The effects of a combined psychotherapy and physiotherapy group treatment program for survivors of torture incarcerated in an adult prison in Kurdistan, Iraq: A pilot study


  • April Gamble, Dr. Physiotherapy Technical Coordinator, Wchan Organization for Victims of Human Rights Violations; Founder of ACR – The American Center for Rehabilitation
  • Ahmed M. Amin Ahmed, Dr. Executive Director, Wchan Organization for Victims of Human Rights; Lecturer, Sulaimani Polytechnic University – Technical College of Health
  • Salah Hassan Rahim Mental Health Director, Wchan Organization for Victims of Human Rights
  • Jeff Hartman, Dr. Assistant professor, University of Wisconsin School of Medicine and Public Health, Doctor of Physical Therapy program, Madison, WI.



Prisons, Pain, Mental Health, Physical Therapists, Psychotherapy


Introduction: Survivors of torture have high rates of mental health problems and can experience a sequela of physical effects with the most common being persistent pain. Similar to survivors of torture, persons that are incarcerated have high rates of mental health problems, persistent pain and pain-related disability.The purpose of this study is to assess the effect of an interdisciplinary group treatment approach, involving psychotherapy and physiotherapy, with survivors of torture whom are incarcerated in a prison in Kurdistan, Iraq.

Methods: A parallel group study design was used to compare a treatment group (n=11) and a wait-list control group (n=16). The treatment group participated in an interdisciplinary treatment service for a total of 10 weekly group sessions for each discipline.The primary outcome measures were symptoms of nociplastic pain, anxiety, depression, and PTSD. Secondary outcome measures evaluated physical functioning, sleep quality, and general self-efficacy.

Results: A statistically significant reduction in outcome measure scores was seen in all symptoms measured immediately post-treatment.

Discussion and Conclusion: These findings suggest that a culturally and contextually appropriate interdisciplinary group treatment intervention for survivors of torture in a prison could be effective for short-term reductions in symptoms of anxiety, depression, PTSD, persistent pain, and function. The study has limitations including a small sample size, lack of long-term outcome measures, and an inability to isolate effect of each component of care. The study does demonstrate the feasibility of implementing research that follows international research standards and practices within under-researched settings and post-conflict areas.

Author Biography

April Gamble, Dr., Physiotherapy Technical Coordinator, Wchan Organization for Victims of Human Rights Violations; Founder of ACR – The American Center for Rehabilitation


April Gamble PT, DPT, CLT is a licensed physical therapist that earned her Doctorate of Physical Therapy in Michigan, USA. Her expertise is in collaborating with local providers to develop trauma-informed rehabilitation services for under-served populations. She is the physiotherapy technical coordinator at Wchan Organization for Human Rights Violations in Kurdistan, Iraq where she leads the development of interdisciplinary treatment services for survivors of torture and war trauma. In role her as founder of ACR - The American Center for Rehabilitation, Dr. Gamble has also consulted with various international NGOs including Heartland Alliance International, Handicap International, and DIGNITY – Danish Institute Against Torture to develop rehabilitation and mental health services for survivors of torture and war trauma across the Middle East Region. April also serves as the technical director for a locally driven capacity building project in Kurdistan, Iraq that aims to develop the region’s first cancer rehabilitation services. She is the 2019 recipient of the International Association for the Study of Pain’s Developing Countries grant which will result in over 250 Kurdish physiotherapists being equipped with the skills and knowledge to treat pain from a biopsychosocial approach. April has publications in peer reviewed international journals and frequently presents at national and international meetings. April is the current secretary for the Global Health Special Interest Group of the American Physical Therapy Association and the chair of the Global Outreach Committee of the MPTA’s Oncology Rehab Special Interest Group.


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How to Cite

Gamble, A., Amin Ahmed, A. M., Hassan Rahim, S., & Hartman, J. (2020). The effects of a combined psychotherapy and physiotherapy group treatment program for survivors of torture incarcerated in an adult prison in Kurdistan, Iraq: A pilot study. Torture Journal, 30(2), 58–76.