeutic, we consider the multiple dimensions or domains that may be targeted by healing rituals and interventions. We then outline a theoretical model of the generation of trauma-related symptoms and distress. We present the multiplex model of symptom generation which posits multiple cognitive, social, and physiological mechanisms by which various triggers can lead to severe distress among trauma victims in acute episodes, and which may be targeted in treatment. More persistent forms of distress can be explained in terms of the effects of persistent mood states and associated modes of cognitive processing and behavior that render individuals vulnerable to chronic symptoms and acute exacerbations. The beneficial effects of healing rituals and interventions may occur, in part, by inducing positive affective states associated with a flexible mind-set. We conclude by summarizing some of the contributions of the papers in this issue to understanding local therapeutic processes of healing.
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Hinton DE, Peou S, Joshi S, Nickerson A, Simon NM. Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead. Cult Med Psychiatry 2013; 37:427-64. [PMID: 23868080 PMCID: PMC3759644 DOI: 10.1007/s11013-013-9324-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and post-traumatic stress disorder (PTSD) interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about "bad death" and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76 % of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in "category truncation," i.e., a lack of content validity, a form of category fallacy.
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Hinton DE, Field NP, Nickerson A, Bryant RA, Simon N. Dreams of the dead among Cambodian refugees: frequency, phenomenology, and relationship to complicated grief and posttraumatic stress disorder. Death Stud 2013; 37:750-767. [PMID: 24521031 DOI: 10.1080/07481187.2012.692457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors investigated the importance of dreams of the deceased in the experiencing of prolonged grief (PG) and posttraumatic stress disorder (PTSD) among Cambodian refugees who survived the Pol Pot genocide (1975-1979). Such dreams were frequent in the last month (52% of those surveyed), and most often involved a relative who died in the Pol Pot period. Past month frequency was correlated with PG severity (r = .59) and PTSD severity (r = .52). The dreams were almost always deeply upsetting because the dreams indicated the deceased to be in a difficult spiritual state. Dreams of the deceased as a central component of PG and PTSD among Cambodian refugees is discussed.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Nigel P Field
- Program in Clinical Psychology, Palo Alto University, Palo Alto, California, USA
| | - Angela Nickerson
- Department of Psychology, Boston University, Boston, Masschusetts, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - Naomi Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Hinton DE, Ojserkis RA, Jalal B, Peou S, Hofmann SG. Loving-kindness in the treatment of traumatized refugees and minority groups: a typology of mindfulness and the nodal network model of affect and affect regulation. J Clin Psychol 2013; 69:817-28. [PMID: 23784718 DOI: 10.1002/jclp.22017] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article discusses how loving-kindness can be used to treat traumatized refugees and minority groups, focusing on examples from our treatment, culturally adapted cognitive-behavioral therapy (CA-CBT). To show how we integrate loving-kindness with other mindfulness interventions and why loving-kindness should be an effective therapeutic technique, we present a typology of mindfulness states and the Nodal Network Model (NNM) of Affect and Affect Regulation. We argue that mindfulness techniques such as loving-kindness are therapeutic for refugees and minority populations because of their potential for increasing emotional flexibility, decreasing rumination, serving as emotional regulation techniques, and forming part of a new adaptive processing mode centered on psychological flexibility. We present a case to illustrate the clinical use of loving-kindness within the context of CA-CBT.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital, Department of Psychiatry, 15 Parkman Street, WACC 812, Boston, MA 02114, USA.
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Hinton DE, Kredlow MA, Pich V, Bui E, Hofmann SG. The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). Transcult Psychiatry 2013; 50:347-70. [PMID: 23630226 DOI: 10.1177/1363461513481187] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes a culturally sensitive questionnaire for the assessment of the effects of trauma in the Cambodian refugee population, the Cambodian Somatic Symptom and Syndrome Inventory (CSSI), and gives the results of a survey with the instrument. The survey examined the relationship of the CSSI, the two CSSI subscales, and the CSSI items to posttraumatic stress disorder (PTSD) severity and self-perceived functioning. A total of 226 traumatized Cambodian refugees were assessed at a psychiatric clinic in Lowell, MA, USA. There was a high correlation of the CSSI, the CSSI somatic and syndrome scales, and all the CSSI items to the PTSD Checklist (PCL), a measure of PTSD severity. All the CSSI items varied greatly across three levels of PTSD severity, and patients with higher levels of PTSD had very high scores on certain CSSI-assessed somatic items such as dizziness, orthostatic dizziness (upon standing), and headache, and on certain CSSI-assessed cultural syndromes such as khyâl attacks, "fear of fainting and dying upon standing up," and "thinking a lot." The CSSI was more highly correlated than the PCL to self-perceived disability assessed by the Short Form-12 Health Survey (SF-12). The study demonstrates that the somatic symptoms and cultural syndromes described by the CSSI form a central part of the Cambodian refugee trauma ontology. The survey indicates that locally salient somatic symptoms and cultural syndromes need be profiled to adequately assess the effects of trauma.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Van Wettere AJ, Kullman SW, Hinton DE, Law JM. Immunohistochemical characterization of the hepatic progenitor cell compartment in medaka (Oryzias latipes) following hepatic injury. J Comp Pathol 2013; 149:434-45. [PMID: 23664425 DOI: 10.1016/j.jcpa.2013.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/06/2013] [Accepted: 03/17/2013] [Indexed: 12/22/2022]
Abstract
Laboratory fish species are used increasingly in biomedical research and are considered robust models for the study of regenerative processes. Studies investigating the response of the fish liver to injury have demonstrated the presence of a ductular reaction and oval-like cells in injured and regenerating liver. To date, however, it is unclear if this cell population is the piscine equivalent of oval cells (OCs) or intermediate hepatobiliary cells (IHBCs) identified in rodents and man, respectively. The present study defines the process of OC differentiation in fish liver using histopathology, immunohistochemistry and transmission electron microscopy. To generate OC proliferation in Japanese medaka (Oryzias latipes), hepatic injury was induced by exposure of adult fish to either microcystin LR or dimethylnitrosamine. A transgenic strain of medaka expressing a red fluorescent protein (RFP) exclusively in hepatocytes was used. The morphological response to injury was characterized by a ductular reaction comprised of cytokeratin (CK) AE1/AE3(+) OCs progressing to IHBCs variably positive for CK and RFP and finally mature RFP(+) hepatocytes and CK(+) cholangiocytes. These observations support a bipotential differentiation pathway of fish OCs towards hepatocytes and cholangiocytes. Ultrastructural morphology confirmed the presence of OCs and differentiation towards hepatocytes. These results demonstrated clear similarities between patterns of reaction to injury in fish and mammalian livers. They also confirm the presence of, and support the putative bipotential lineage capabilities of, the fish OC.
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Affiliation(s)
- A J Van Wettere
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA; Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, NC, USA.
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Hinton DE, Nickerson A, Bryant RA. Prolonged Grief in Cambodian Refugees Following Genocide: Rebirth Concerns and Avoidance of Reminders. Journal of Loss and Trauma 2013. [DOI: 10.1080/15325024.2012.714218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hinton DE, Hinton AL, Eng KT, Choung S. PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey. Med Anthropol Q 2013; 26:383-407. [PMID: 23259349 DOI: 10.1111/j.1548-1387.2012.01224.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article describes a culturally sensitive assessment tool for traumatized Cambodians, the Cambodian "Somatic Symptom and Syndrome Inventory" (SSI), and reports the outcome of a needs assessment conducted in rural Cambodia using the instrument. Villagers locally identified (N = 139) as still suffering the effects of the Pol Pot genocide were evaluated. All 139 had post-traumatic stress disorder (PTSD) as assessed by the PTSD Checklist (PCL), and they had elevated SSI scores. The severity of the SSI items varied by level of PTSD severity, and several items--for example, dizziness, dizziness on standing, khyâl (a windlike substance) attacks, and "thinking a lot"--were extremely elevated in those participants with higher levels of PTSD. The SSI was more highly correlated to self-perceived health (Short Form Health Survey-3) and past trauma events (Harvard Trauma Questionnaire) than was the PCL. The study shows the SSI items to be a core aspect of the Cambodian trauma ontology.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital and Department of Psychiatry Harvard Medical School, USA
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Hinton DE, Pich V, Hofmann SG, Otto MW. Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From "Culturally Adapted CBT". Cognitive and Behavioral Practice 2013. [DOI: 10.1016/j.cbpra.2011.09.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nickerson A, Bryant RA, Aderka IM, Hinton DE, Hofmann SG. The impacts of parental loss and adverse parenting on mental health: Findings from the National Comorbidity Survey-Replication. ACTA ACUST UNITED AC 2013. [DOI: 10.1037/a0025695] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Devon E. Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
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Hinton DE, Rivera EI, Hofmann SG, Barlow DH, Otto MW. Adapting CBT for traumatized refugees and ethnic minority patients: examples from culturally adapted CBT (CA-CBT). Transcult Psychiatry 2012; 49:340-65. [PMID: 22508639 DOI: 10.1177/1363461512441595] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we illustrate how cognitive behavioral therapy (CBT) can be adapted for the treatment of PTSD among traumatized refugees and ethnic minority populations, providing examples from our treatment, culturally adapted CBT, or CA-CBT. CA-CBT has a unique approach to exposure (typical exposure is poorly tolerated in these groups), emphasizes the treatment of somatic sensations (a particularly salient part of the presentation of PTSD in these groups), and addresses comorbid anxiety disorders and anger. To accomplish these treatment goals, CA-CBT emphasizes emotion exposure and emotion regulation techniques such as meditation and aims to promote emotional and psychological flexibility. We describe 12 key aspects of adapting CA-CBT that make it a culturally sensitive treatment of traumatized refugee and ethnic minority populations. We discuss three models that guide our treatment and that can be used to design culturally sensitive treatments: (a) the panic attack-PTSD model to illustrate the many processes that generate PTSD in these populations, highlighting the role of arousal and somatic symptoms; (b) the arousal triad to demonstrate how somatic symptoms are produced and the importance of targeting comorbid anxiety conditions and psychopathological processes; and (c) the multisystem network (MSN) model of emotional state to reveal how some of our therapeutic techniques (e.g., body-focused techniques: bodily stretching paired with self-statements) bring about psychological flexibility and improvement.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Hinton DE, Kredlow MA, Bui E, Pollack MH, Hofmann SG. Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD. Depress Anxiety 2012; 29:147-54. [PMID: 22065554 DOI: 10.1002/da.20905] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/26/2011] [Accepted: 08/27/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is only one previously published study of treatment change across initial pharmacological treatment for a minority or refugee group with posttraumatic stress disorder (PTSD). That study found that certain somatic symptoms among Southeast Asian populations did not improve across treatment. This article assesses in a culturally sensitive way symptom change through time of Cambodian patients presenting for pharmacotherapy treatment of PTSD. METHODS Fifty-six Cambodian refugees with PTSD and no previous psychiatric treatment were assessed at baseline and then at 3 and 6 months after initiating pharmacotherapy. The measures included the PTSD Checklist; the Cambodian Somatic Symptom and Syndrome Inventory (SSI) to assess culturally salient somatic symptoms and cultural syndromes; and the Short Form-12 Health Survey to assess self-perceived functioning. RESULTS Across treatment, large effect sizes were seen on all measures (Cohen's d = 1.1-1.4). The SF-12 change score was more highly correlated to the SSI change score (r = .82) than to the PTSD change score (r = .61). Significant change only occurred from baseline to 3 months. CONCLUSIONS Pharmacological treatment for traumatized Cambodian refugees with PTSD seems to lead to improvement not only in PTSD symptoms, but also in culturally salient somatic symptoms and cultural syndromes. Culturally sensitive assessment and treatment should ideally include the assessment of culturally salient somatic symptoms and cultural syndromes.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: potential for psychological interventions. Clin Psychol Rev 2011; 31:1126-32. [PMID: 21840289 PMCID: PMC3176989 DOI: 10.1016/j.cpr.2011.07.003] [Citation(s) in RCA: 346] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 07/08/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
Mindfulness-based meditation interventions have become increasingly popular in contemporary psychology. Other closely related meditation practices include loving-kindness meditation (LKM) and compassion meditation (CM), exercises oriented toward enhancing unconditional, positive emotional states of kindness and compassion. This article provides a review of the background, the techniques, and the empirical contemporary literature of LKM and CM. The literature suggests that LKM and CM are associated with an increase in positive affect and a decrease in negative affect. Preliminary findings from neuroendocrine studies indicate that CM may reduce stress-induced subjective distress and immune response. Neuroimaging studies suggest that LKM and CM may enhance activation of brain areas that are involved in emotional processing and empathy. Finally, preliminary intervention studies support application of these strategies in clinical populations. It is concluded that, when combined with empirically supported treatments, such as cognitive-behavioral therapy, LKM and CM may provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, MA 02215-2002, United States.
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Abstract
Recent research has highlighted the importance of traditional methods of healing in relation to the treatment of psychological distress in non-Western populations. This pilot study, conducted in Massachusetts, investigates what Buddhist Cambodian monks consider to be the causes, phenomenology and appropriate intervention strategies for anger among Cambodian refugees. Six monks were interviewed at four major temples in Massachusetts. Findings suggested that anger was common in the Cambodian community, was frequently triggered by marital discord, and commonly resulted in verbal and physical violence and, sometimes, suicidality. Buddhist-based anger management strategies identified as useful by the monks included education about Buddhist doctrines, mindfulness meditation practices, and the use of herbal medication and holy water. These anger regulation strategies and treatments are discussed in the context of Buddhist beliefs and Western psychological interventions.
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Affiliation(s)
- Angela Nickerson
- Massachusetts General Hospital and Harvard Medical School, One Bowdoin Square, Boston, MA 02114, USA.
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Hinton DE, Lewis-Fernández R. The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depress Anxiety 2011; 28:783-801. [PMID: 21910185 DOI: 10.1002/da.20753] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 08/21/2010] [Accepted: 08/26/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is considerable debate about the cross-cultural applicability of the posttraumatic stress disorder (PTSD) category as currently specified. Concerns include the possible status of PTSD as a Western culture-bound disorder and the validity of individual items and criteria thresholds. This review examines various types of cross-cultural validity of the PTSD criteria as defined in DSM-IV-TR, and presents options and preliminary recommendations to be considered for DSM-5. METHODS Searches were conducted of the mental health literature, particularly since 1994, regarding cultural-, race-, or ethnicity-related factors that might limit the universal applicability of the diagnostic criteria of PTSD in DSM-IV-TR and the possible criteria for DSM-5. RESULTS Substantial evidence of the cross-cultural validity of PTSD was found. However, evidence of cross-cultural variability in certain areas suggests the need for further research: the relative salience of avoidance/numbing symptoms, the role of the interpretation of trauma-caused symptoms in shaping symptomatology, and the prevalence of somatic symptoms. This review also indicates the need to modify certain criteria, such as the items on distressing dreams and on foreshortened future, to increase their cross-cultural applicability. Text additions are suggested to increase the applicability of the manual across cultural contexts: specifying that cultural syndromes-such as those indicated in the DSM-IV-TR Glossary-may be a prominent part of the trauma response in certain cultures, and that those syndromes may influence PTSD symptom salience and comorbidity. CONCLUSIONS The DSM-IV-TR PTSD category demonstrates various types of validity. Criteria modification and textual clarifications are suggested to further improve its cross-cultural applicability.
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Affiliation(s)
- Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Mondon JA, Howitt J, Tosiano M, Kwok KWH, Hinton DE. A simple osmium post-fixation paraffin-embedment technique to identify lipid accumulation in fish liver using medaka (Oryziaslatipes) eggs and eleutheroembryos as lipid rich models. Mar Pollut Bull 2011; 63:86-90. [PMID: 21592532 DOI: 10.1016/j.marpolbul.2011.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 04/06/2011] [Accepted: 04/11/2011] [Indexed: 05/30/2023]
Abstract
Hepatic lipidosis is a non-specific biomarker of effect from pollution exposure in fish. Fatty liver is often misdiagnosed or overlooked in histological assessments due to the decreasing application of specific fat procedures and stains. For example, ethanol dehydration in standard paraffin processing removes lipids, leaving vacuoles of which the precise nature is unknown. Lipids can be identified using osmium post-fixation in semi-thin resin sections or transmission electron microscopy. However, both are expensive and technically demanding procedures, often not available for routine environmental risk assessment and monitoring programs. The current emphasis to reduce and refine animal toxicity testing, requires refinement of the suite of histopathological techniques currently available to maximize information gained from using fish for toxicity testing and as bio-indicators of environmental quality. This investigation has successfully modified an osmium post-fixation technique to conserve lipids in paraffin-embedded tissues using medaka (Oryzias latipes) eleutheroembryos and eggs (embryos) as lipid rich models.
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Affiliation(s)
- J A Mondon
- School of Life & Environmental Sciences, Deakin University, Warrnambool, Victoria 3280, Australia.
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