Psychotherapy with traumatised refugees – the design of a randomised clinical trial

Authors

  • Erik Vindbjerg The Competence Center for Transcultural Psychiatry (CTP), Psychiatric Center Ballerup, the Mental Health Services of the Capital Region of Denmark
  • Christoph Klimpke The Competence Center for Transcultural Psychiatry (CTP), Psychiatric Center Ballerup, the Mental Health Services of the Capital Region of Denmark
  • Jessica Carlsson University of Copenhagen; The Competence Center for Transcultural Psychiatry (CTP), Psychiatric Center Ballerup, the Mental Health Services of the Capital Region of Denmark

DOI:

https://doi.org/10.7146/torture.v24i1.109719

Keywords:

Post-traumatic Stress Disorder, Depression, Psychotherapy, clinical trial, Cognitive Behavioural Therapy

Abstract

There is little evidence as to which kind of psychotherapy is the most effective in the treatment of traumatised refugees. At the Competence Center for Transcultural Psychiatry, a series of clinical trials have been conducted since 2008. The first results are pending publication. The aim of this paper is to discuss some of the challenges in adapting Cognitive Behavioural Therapy (CBT) to the treatment of traumatised refugees, as well as describe a randomised clinical trial designed to test two such adaptations. In the described trial one group receives CBT with a focus on cognitive restructuring while the other group receives CBT focusing on Stress Management. A main goal of this setup is to test whether some, perhaps even most, of the traumatised refugees referred to treatment, may benefit from a more direct focus on current stress, and its alleviation through simple, repetitive exercises, compared to a focus on analysing and changing thought patterns.

References

1. Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003388.
2. Jaranson JM, Quiroga J. Evaluating the services of torture rehabilitation programmes: history and recommendations. Torture. 2011;21(2):98-140.
3. Foa EB, Rothbaum BO, Riggs DS, Murdock TB. Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitivebehavioural procedures and counselling. J Consult Clin Psychol. 1991 Oct;59(5):715-23.
4. Schnurr PP, Lunney CA, Sengupta A, Waelde LC. A descriptive analysis of PTSD chronicity in Vietnam veterans. J Trauma Stress. 2003 Dec;16(6):545-53.
5. Crumlish N, O'Rourke K. A systematic review of treatments for post-traumtic stress disorder among refugees and asylum-seekers. J Nerv Ment Dis. 2010 Apr;198(4):237-51 .
6. Hinton DE, Chhean D, Pich V, Safren SA, Hofmann SG, Pollack MH. A randomized controlled trial of cognitive-behaviour therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: a cross-over design. J Trauma Stress. 2005 Dec;18(6):617-29 .
7. 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.
8. Palic S, Elklit A. Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. J Affect Disord. 2011 Jun;131(1-3):8-23.
9. Hjortkjær DB, Hero EK, Calmer J, Hansen K, Jensen M, Parwani N. Psykoterapi med traumatiserede flygtninge. Psykolognyt. 2009;10:12-6. Available from: http://infolink2003.elbo.dk/ PsyNyt/Dokumenter/doc/15905.pdf
10. Kirmayer, LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62 suppl 13:22-8; discussion 29-30.
11. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behav Sci. 1974 Jan;19(1):1-15.
12. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987 Apr;144(4):497-500.
13. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in refugees: a critical review. JAMA. 2002 Aug 7;288(5):611-21.
14. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992 Feb;180(2):111-6.
15. Folker H, Folker AP. WHO-5 as a simple method for measuring quality of life in daily psychiatric clinics. Ugeskr for Læger. 2008 Mar 3;170(10):830-4.
16. Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol. 2008 Mar;23(2):70-83.
17. Schwartz RC. Concurrent validity of the Global Assessment of Functioning Scale for clients with Schizophrenia. Psychol Rep. 2007 Apr;100(2):571-4.
18. Meoni P, Salinas E, Brault Y, Hacket D. Pattern of symptom improvement following treatment with venlafaxin XR in patients with generalized anxiety disorder. J Clin Psychiatry. 2001 Nov;62(11):888-93.
19. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiat. 1960 Feb;23:56-62.
20. Bech P. Rating Scales for Psychopathology, Health Status and Quality of Life. A Compendium on Documentation in Accordance with the DSM-III-R and WHO Systems. 1 ed. Berlin: Springer Verlag; 1993.
21. Kiresuk TJ, Sherman RE. Goal attainment scaling: a general method of evaluating comprehensive community mental health programs. Community Mental Health Journal 1968 Dec;4:443-53.
22. Lehrer PM, Woolfolk RL, Sime WE, Barlow DH. Principles and Practice of Stress Management. 3rd ed. New York: Guilford Press; 2007.
23. Lazarus RS, Folkman S. Stress Appraisal and Coping. New York: Springer Publishing; 1984.
24. Meichenbaum D. Stress Inoculation Training, a Preventive and Treatment Approach. In: Lehrer PM, Woolfolk RL, Sime WE, editors. Principles and Practice of Stress Management. 3rd ed. New York: Guilford Press; 2007. p. 497-518.
25. Bernstein DA, Carlson RC, Schmidt JE. Progressive Relaxation: Abbreviated methods. In: Lehrer PM, Woolfolk RL, Sime WE, editors. Principles and Practice of Stress Management. 3rd ed. New York: Guilford Press; 2007. p. 88-122.
26. Giardino ND, McGrady A, Andrasik F. Stress Management and Relaxation Therapies for Somatic Disorders. In: Lehrer PM, Woolfolk RL, Sime WE, editors. Principles and Practice of Stress Management. 3rd ed. New York: Guilford Press; 2007. p. 682-702.

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Published

2018-10-08

How to Cite

Vindbjerg, E., Klimpke, C., & Carlsson, J. (2018). Psychotherapy with traumatised refugees – the design of a randomised clinical trial. Torture Journal, 24(1), 9. https://doi.org/10.7146/torture.v24i1.109719

Issue

Vol. 24 No. 1 (2014): Torture Journal: Journal on Rehabilitation of Torture Victims and Prevention of Torture

Section

Research and Scientific articles

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