The impact of torture on mental health in the narratives of two torture survivors
DOI:
https://doi.org/10.7146/torture.v28i2.106810Palabras clave:
Refugees, torture, PTSD, Posttraumatic Stress Disorder, trauma, narrative exposure therapyResumen
Introduction: Torture survivors risk developing Posttraumatic Stress Disorder (PTSD) as well as other mental health problems. This clinical case study describes the impact of torture on two survivors who were treated for their PTSD with Narrative Exposure Therapy.
Methods: The reports of the narratives of two torture survivors were qualitatively analyzed. It was hypothesized that torture yields overaccommodating cognitions, as well as mental defeat, which in turn, are related to severity of psychological complaints.
Results: Both patients have experienced an accumulation of traumatic events. The psychological and physical torture they experienced lead to increased anticipation anxiety, loss of control and feelings of hopelessness, as well as overaccommodating cognitions regarding self and others.
Conclusions: Cognitions, culture and beliefs, as well as issues of confidence and a more long-term perspective affect therapeutic work. Building trust, pacing the therapeutic process, and applying tailor-made interventions that focus on cognitions regarding self-esteem, trust in relationships, as well as safety and control are warranted.
Citas
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Başoğlu, M. (Ed.). (2017). Torture and its definition in international law: An interdisciplinary approach. New York: Oxford University Press.
Campbell, T. A. (2007). Psychological assessment, diagnosis, and treatment of torture survivors: a review. Clinical Psychology Review, 27(5), 628-641. https://doi.org/10.1016/j.cpr.2007.02.003
DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., Eisenberger, N. I. (2010). Acetaminophen reduces social pain: Behavioral and neural evidence. Psychological Science, 21(7), 931–937. https://doi. org/10.1177/0956797610374741
Eisenberger, N. I., & Lieberman, M. D. (2005). Why it hurts to be left out: the neurocognitive overlap between physical and social pain. In: K. D. Williams, J. P. Forgas, & W. von Hippel (Eds.), The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127). New York: Cambridge University Press.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38 (4), 319–345. https://doi. org/10.1016/S0005-7967(99)00123-0
Ehlers, A., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress, 11 (3), 457–471.
Ehlers, A., Maercker, A., & Boos, A. (2000). Posttraumatic stress disorder following political imprisonment: The role of mental defeat, alienation, and perceived permanent change. Journal of Abnormal Psychology, 109 (1), 45–55. https://doi. org/10.1037//0021-843X.109.1.45
Gwozdziewycz, N. M. A. & Mehl-Madrona, L. (2013). Meta-Analysis of the Use of Narrative Exposure Therapy for the Effects of Trauma Among Refugee Populations. Permanente Journal, 17 (1), 70-76. https://doi.org/10.7812/ TPP/12-058
Hocking, D. C., Kennedy, G. A., & Sundram, S. (2015). Mental disorders in asylum seekers: The role of the refugee determination process and employment. Journal of Nervous and Mental Disease, 203(1), 28–32. https://doi.org/10.1097/ NMD.0000000000000230
Iverson, K.M., King, M., Cunningham, K.C., & Resick, P.C. (2015). Rape survivors’ trauma-related beliefs before and after Cognitive processing therapy: Associations with PTSD and depression symptoms. Behaviour Research and Therapy 66, 49- 55. https://doi.org/10.1177/0886260515592618
Jaranson, J., & Popkin, M. (Eds.). (1998). Caring for Victims of Torture. Washington, DC: American Psychiatric Press.
Kirmayer, L. J., Rousseau, C., & Measham, T. (2010). Sociocultural considerations. In D. Benedek & G. H. Wynn (Eds.), Clinical manual for the management of posttraumatic stress disorder. Washington: American Psychiatric Publishing, Inc.
Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 108(15), 6270–6275.
Lambert, J. E. & Alhassoon, O. (2015). Trauma- Focused Therapy for Refugees: Meta-Analytic Findings. Journal of Counseling Psychology, 62(1), 28–37. https://doi.org/10.1037/cou0000048
Nickerson, A., Schick, M., Schnyder, U., Bryant, A.E. & Morina, N. (2017). Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment-Seeking Refugees. Journal of Traumatic Stress, 30 (4), 409–415. http://dx.doi. org/10.1002/jts.22205
Patel N., Kellezi B., & Williams A.C.D.C. (2014). Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database of Systematic Reviews, Issue 11. https://doi. org/10.1002/14651858.CD009317
Peel, M., Lubell, N., & Beynon, J. (2005). Medical Investigation and Documentation of Torture. A Handbook for Health Professionals. Human Rights Center: University of Essex.
Pérez-Sales, P. (2017a). Psychological torture: Definition, evaluation and measurement. London: Routledge.
Pérez-Sales, P. (2017b). Psychotherapy for torture survivors – Suggested pathways for research. Torture, 27(1), 1–12.
Quiroga, J. & Jaranson, J.M. (2005) Politicallymotivated torture and its survivors: A desk study review of the literature. Torture, 15,(2-3)
Rasmussen, O. V. (2006). The medical aspects of the UN Convention against Torture. Torture, 16(1), 58–64.
Schauer M, Neuner F, Elbert T. (2011). Narrative Exposure Therapy. A Short-term Intervention for Traumatic Stress Disorders after War, Terror or Torture. 2nd, expanded edition, Göttingen: Hogrefe & Huber Publishers.
Skylv, G. (1992). The physical sequelae of torture. In: Başoğlu, M. (ed), Torture and its consequences: current treatment approaches (pp 38-55). New York: Cambridge University Press.
Startup, M., Jackson, M. C., & Bendix, S. (2002). The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology, 41 (4), 417-422. https://doi. org/10.1348/014466502760387533
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Journal of the American Medical Association, 302 (5), 537-549. https://doi.org/10.1001/jama.2009.1132
United Nations (1984). Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., & Marx, B. P. (2017). The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment, 30(3), 383-395.
Wilker, S. Kleim, B., Geiling A., Pfeiffer A., Elbert, T. & Kolassa I.T. (2017). Mental defeat and cumulative trauma experiences predict traumarelated psychopathology: Evidence from a postconflict population in Northern Uganda. Clinical Psychological Science, 5(6),974–984. https://doi. org/10.1177/2167702617719946
Young, J. E; Klosko, J. S; Weishaar, M. E. (2003). Schema therapy: a practitioner’s guide. New York: Guilford Press.
Başoğlu, M. (2009). A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments: Implications for an evidence-based definition of torture. American Journal of Orthopsychiatry 79 (2), 135-145. https://doi. org/10.1037/a0015681
Başoğlu, M. (Ed.). (2017). Torture and its definition in international law: An interdisciplinary approach. New York: Oxford University Press.
Campbell, T. A. (2007). Psychological assessment, diagnosis, and treatment of torture survivors: a review. Clinical Psychology Review, 27(5), 628-641. https://doi.org/10.1016/j.cpr.2007.02.003
DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., Eisenberger, N. I. (2010). Acetaminophen reduces social pain: Behavioral and neural evidence. Psychological Science, 21(7), 931–937. https://doi. org/10.1177/0956797610374741
Eisenberger, N. I., & Lieberman, M. D. (2005). Why it hurts to be left out: the neurocognitive overlap between physical and social pain. In: K. D. Williams, J. P. Forgas, & W. von Hippel (Eds.), The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127). New York: Cambridge University Press.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38 (4), 319–345. https://doi. org/10.1016/S0005-7967(99)00123-0
Ehlers, A., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress, 11 (3), 457–471.
Ehlers, A., Maercker, A., & Boos, A. (2000). Posttraumatic stress disorder following political imprisonment: The role of mental defeat, alienation, and perceived permanent change. Journal of Abnormal Psychology, 109 (1), 45–55. https://doi. org/10.1037//0021-843X.109.1.45
Gwozdziewycz, N. M. A. & Mehl-Madrona, L. (2013). Meta-Analysis of the Use of Narrative Exposure Therapy for the Effects of Trauma Among Refugee Populations. Permanente Journal, 17 (1), 70-76. https://doi.org/10.7812/ TPP/12-058
Hocking, D. C., Kennedy, G. A., & Sundram, S. (2015). Mental disorders in asylum seekers: The role of the refugee determination process and employment. Journal of Nervous and Mental Disease, 203(1), 28–32. https://doi.org/10.1097/ NMD.0000000000000230
Iverson, K.M., King, M., Cunningham, K.C., & Resick, P.C. (2015). Rape survivors’ trauma-related beliefs before and after Cognitive processing therapy: Associations with PTSD and depression symptoms. Behaviour Research and Therapy 66, 49- 55. https://doi.org/10.1177/0886260515592618
Jaranson, J., & Popkin, M. (Eds.). (1998). Caring for Victims of Torture. Washington, DC: American Psychiatric Press.
Kirmayer, L. J., Rousseau, C., & Measham, T. (2010). Sociocultural considerations. In D. Benedek & G. H. Wynn (Eds.), Clinical manual for the management of posttraumatic stress disorder. Washington: American Psychiatric Publishing, Inc.
Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 108(15), 6270–6275.
Lambert, J. E. & Alhassoon, O. (2015). Trauma- Focused Therapy for Refugees: Meta-Analytic Findings. Journal of Counseling Psychology, 62(1), 28–37. https://doi.org/10.1037/cou0000048
Nickerson, A., Schick, M., Schnyder, U., Bryant, A.E. & Morina, N. (2017). Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment-Seeking Refugees. Journal of Traumatic Stress, 30 (4), 409–415. http://dx.doi. org/10.1002/jts.22205
Patel N., Kellezi B., & Williams A.C.D.C. (2014). Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database of Systematic Reviews, Issue 11. https://doi. org/10.1002/14651858.CD009317
Peel, M., Lubell, N., & Beynon, J. (2005). Medical Investigation and Documentation of Torture. A Handbook for Health Professionals. Human Rights Center: University of Essex.
Pérez-Sales, P. (2017a). Psychological torture: Definition, evaluation and measurement. London: Routledge.
Pérez-Sales, P. (2017b). Psychotherapy for torture survivors – Suggested pathways for research. Torture, 27(1), 1–12.
Quiroga, J. & Jaranson, J.M. (2005) Politicallymotivated torture and its survivors: A desk study review of the literature. Torture, 15,(2-3)
Rasmussen, O. V. (2006). The medical aspects of the UN Convention against Torture. Torture, 16(1), 58–64.
Schauer M, Neuner F, Elbert T. (2011). Narrative Exposure Therapy. A Short-term Intervention for Traumatic Stress Disorders after War, Terror or Torture. 2nd, expanded edition, Göttingen: Hogrefe & Huber Publishers.
Skylv, G. (1992). The physical sequelae of torture. In: Başoğlu, M. (ed), Torture and its consequences: current treatment approaches (pp 38-55). New York: Cambridge University Press.
Startup, M., Jackson, M. C., & Bendix, S. (2002). The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology, 41 (4), 417-422. https://doi. org/10.1348/014466502760387533
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Journal of the American Medical Association, 302 (5), 537-549. https://doi.org/10.1001/jama.2009.1132
United Nations (1984). Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., & Marx, B. P. (2017). The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment, 30(3), 383-395.
Wilker, S. Kleim, B., Geiling A., Pfeiffer A., Elbert, T. & Kolassa I.T. (2017). Mental defeat and cumulative trauma experiences predict traumarelated psychopathology: Evidence from a postconflict population in Northern Uganda. Clinical Psychological Science, 5(6),974–984. https://doi. org/10.1177/2167702617719946
Young, J. E; Klosko, J. S; Weishaar, M. E. (2003). Schema therapy: a practitioner’s guide. New York: Guilford Press.
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2018-07-26
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de la Rie, S. M., Bos, J., Knipscheer, J., & Boelen, P. A. (2018). The impact of torture on mental health in the narratives of two torture survivors. Torture Journal, 28(2), 130–139. https://doi.org/10.7146/torture.v28i2.106810
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