Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical Issues
DOI:
https://doi.org/10.7146/torture.v26i1.108060Keywords:
intervention evaluation, systematic review, ethical challenges, interpretation, torture survivorsAbstract
Background: Torture survivors face multiple problems, including psychological difficulties, whether they are refugees or remain in the country where they were tortured. Provision of rehabilitation varies not only with the needs of survivors and resources available but also with service models, service provider preferences and the local and country context. Despite increasing efforts in research on the effectiveness of psychological interventions with torture survivors, results are inconclusive.
Methods: We undertook a Cochrane systematic review of psychological, social and welfare provision, with meta-analysis to best estimate efficacy. The process raised conceptual, methodological and ethical issues of relevance to the wider field. Findings: We searched very widely, but rejected hundreds of papers which recommended treatment without providing evidence. We found nine randomized controlled trials, from developed and under-resourced settings. All conceptualized survivors’ problems in psychiatric terms, using outcomes of post-traumatic stress symptoms, distress, and quality of life, by self-report, with or without translation or unstandardized interpretation, and with little mention of cultural or language issues. None used social or welfare interventions. Four related studies used narrative exposure therapy (NET) in a brief form, and without ensuring a safe setting as recommended. Five used mixed methods, including exposure, cognitive behavioral therapy, and eye movement desensitization. Combined, the studies showed no immediate improvement in PTSD, distress, or quality of life; at six months follow-up, a minority showed some improvement in PTSD and distress, although participants remained severely affected.
Conclusions: While applauding researchers’ commitment in running these trials, we raise ethical issues about exposure in particular, and about the effects of shortcomings in methodology, particularly around assessment using unfamiliar cultural frameworks and language, and the lack of concern about dropout which may indicate harm. The issues addressed aid interpretation of existing research, and guide clinical practice as well as future studies evaluating its effectiveness.
References
1. 26 June - International Day against Torture. The fight against torture: a key priority for the EU [Internet] 2007 June 26 [updated 2015 Oct 22; cited 2010 Feb 25]. Available from: http://europa.eu/rapid/pressReleasesAction. do?reference=MEMO/07/254.
2. Jaranson JM. Government-sanctioned torture: status of the rehabilitation movement. Transcult Psychiat Res Rev. 1995;32:253-86.
3. Montgomery E, Patel N. Torture rehabilitation: reflections on treatment outcome studies. Torture. 2011;21(2):141-5.
4. UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1984, New York.
5. Westermeyer J, Williams M. Three categories of victimization among refugees in a psychiatric clinic. In: Jaranson JM, Popkin MK, editors, Caring for victims of torture. Washington, DC: American Psychiatric Association, 1998:61-86.
6. Quiroga J, Jaranson JM. Politically motivated torture and its survivors: a desk study review of the literature. Torture. 2005;15:1-111.
7. Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clinical Psychology Review. 2008 Jan 1;28(1):36–47.
8. Sjölund B, Kastrup M, Montgomery E, Persson AL. Rehabilitating torture survivors. J Rehabil Med. 2009;41:689-96.
9. Patel N. The psychologisation of torture. In: M Rapley, J Moncrieff, J Dillon, editors. De-medicalising misery: psychiatry, psychology and the human condition. London: Palgrave Macmillan, 2011, 239-55.
10. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA. 2009 Aug 5;302(5):537.
11. Guzel A. Asiye’s Story. London: Saqi Books; 2003.
12. Bould G. Conscience be my guide. London: Zed Books; 1991.
13. Frankl VE. Man’s search for meaning. London: Beacon Press; 1962.
14. Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik INA. Impact of immigration detention and temporary protection on the mental health of refugees. Brit J Psychiatry. 2006 Jan;188:58–64.
15. Mahtani A. The right of refugee clients to an appropriate and ethical psychological service. Int J Human Rights. 2003;7:40-57.
16. Patel N. Torture, psychology and the 'war on terror': a human rights framework. In: Roberts R, editor. Just war: psychology and terrorism. Rosson-Wye, UK: PCCS Books; 2007.
17. Miller KE, Weine SM, Ramic A, Brkic N, Bjedic ZD, Smajkic A, Boskailo E, Worthington G. The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Traum Stress. 2002 Oct;15:377-87.
18. Gorst-Unsworth C, Goldenberg E. Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. Br J Psychiatry. 1998 Jan;172:90-4.
19. Porter M, Haslam N. Internally displaced persons: a meta-analysis associated with mental health of refugees and predisplacement and postdisplacement factors. JAMA. 2005 Aug 3;294(5):602-12.
20. Patel N. Justice and Reparation for torture survivors. JCPCP. 2011;11(3):135-47.
21. Bracken P, Giller J, Summerfield D. Psychological responses of war and atrocity: Limitations of current concepts. Soc Sci Med. 1995 Apr;40(8):1073-82.
22. Bracken PJ, Celia P. Rethinking the trauma of war. London: Save the Children with Free Association Books; 1998.
23. Patel N. Clinical psychology: reinforcing inequalities or facilitating empowerment? Int J Human Rights. 2003;7(1):16-39.
24. Summerfield D. The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ. 2001 Jan 13;322(7278):95-98.
25. Boyle M. Diagnosis. In: C. Newnes, G. Holmes, C. Dunn, editors. This is madness: a critical look at psychiatry and the future of mental health services. Ross-on-Wye: PCCS; 1999. p. 75-90.
26. Boyle M. The problem with diagnosis. Psychologist. 2007;20(5):290-2.
27. Kutchins H. and Kirk S. Making us crazy: DSM, the psychiatric bible and the creation of mental disorders. New York: Free Press; 1997.
28. Pilgrim D., Bentall R. The medicalisation of misery: A critical realist analysis of the concept of depression. J Ment Health. 1999 Jan;8:261-74.
29. Bentall R. Researching psychotic complaints. Psychologist. 2007;20(5):293-5.
30. Rapley M, Moncrieff J, Dillon J, editors. Demedicalising misery: psychiatry, psychology and the human condition. London: Palgrave Macmillan; 2011.
31. Rutter M in Nemeroff CB, Weinberger D,Rutter R, MacMillan HL, Bryant RA, Wessely S, Stein DJ, Pariante CM, Seemüller F, Berk M, Malhi GS, Preisig M, Brüne M, Lysaker P. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med. 2013 Sep 12;11:202.
32. British Psychological Society. DSM-5: The future of psychiatric diagnosis: British Psychological Society response to the American Psychiatric Association. Leicester: BPS; 2012.
33. Galatzer-Levy IR, Bryant RA. 636,120 ways to have post-traumatic stress disorder. Perspect Psychol Sci. 2013 Nov;8(6):651-62.
34. Tol W, Barbui C, Galapatti A, Silove D, Betancourt TS, Souza R, Golaz A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet. 2011 Oct 29;378(9802):1581-91.
35. Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatr Dis Treat. 2011;7:167-81.
36. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004 May 29;328:1312-5.
37. Hollifield M, Warner T, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in a refugees: a critical review. JAMA. 2002 Aug 7;288(5):611-21.
38. Lund M, Sørensen JH, Christensen JB, Ølholm A. MTV om behandling og rehabilitering af PTSD - herunder traumatiserede flygtninge [Health technology assessment on the treatment and rehabilitation of PTSD – including traumatised refugees). Vejle: Published by Center for Quality, Southern Denmark; 2008.
39. Patel N, Kellezi B,Williams ACdeC. Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database of Systematic Reviews 2011, Issue 10. Art.No.: CD009317. DOI: 10.1002/14651858.CD009317.
40. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. J Cons Clin Psychol. 2004;72(4):579-87.
41. Difede JA, Cukor J, Jayasinghe N, Patt I, Jedel S, Spielman L, Giosan C, Hoffman HG. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry. 2007 Nov;68:1639-47.
42. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006 Oct;74(5):898-907.
43. Rasmussen OV. Medical aspects of torture. Dan Med Bull. 1990 Jan;37 Suppl 1:1-88.
44. Thakker J, Ward T, Strongman KT. Mental disorder and cross-cultural psychology: a constructivist perspective. Clin Psychol Rev. 1999 Nov;19(7):843-74.
45. Gurr R, Quiroga J. Approaches to torture rehabilitation. Torture. 2001;11:5-35.
46. Hollifield M. Accurate measurement in cultural psychiatry: will we pay the costs? Transcult Psychiatry. 2002;39:419-21.
47. Newlands J, Patel N. Working with diversity: professional practice and ethical considerations. In: Trbe R, Morrissey J, editors. The handbook of professional and ethical practice for psychologists, counsellors and psychotherapists. East Sussex: Brunner-Routledge; 2004. P.233-46.
48. Bichescu D, Neuner F, Schauer M, Elbert T. Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behav Res Ther. 2007 Sep;45(9):2212-20.
49. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39(2):81-91.
50. Igreja V, Kleijn WC, Schreuder BJ, Van Dijk JA, Verschuur M. Testimony method to ameliorate post-traumatic stress symptoms. Communitybased intervention study with Mozambican civil war survivors. Br J Psychiatry. 2004 Mar;184:251-7.
51. Yeomans PD, Forman EM, Herbert JD, Yuen E. A randomized trial of a reconciliation workshop with and without PTSD psychoeducation in Burundian sample. J Trauma Stress. 2010 Jun;23(3):305-12.
52. Arrindell WA. Changes in waiting-list patients over time: data on some commonly-used measures. Beware! Behav Res Ther. 2001 Oct;39(10):1227-47.
53. Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001 Oct;39(10):1183-97.
54. Hensel-Dittmann D, Schauer M, Ruf M, Catani C, Odenwald M, Elbert T, Neuner F. Treatment of traumatized victims of war and torture : a randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychother Psychosom. 2011;80(6):345-52.
55. Schauer M, Elbert T, Gotthardt S, Rockstroh B, Odenwald M, Neuner F. Wiedererfahrung durch Psychotherapie modifiziert Geistund Gehirn [Imaginary reliving in psychotherapy modifies mind and brain] Verhaltenstherapie. 2006;16(2):96103.
56. Cienfuegos J, Monelli C. The testimony of political repression as a therapeutic instrument. Am J Orthopsychiatry. 1983 Jan;53(1):43-51.
57. Mundt AP, Wunsch P, Heinz A, Pross C. Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy. Intervention. 2014 Jul;12(2):250-66.
58. Grey N, Young K. Cognitive behaviour therapy with refugees and asylum seekers experiencing traumatic stress symptoms. Behav Cog Psychother. 2008;36(1):3-19.
59. Clark DA, Beck AT. Cognitive therapy of anxiety disorders: science and practice. Guilford Press; 2011.
60. Robjant K, Fazel M. The emerging evidence for narrative exposure therapy: a review. Clin Psychol Rev. 2010 Dec;30(8):1030-9.
61. Miller KE, Davis JL. Book review: Narrative exposure therapy: a short-term treatment for traumatic stress disorders, by M Schauer, F Neuner, and T Elbert. J Trauma Dissociation. 2013;14:592-4.
62. McFarlane CA, Kaplan I. Evidence-based psychological interventions for adult survivors of torture and trauma: a 30 year review. Transcult Psychiatry. 2012;49:539-67.
63. Nickerson A, Bryant RA, Silove D, Steel Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev. 2010;39(3):399–417.
64. Stein DJ, Seedat S, Iversen A, Wessely S. Post traumatic stress disorder: medicine and politics. Lancet. 2007 Jan 13;369:139-44.
65. National Institute for Clinical Excellence (NICE), Post traumatic stress disorder (PTSD). The management of PTSD in adults and children in primary and secondary care. National Clinical Practice Guideline 26, 2005.
66. Wenk-Ansohn M. Treatment of torture survivors – influences of the exile situation on the course of traumatic process and therapeutic possibilities. Torture. 2007;17(2):88-95.
67. Ginzburg K, Neria Y. Mental health interventions for survivors of torture. Current status and future directions. J Psychol. 2011;219(3):187-9.
68. Bisson JI. Post-traumatic stress disorder. BMJ. 2007 Apr 14;334:789-93.
69. Basoglu M, Salcioglu E. A mental healthcare model for mass trauma survivors: control-focused behavioral treatment of earthquake, war and torture trauma. Cambridge: Cambridge University Press; 2011.
70. Goswami S, Rodriguez-Sierra O, Cascardi M, Pare D. Animal models of post-traumatic stress disorder: face validity. Front Neurosci. 2013 May 31;7:89.
71. Crumlish N, O’Rourke K. A systematic review of treatments for post-traumatic stress disorder among refugees and asylum seekers. J Nerv Ment Dis. 2010 Apr;198(4):237-51
72. Nicholl C, Thompson A. The psychological treatment of post traumatic stress disorder (PTSD) in adult refugees: a review of the current state of psychological therapies. J Ment Health. 2004; 13(4):351-62
73. Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, version 5.0.2 [updated 2009 Sept]. Available from www.cochrane-handbook.org.
74. Gaffan EA, Tsaquisis I, Kemp-Wheeler SM. Researcher allegiance and meta-analysis: the case of cognitive therapy for depression. J Consult Clin Psychol. 1995 Dec;63(6):966-80.
75. Johnson TP. Methods and frameworks for cross-cultural measurement. Med Care. 2006 Nov;44(11 Suppl 3):S17-20.
76. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011 Apr;17(2):268-74
77. Tanzer NK, Sim CQE. Adapting instruments for use in multiple languages and cultures: a review of the ITC guidelines for test adaptations. Eur J Psychol Assess 1999;15:258-69.
78. Vrana SR, Campbell TA, Clay R. Survey of national consortium of torture treatment program therapists about the assessment, diagnosis, and treatment of the psychological sequelae of torture. Traumatology. 2013;19(2):144-53.
79. Bittenbinder E, editor. Good practice in the care of victims of torture. Karlsruhe: Von Loeper Literaturverlag; 2010.
80. Bittenbinder E. Beyond statistics: sharing, learning and developing good practice in the care of victims of torture. Karlsruhe: Von Loeper Literaturverlag; 2012.
81. Patel N, Williams ACdeC. Monitoring and evaluation of rehabilitation services for torture survivors: Handbook for service providers. London: ICHHR; 2014.
82. Rousseau CT, Measham T, Nadeau L. Addressing trauma in collaborative mental health care for refugee children. Clin Child Psychol Psychiatry. 2013 Jan;18(1):121-36.
83. Pokhariyal GP, Rono R, Munywoki S. Analysis of treatment methods for victims of torture in Kenya and East Africa region. Traumatology 2013;19(2):107-17.
84. Ter Heide JJ, Mooren TM, Kleijn W, de Jongh A, Kleber RJ. EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study. European Journal of Psychotraumatology. 2011;2:5881-92.
2. Jaranson JM. Government-sanctioned torture: status of the rehabilitation movement. Transcult Psychiat Res Rev. 1995;32:253-86.
3. Montgomery E, Patel N. Torture rehabilitation: reflections on treatment outcome studies. Torture. 2011;21(2):141-5.
4. UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1984, New York.
5. Westermeyer J, Williams M. Three categories of victimization among refugees in a psychiatric clinic. In: Jaranson JM, Popkin MK, editors, Caring for victims of torture. Washington, DC: American Psychiatric Association, 1998:61-86.
6. Quiroga J, Jaranson JM. Politically motivated torture and its survivors: a desk study review of the literature. Torture. 2005;15:1-111.
7. Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clinical Psychology Review. 2008 Jan 1;28(1):36–47.
8. Sjölund B, Kastrup M, Montgomery E, Persson AL. Rehabilitating torture survivors. J Rehabil Med. 2009;41:689-96.
9. Patel N. The psychologisation of torture. In: M Rapley, J Moncrieff, J Dillon, editors. De-medicalising misery: psychiatry, psychology and the human condition. London: Palgrave Macmillan, 2011, 239-55.
10. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA. 2009 Aug 5;302(5):537.
11. Guzel A. Asiye’s Story. London: Saqi Books; 2003.
12. Bould G. Conscience be my guide. London: Zed Books; 1991.
13. Frankl VE. Man’s search for meaning. London: Beacon Press; 1962.
14. Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik INA. Impact of immigration detention and temporary protection on the mental health of refugees. Brit J Psychiatry. 2006 Jan;188:58–64.
15. Mahtani A. The right of refugee clients to an appropriate and ethical psychological service. Int J Human Rights. 2003;7:40-57.
16. Patel N. Torture, psychology and the 'war on terror': a human rights framework. In: Roberts R, editor. Just war: psychology and terrorism. Rosson-Wye, UK: PCCS Books; 2007.
17. Miller KE, Weine SM, Ramic A, Brkic N, Bjedic ZD, Smajkic A, Boskailo E, Worthington G. The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Traum Stress. 2002 Oct;15:377-87.
18. Gorst-Unsworth C, Goldenberg E. Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. Br J Psychiatry. 1998 Jan;172:90-4.
19. Porter M, Haslam N. Internally displaced persons: a meta-analysis associated with mental health of refugees and predisplacement and postdisplacement factors. JAMA. 2005 Aug 3;294(5):602-12.
20. Patel N. Justice and Reparation for torture survivors. JCPCP. 2011;11(3):135-47.
21. Bracken P, Giller J, Summerfield D. Psychological responses of war and atrocity: Limitations of current concepts. Soc Sci Med. 1995 Apr;40(8):1073-82.
22. Bracken PJ, Celia P. Rethinking the trauma of war. London: Save the Children with Free Association Books; 1998.
23. Patel N. Clinical psychology: reinforcing inequalities or facilitating empowerment? Int J Human Rights. 2003;7(1):16-39.
24. Summerfield D. The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ. 2001 Jan 13;322(7278):95-98.
25. Boyle M. Diagnosis. In: C. Newnes, G. Holmes, C. Dunn, editors. This is madness: a critical look at psychiatry and the future of mental health services. Ross-on-Wye: PCCS; 1999. p. 75-90.
26. Boyle M. The problem with diagnosis. Psychologist. 2007;20(5):290-2.
27. Kutchins H. and Kirk S. Making us crazy: DSM, the psychiatric bible and the creation of mental disorders. New York: Free Press; 1997.
28. Pilgrim D., Bentall R. The medicalisation of misery: A critical realist analysis of the concept of depression. J Ment Health. 1999 Jan;8:261-74.
29. Bentall R. Researching psychotic complaints. Psychologist. 2007;20(5):293-5.
30. Rapley M, Moncrieff J, Dillon J, editors. Demedicalising misery: psychiatry, psychology and the human condition. London: Palgrave Macmillan; 2011.
31. Rutter M in Nemeroff CB, Weinberger D,Rutter R, MacMillan HL, Bryant RA, Wessely S, Stein DJ, Pariante CM, Seemüller F, Berk M, Malhi GS, Preisig M, Brüne M, Lysaker P. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med. 2013 Sep 12;11:202.
32. British Psychological Society. DSM-5: The future of psychiatric diagnosis: British Psychological Society response to the American Psychiatric Association. Leicester: BPS; 2012.
33. Galatzer-Levy IR, Bryant RA. 636,120 ways to have post-traumatic stress disorder. Perspect Psychol Sci. 2013 Nov;8(6):651-62.
34. Tol W, Barbui C, Galapatti A, Silove D, Betancourt TS, Souza R, Golaz A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet. 2011 Oct 29;378(9802):1581-91.
35. Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatr Dis Treat. 2011;7:167-81.
36. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004 May 29;328:1312-5.
37. Hollifield M, Warner T, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in a refugees: a critical review. JAMA. 2002 Aug 7;288(5):611-21.
38. Lund M, Sørensen JH, Christensen JB, Ølholm A. MTV om behandling og rehabilitering af PTSD - herunder traumatiserede flygtninge [Health technology assessment on the treatment and rehabilitation of PTSD – including traumatised refugees). Vejle: Published by Center for Quality, Southern Denmark; 2008.
39. Patel N, Kellezi B,Williams ACdeC. Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database of Systematic Reviews 2011, Issue 10. Art.No.: CD009317. DOI: 10.1002/14651858.CD009317.
40. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. J Cons Clin Psychol. 2004;72(4):579-87.
41. Difede JA, Cukor J, Jayasinghe N, Patt I, Jedel S, Spielman L, Giosan C, Hoffman HG. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry. 2007 Nov;68:1639-47.
42. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006 Oct;74(5):898-907.
43. Rasmussen OV. Medical aspects of torture. Dan Med Bull. 1990 Jan;37 Suppl 1:1-88.
44. Thakker J, Ward T, Strongman KT. Mental disorder and cross-cultural psychology: a constructivist perspective. Clin Psychol Rev. 1999 Nov;19(7):843-74.
45. Gurr R, Quiroga J. Approaches to torture rehabilitation. Torture. 2001;11:5-35.
46. Hollifield M. Accurate measurement in cultural psychiatry: will we pay the costs? Transcult Psychiatry. 2002;39:419-21.
47. Newlands J, Patel N. Working with diversity: professional practice and ethical considerations. In: Trbe R, Morrissey J, editors. The handbook of professional and ethical practice for psychologists, counsellors and psychotherapists. East Sussex: Brunner-Routledge; 2004. P.233-46.
48. Bichescu D, Neuner F, Schauer M, Elbert T. Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behav Res Ther. 2007 Sep;45(9):2212-20.
49. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39(2):81-91.
50. Igreja V, Kleijn WC, Schreuder BJ, Van Dijk JA, Verschuur M. Testimony method to ameliorate post-traumatic stress symptoms. Communitybased intervention study with Mozambican civil war survivors. Br J Psychiatry. 2004 Mar;184:251-7.
51. Yeomans PD, Forman EM, Herbert JD, Yuen E. A randomized trial of a reconciliation workshop with and without PTSD psychoeducation in Burundian sample. J Trauma Stress. 2010 Jun;23(3):305-12.
52. Arrindell WA. Changes in waiting-list patients over time: data on some commonly-used measures. Beware! Behav Res Ther. 2001 Oct;39(10):1227-47.
53. Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001 Oct;39(10):1183-97.
54. Hensel-Dittmann D, Schauer M, Ruf M, Catani C, Odenwald M, Elbert T, Neuner F. Treatment of traumatized victims of war and torture : a randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychother Psychosom. 2011;80(6):345-52.
55. Schauer M, Elbert T, Gotthardt S, Rockstroh B, Odenwald M, Neuner F. Wiedererfahrung durch Psychotherapie modifiziert Geistund Gehirn [Imaginary reliving in psychotherapy modifies mind and brain] Verhaltenstherapie. 2006;16(2):96103.
56. Cienfuegos J, Monelli C. The testimony of political repression as a therapeutic instrument. Am J Orthopsychiatry. 1983 Jan;53(1):43-51.
57. Mundt AP, Wunsch P, Heinz A, Pross C. Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative Exposure Therapy. Intervention. 2014 Jul;12(2):250-66.
58. Grey N, Young K. Cognitive behaviour therapy with refugees and asylum seekers experiencing traumatic stress symptoms. Behav Cog Psychother. 2008;36(1):3-19.
59. Clark DA, Beck AT. Cognitive therapy of anxiety disorders: science and practice. Guilford Press; 2011.
60. Robjant K, Fazel M. The emerging evidence for narrative exposure therapy: a review. Clin Psychol Rev. 2010 Dec;30(8):1030-9.
61. Miller KE, Davis JL. Book review: Narrative exposure therapy: a short-term treatment for traumatic stress disorders, by M Schauer, F Neuner, and T Elbert. J Trauma Dissociation. 2013;14:592-4.
62. McFarlane CA, Kaplan I. Evidence-based psychological interventions for adult survivors of torture and trauma: a 30 year review. Transcult Psychiatry. 2012;49:539-67.
63. Nickerson A, Bryant RA, Silove D, Steel Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev. 2010;39(3):399–417.
64. Stein DJ, Seedat S, Iversen A, Wessely S. Post traumatic stress disorder: medicine and politics. Lancet. 2007 Jan 13;369:139-44.
65. National Institute for Clinical Excellence (NICE), Post traumatic stress disorder (PTSD). The management of PTSD in adults and children in primary and secondary care. National Clinical Practice Guideline 26, 2005.
66. Wenk-Ansohn M. Treatment of torture survivors – influences of the exile situation on the course of traumatic process and therapeutic possibilities. Torture. 2007;17(2):88-95.
67. Ginzburg K, Neria Y. Mental health interventions for survivors of torture. Current status and future directions. J Psychol. 2011;219(3):187-9.
68. Bisson JI. Post-traumatic stress disorder. BMJ. 2007 Apr 14;334:789-93.
69. Basoglu M, Salcioglu E. A mental healthcare model for mass trauma survivors: control-focused behavioral treatment of earthquake, war and torture trauma. Cambridge: Cambridge University Press; 2011.
70. Goswami S, Rodriguez-Sierra O, Cascardi M, Pare D. Animal models of post-traumatic stress disorder: face validity. Front Neurosci. 2013 May 31;7:89.
71. Crumlish N, O’Rourke K. A systematic review of treatments for post-traumatic stress disorder among refugees and asylum seekers. J Nerv Ment Dis. 2010 Apr;198(4):237-51
72. Nicholl C, Thompson A. The psychological treatment of post traumatic stress disorder (PTSD) in adult refugees: a review of the current state of psychological therapies. J Ment Health. 2004; 13(4):351-62
73. Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, version 5.0.2 [updated 2009 Sept]. Available from www.cochrane-handbook.org.
74. Gaffan EA, Tsaquisis I, Kemp-Wheeler SM. Researcher allegiance and meta-analysis: the case of cognitive therapy for depression. J Consult Clin Psychol. 1995 Dec;63(6):966-80.
75. Johnson TP. Methods and frameworks for cross-cultural measurement. Med Care. 2006 Nov;44(11 Suppl 3):S17-20.
76. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011 Apr;17(2):268-74
77. Tanzer NK, Sim CQE. Adapting instruments for use in multiple languages and cultures: a review of the ITC guidelines for test adaptations. Eur J Psychol Assess 1999;15:258-69.
78. Vrana SR, Campbell TA, Clay R. Survey of national consortium of torture treatment program therapists about the assessment, diagnosis, and treatment of the psychological sequelae of torture. Traumatology. 2013;19(2):144-53.
79. Bittenbinder E, editor. Good practice in the care of victims of torture. Karlsruhe: Von Loeper Literaturverlag; 2010.
80. Bittenbinder E. Beyond statistics: sharing, learning and developing good practice in the care of victims of torture. Karlsruhe: Von Loeper Literaturverlag; 2012.
81. Patel N, Williams ACdeC. Monitoring and evaluation of rehabilitation services for torture survivors: Handbook for service providers. London: ICHHR; 2014.
82. Rousseau CT, Measham T, Nadeau L. Addressing trauma in collaborative mental health care for refugee children. Clin Child Psychol Psychiatry. 2013 Jan;18(1):121-36.
83. Pokhariyal GP, Rono R, Munywoki S. Analysis of treatment methods for victims of torture in Kenya and East Africa region. Traumatology 2013;19(2):107-17.
84. Ter Heide JJ, Mooren TM, Kleijn W, de Jongh A, Kleber RJ. EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study. European Journal of Psychotraumatology. 2011;2:5881-92.
Downloads
Published
2018-09-06
How to Cite
Patel, N., Williams, A. C. de C., & Kellezi, B. (2018). Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical Issues. Torture Journal, 26(1), 15. https://doi.org/10.7146/torture.v26i1.108060
Issue
Section
Research and Scientific articles
License
We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.
