Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors


  • Deborah Larson-Stoa Disaster Mental Health Institute at University of South Dakota
  • Gerard A. Jacobs Disaster Mental Health Institute at University of South Dakota
  • Abraham Jonathan International Catholic Migration Commission (ICMC), Indonesia
  • Bhava Poudyal International Catholic Migration Commission (ICMC), Indonesia




Paraprofessionals, task shifting, counseling, support groups, depression, anxiety, somatic, functioning, torture survivors, Indonesia


The Indonesian population has faced political violence, victimization, and torture throughout the last 70 years. Due to the scarcity of mental health professionals in many low and middle-income countries, counseling programs are increasingly utilizing paraprofessionals to provide support to the affected population as a strategy of task shifting. In this article, we would like to examine the effectiveness of counseling services provided by such trained paraprofessionals. This study was part of program evaluation to determine whether the participants (torture survivors) improved after counseling services provided by trained paraprofessionals in Indonesia. Local communities were invited to join the psychosocial program created and implemented by an NGO in 2005. The 178 participants were recruited from Jakarta, Papua, and Aceh, Indonesia for the program, which aimed to help survivors of violence suffering from “heavy hearts.” The intervention lasted three months, and the follow-up intake was conducted after four months.
The results indicated the participants’ anxiety symptoms, depressive symptoms, somatic symptoms, and functioning improved from the intake to the follow-up. The program appeared to have been effective in reducing the participants’ symptoms and impairment in functioning. This indicates that in countries where there is a scarcity of mental health professionals, working with paraprofessionals has the potential to help survivors of torture and violence.


1. Amnesty International. Amnesty International Report 2011: The State of the World’s Human Rights. London; 2011.
2. Vesti P, Kastrup M. Treatment of torture survivors: Psychosocial and Somatic Aspects. In Freedy JR, Hobfoll SE, editors. Traumatic Stress: From Theory to Practice (Plenum Series on Stress and Coping). New York: Plenum Publishing; 1995.pp. 339-363.
3. Gorman W. Refugee survivors of torture: Trauma and treatment. Professional Psychology: Research and Practice. American Psychological Association (APA); 2001;32(5):443–51.
4. Riemer JM. At the side of torture survivors: treating a terrible assault on human dignity. Graessner S, Gurris N, Pross C, editors. Baltimore, MD: The Johns Hopkins University Press; 2001.
5. Elsass P. Treating Victims of Torture and Violence. NYU Press; 1997.
6. Crescenzi A, Ketzer E, van Ommeren M, Phuntsok K, Komproe I, de Jong JTVM. Effect of political imprisonment and trauma history on recent Tibetan refugees in India. J Trauma Stress. Wiley-Blackwell; 2002 Oct;15(5):369–75.
7. De Jong J, editor. Trauma, War, and Violence: Public Mental Health in Socio-Cultural Context (The Springer Series in Social/Clinical Psychology). New York: Kluwer Academic/Plenum Publishers; 2002.
8. Dross P. Survivors of politically motivated torture: A large, growing, and invisible population of crime victims. U.S. Department of Justice, Office for Victims of Crime Report. 2000 Jan p. 1–12.
9. McCullough-Zander K, Larson S. ‘The Fear Is Still in Me’: Caring for Survivors of Torture. American Journal of Nursing. Ovid Technologies (Wolters Kluwer Health); 2004;104(10):54–64.
10. Van Ommeren M, de Jong JTVM, Sharma B, Komproe I, Thapa SB, Cardeña E. Psychiatric Disorders Among Tortured Bhutanese Refugees in Nepal. Archives of General Psychiatry. American Medical Association (AMA); 2001 May 1;58(5):475.
11. Carlsson JM, Olsen DR, Mortensen EL, Kastrup M. Mental Health and Health-Related Quality of Life. The Journal of Nervous and Mental Disease. Ovid Technologies (Wolters Kluwer Health); 2006;194(10):725–31.
12. Jakupcak M, Osborne T, Michael S, Cook J, Albrizio P, McFall M. Anxiety sensitivity and depression: Mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder. Journal of Traumatic Stress. WileyBlackwell; 2006;19(4):471–9.
13. Rasmussen A, Rosenfeld B, Reeves K, Keller AS. The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample. Journal of Abnormal Psychology. American Psychological Association (APA); 2007;116(4):734–40.
14. Olsen DR, Montgomery E, Bøjholm S, Foldspang A. Prevalence of pain in the head, back and feet in refugees previously exposed to torture: A ten-year follow-up study. Disability and Rehabilitation. Informa UK; 2007 Jan;29(2):163–71.
15. Amris K, C. de C. Williams A. Chronic Pain in Survivors of Torture. Pain. 2007 Oct;15(7).
16. Başoğlu M, Livanou M, Crnobarić C. Torture vs Other Cruel, Inhuman, and Degrading Treatment. Archives of General Psychiatry. American Medical Association (AMA); 2007 Mar 1;64(3):277.
17. Başoğlu M, Paker M. Severity of trauma as predictor of long-term psychological status in survivors of torture. Journal of Anxiety Disorders. Elsevier BV; 1995 Jul;9(4):339–50.
18. Stepakoff S, Hubbard J, Katoh M, Falk E, Mikulu J-B, Nkhoma P, et al. Trauma healing in refugee camps in Guinea: A psychosocial program for Liberian and Sierra Leonean survivors of torture and war. American Psychologist. American Psychological Association (APA); 2006;61(8):921–32.
19. Jaranson JM, Popkin MK, editors. Caring for victims of torture. 1st ed. Washington, DC: American Psychiatric Press; 1998.
20. Başoğlu M, Ekblad S, Bäärnhielm S, Livanou M. Cognitive-behavioral treatment of tortured asylum seekers: a case study. Journal of Anxiety Disorders. Elsevier BV; 2004 Jan;18(3):357–69.
21. Bichescu D, Neuner F, Schauer M, Elbert T. Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behaviour Research and Therapy. Elsevier BV; 2007 Sep;45(9):2212–20.
22. Tol WA, Barbui C, Galappatti A, Silove D, Betancourt TS, Souza R, et al. Mental health and psychosocial support in humanitarian settings: linking practice and research. The Lancet. Elsevier BV; 2011 Oct;378(9802):1581–91.
23. Mental Health Atlas 2011. Geneva: World Health Organization; 2011.
24. Morris J, Lora A, McBain R, Saxena S. Global Mental Health Resources and Services: A WHO Survey of 184 Countries. Public Health Reviews. 2012;34(2):1–19.
25. Patel V. Global Mental Health: From Science to Action. Harvard Review of Psychiatry. Ovid Technologies (Wolters Kluwer Health); 2012;20(1):6–12.
26. Mollica RF, Wyshak G, Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. American Journal of Psychiatry. American Psychiatric Publishing; 1987 Apr;144(4):497–500.
27. Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting Depressive Disorder With the Hopkins Symptom Checklist-25 in Tanzania. International Journal of Social Psychiatry. SAGE Publications; 2008 Jan 1;54(1):7–20.
28. Mumford DB, Bavington JT, Bhatnagar KS, Hussain Y, Mirza S, Naraghi MM. The Bradford Somatic Inventory. A multi-ethnic inventory of somatic symptoms reported by anxious and depressed patients in Britain and the Indo-Pakistan subcontinent. The British Journal of Psychiatry. Royal College of Psychiatrists; 1991 Mar 1;158(3):379–86.
29. Van Ommeren M, Sharma B, Prasain D, Poudyal B. Addressing Human Rights Violations: A Public Mental Health Perspective on Helping Torture Survivors in Nepal. In J. d. Jong (Ed.), Trauma, War, and Violence: Public Mental Health in Sociocultural Context. Springer; 2002 259-281.




How to Cite

Larson-Stoa, D., Jacobs, G. A., Jonathan, A., & Poudyal, B. (2018). Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors. Torture Journal, 25(2), 11. https://doi.org/10.7146/torture.v25i2.109669