The chronic traumatic stress treatment (CTS-T)
A resilience-focused, culturally responsive intervention for refugees and survivors of torture - including a mobile mental health application
DOI:
https://doi.org/10.7146/torture.v31i2.121222Palabras clave:
Torture Survivor, Refugee, Mental Health, Intervention, Holistic, Mobile ApplicationResumen
This manuscript introduces the Chronic Traumatic Stress-Treatment for refugees and survivors of torture (CTS-Treatment; Mazzulla & Fondacaro, 2018). CTS-Treatment aligns with the Chronic Traumatic Stress model (CTS; Fondacaro & Mazulla, 2018), a biopsychosocial-spiritual and culturally responsive theoretical framework designed to guide empirical investigation and intervention for refugees and survivors of torture. CTS-Treatment is designed for use by mental health clinicians working within an individual or group format. The ten modules of CTS-Treatment are in sequence; however, flexibility in implementation is strongly encouraged. The ten intervention modules include: 1) Mental Health Discussion, 2) Safety, 3) Values, 4) Behavioral Activation, 5) Coping Skills, 6) Sleep Hygiene, 7) Working with Thoughts, 8) Acceptance and Tolerance of Emotions, 9) Life-Path Exercise and Narrative Exposure, and 10) Celebration of Life. Empirical principles underlying the treatment, along with supporting research, are presented for each module. The final section of each module explains a component of a language-free mobile mental health application for refugees. Clients are encouraged to practice the mHealth app skills at the end of each session and between sessions.
Citas
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Borkovec, T. D., & Sides, J. K. (1979). Critical procedural variables related to the physiological effects of progressive relaxation: A review. Behaviour Research and Therapy, 17(2), 119–125. https://doi.org/10.1016/0005-7967(79)90020-2
Bunn, M., Goesel, C., Kinet, M., & Ray, F. (2018). Group treatment for survivors of torture and severe violence: A literature review. Torture Journal, 26(1), 23. https://doi.org/10.7146/torture.v26i1.108062
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4), 587–595. https://doi.org/10.1037/1528-3542.6.4.587
Clifton, J., Seehuus, M., Parent, J., Pichler, E., & Fondacaro, K. (2019). Emotional responding: Integration of multiple constructs and association with psychological health. Journal of Clinical Psychology, jclp.22885. https://doi.org/10.1002/jclp.22885
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27(3), 318–326. https://doi.org/10.1016/j.cpr.2006.11.001
de C Williams, A. C., & van der Merwe, J. (2013). The psychological impact of torture. British Journal of Pain, 7(2), 101–106. https://doi.org/10.1177/2049463713483596
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. PLoS ONE, 9(6), e100100. https://doi.org/10.1371/journal.pone.0100100
Fondacaro, K. M., & Mazzulla, E. C. (2018). The Chronic Traumatic Stress Framework: A conceptual model to guide empirical investigation and mental health treatment for refugees and survivors of torture. Torture Journal, 28(1). https://doi.org/10.7146/torture.v28i1.105477
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression. Behavior Modification, 31(6), 772–799. https://doi.org/10.1177/0145445507302202
Fuchs, C., Lee, J. K., Roemer, L., & Orsillo, S. M. (2013). Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series. Cognitive and Behavioral Practice, 20(1), 1–12. https://doi.org/10.1016/j.cbpra.2011.12.004
Geethanjali, B., Adalarasu, K., & Jagannath, M. (2018). Music Induced Emotion and Music Processing in the Brain– A Review. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/JCDR/2018/30384.11060
Gwozdziewycs, N. (2013). Meta-Analysis of the Use of Narrative Exposure Therapy for the Effects of Trauma Among Refugee Populations. The Permanente Journal, 17(1), 72–78. https://doi.org/10.7812/TPP/12-058
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (Second edition). New Harbinger Publications, Inc.
Havekes, R., Vecsey, C. G., & Abel, T. (2012). The impact of sleep deprivation on neuronal and glial signaling pathways important for memory and synaptic plasticity. Cellular Signalling, 24(6), 1251–1260. https://doi.org/10.1016/j.cellsig.2012.02.010
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist, 40(7), 976–1002. https://doi.org/10.1177/0011000012460836
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: The process and practice of mindful change.
Herman, J. L. (2015). Trauma and recovery (2015 edition). BasicBooks.
Hershenberg, R., Paulson, D., Gros, D. F., & Acierno, R. (2015). Does Amount and Type of Activity Matter in Behavioral Activation? A Preliminary Investigation of the Relationship between Pleasant, Functional, and Social Activities and Outcome. Behavioural and Cognitive Psychotherapy, 43(4), 396–411. https://doi.org/10.1017/S1352465813001185
Hinton, D. E., Pich, V., Hofmann, S. G., & Otto, M. W. (2013). Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From “Culturally Adapted CBT.” Cognitive and Behavioral Practice, 20(1), 33–46. https://doi.org/10.1016/j.cbpra.2011.09.001
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295–304. https://doi.org/10.1037/0022-006X.64.2.295
Kohrt, B. A., & Hruschka, D. J. (2010). Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma. Culture, Medicine, and Psychiatry, 34(2), 322–352. https://doi.org/10.1007/s11013-010-9170-2
Lewis-Fernández, R., Aggarwal, N. K., Hinton, L., Hinton, D. E., & Kirmayer, L. J. (2015). DSM-5® handbook on the cultural formulation interview. American Psychiatric Pub.
Lies, J., Mellor, A., Jobson, L., & Drummond, S. P. A. (2019). Prevalence of sleep disturbance and its relationships with mental health and psychosocial issues in refugees and asylum seekers attending psychological services in Australia. Sleep Health, 5(4), 335–343. https://doi.org/10.1016/j.sleh.2019.06.002
Mazzulla, E. C., & Fondacaro, K. M. (2018). Chronic Traumatic Stress Treatment (CTS-T); A mental health intervention designed for refugees and survivors of torture. Chronic Traumatic Stress-Treatment (CTS-T); A Mental Health Intervention Designed for Refugees and Survivors of Torture. https://www.newenglandsurvivorsoftorture.org/cts-t-manual
Mazzulla, E. C., Fondacaro, K. M., Weldon, H., Dibble, M., & Price, M. (under review). Addressing the Disparity in Refugee Mental Health Services: A Pilot Study of a Traumatic Stress Intervention Utilizing a Language-Free mHealth Application.
McFarlane, C. A., & Kaplan, I. (2012). Evidence-based psychological interventions for adult survivors of torture and trauma: A 30-year review. Transcultural Psychiatry, 49(3–4), 539–567. https://doi.org/10.1177/1363461512447608
Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Press.
Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement. Journal of Consulting and Clinical Psychology, 72(4), 579–587. https://doi.org/10.1037/0022-006X.72.4.579
Pearlman, L. A., & Ian, P. S. M. (1995). Vicarious Traumatization: An Empirical Study of the Effects of Trauma Work on Trauma Therapists. Professional Psychology: Research and Practice, 26(6), 8.
Porras-Segovia, A., Pérez-Rodríguez, M. M., López-Esteban, P., Courtet, P., Barrigón M, M. L., López-Castromán, J., Cervilla, J. A., & Baca-García, E. (2019). Contribution of sleep deprivation to suicidal behaviour: A systematic review. Sleep Medicine Reviews, 44, 37–47. https://doi.org/10.1016/j.smrv.2018.12.005
Refugee Processing Center. (2020). Refugee Admissions Report January 31, 2020. https://www.wrapsnet.org/admissions-and-arrivals/
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(6), 1083–1089. https://doi.org/10.1037/a0012720
Sandahl, H., Vindbjerg, E., & Carlsson, J. (2017). Treatment of sleep disturbances in refugees suffering from post-traumatic stress disorder. Transcultural Psychiatry, 54(5–6), 806–823. https://doi.org/10.1177/1363461517746314
Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy: A Short-Term Treatment for Traumatic Stress Disorders. Hogrefe Publishing GmbH. http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=5054343
Schweitzer, R., Melville, F., Steel, Z., & Lacherez, P. (2006). Trauma, Post-Migration Living Difficulties, and Social Support as Predictors of Psychological Adjustment in Resettled Sudanese Refugees. Australian & New Zealand Journal of Psychiatry, 40(2), 179–187. https://doi.org/10.1080/j.1440-1614.2006.01766.x
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. JAMA, 302(5), 537. https://doi.org/10.1001/jama.2009.1132
Stewart, M., Simich, L., Beiser, M., Makumbe, K., Makwarimba, E., & Shizha, E. (2011). Impacts of a social support intervention for Somali and Sudanese refugees in Canada. Ethnicity and Inequalities in Health and Social Care, 4(4), 186–199. https://doi.org/10.1108/17570981111250840
Tribe, R. H., Sendt, K.-V., & Tracy, D. K. (2019). A systematic review of psychosocial interventions for adult refugees and asylum seekers. Journal of Mental Health, 28(6), 662–676. https://doi.org/10.1080/09638237.2017.1322182
U.S. Department of Health & Human Services. (n.d.). Why Is Sleep Important? - Sleep Deprivation and Deficiency—Why Is Sleep Important? Retrieved February 25, 2020, from https://www.nhlbi.nih.gov/node/4605
van Dernoot Lipsky, L., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others (1st ed). Berrett-Koehler Publishers.
Vgontzas, A. N., & Kales, A. (1999). Sleep and Its Disorders. Annual Review of Medicine, 50(1), 387–400. https://doi.org/10.1146/annurev.med.50.1.387
Wirz-Justice, A., & Van den Hoofdakker, R. H. (1999). Sleep deprivation in depression: What do we know, where do we go? Biological Psychiatry, 46(4), 445–453. https://doi.org/10.1016/S0006-3223(99)00125-0
Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective ([15th anniversary ed.], rev. pbk. ed). Basic Books.
Bernstein, A. (2019, June 24). Healing Invisible Wounds, One Moment at a Time: Mindful Trauma Recovery for Refugees [Keynote Lecture]. Annual Happiness and Its Causes Meeting, Sydney, Australia.
Borkovec, T. D., & Sides, J. K. (1979). Critical procedural variables related to the physiological effects of progressive relaxation: A review. Behaviour Research and Therapy, 17(2), 119–125. https://doi.org/10.1016/0005-7967(79)90020-2
Bunn, M., Goesel, C., Kinet, M., & Ray, F. (2018). Group treatment for survivors of torture and severe violence: A literature review. Torture Journal, 26(1), 23. https://doi.org/10.7146/torture.v26i1.108062
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4), 587–595. https://doi.org/10.1037/1528-3542.6.4.587
Clifton, J., Seehuus, M., Parent, J., Pichler, E., & Fondacaro, K. (2019). Emotional responding: Integration of multiple constructs and association with psychological health. Journal of Clinical Psychology, jclp.22885. https://doi.org/10.1002/jclp.22885
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27(3), 318–326. https://doi.org/10.1016/j.cpr.2006.11.001
de C Williams, A. C., & van der Merwe, J. (2013). The psychological impact of torture. British Journal of Pain, 7(2), 101–106. https://doi.org/10.1177/2049463713483596
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. PLoS ONE, 9(6), e100100. https://doi.org/10.1371/journal.pone.0100100
Fondacaro, K. M., & Mazzulla, E. C. (2018). The Chronic Traumatic Stress Framework: A conceptual model to guide empirical investigation and mental health treatment for refugees and survivors of torture. Torture Journal, 28(1). https://doi.org/10.7146/torture.v28i1.105477
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression. Behavior Modification, 31(6), 772–799. https://doi.org/10.1177/0145445507302202
Fuchs, C., Lee, J. K., Roemer, L., & Orsillo, S. M. (2013). Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series. Cognitive and Behavioral Practice, 20(1), 1–12. https://doi.org/10.1016/j.cbpra.2011.12.004
Geethanjali, B., Adalarasu, K., & Jagannath, M. (2018). Music Induced Emotion and Music Processing in the Brain– A Review. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/JCDR/2018/30384.11060
Gwozdziewycs, N. (2013). Meta-Analysis of the Use of Narrative Exposure Therapy for the Effects of Trauma Among Refugee Populations. The Permanente Journal, 17(1), 72–78. https://doi.org/10.7812/TPP/12-058
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (Second edition). New Harbinger Publications, Inc.
Havekes, R., Vecsey, C. G., & Abel, T. (2012). The impact of sleep deprivation on neuronal and glial signaling pathways important for memory and synaptic plasticity. Cellular Signalling, 24(6), 1251–1260. https://doi.org/10.1016/j.cellsig.2012.02.010
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist, 40(7), 976–1002. https://doi.org/10.1177/0011000012460836
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: The process and practice of mindful change.
Herman, J. L. (2015). Trauma and recovery (2015 edition). BasicBooks.
Hershenberg, R., Paulson, D., Gros, D. F., & Acierno, R. (2015). Does Amount and Type of Activity Matter in Behavioral Activation? A Preliminary Investigation of the Relationship between Pleasant, Functional, and Social Activities and Outcome. Behavioural and Cognitive Psychotherapy, 43(4), 396–411. https://doi.org/10.1017/S1352465813001185
Hinton, D. E., Pich, V., Hofmann, S. G., & Otto, M. W. (2013). Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From “Culturally Adapted CBT.” Cognitive and Behavioral Practice, 20(1), 33–46. https://doi.org/10.1016/j.cbpra.2011.09.001
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295–304. https://doi.org/10.1037/0022-006X.64.2.295
Kohrt, B. A., & Hruschka, D. J. (2010). Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma. Culture, Medicine, and Psychiatry, 34(2), 322–352. https://doi.org/10.1007/s11013-010-9170-2
Lewis-Fernández, R., Aggarwal, N. K., Hinton, L., Hinton, D. E., & Kirmayer, L. J. (2015). DSM-5® handbook on the cultural formulation interview. American Psychiatric Pub.
Lies, J., Mellor, A., Jobson, L., & Drummond, S. P. A. (2019). Prevalence of sleep disturbance and its relationships with mental health and psychosocial issues in refugees and asylum seekers attending psychological services in Australia. Sleep Health, 5(4), 335–343. https://doi.org/10.1016/j.sleh.2019.06.002
Mazzulla, E. C., & Fondacaro, K. M. (2018). Chronic Traumatic Stress Treatment (CTS-T); A mental health intervention designed for refugees and survivors of torture. Chronic Traumatic Stress-Treatment (CTS-T); A Mental Health Intervention Designed for Refugees and Survivors of Torture. https://www.newenglandsurvivorsoftorture.org/cts-t-manual
Mazzulla, E. C., Fondacaro, K. M., Weldon, H., Dibble, M., & Price, M. (under review). Addressing the Disparity in Refugee Mental Health Services: A Pilot Study of a Traumatic Stress Intervention Utilizing a Language-Free mHealth Application.
McFarlane, C. A., & Kaplan, I. (2012). Evidence-based psychological interventions for adult survivors of torture and trauma: A 30-year review. Transcultural Psychiatry, 49(3–4), 539–567. https://doi.org/10.1177/1363461512447608
Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Press.
Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement. Journal of Consulting and Clinical Psychology, 72(4), 579–587. https://doi.org/10.1037/0022-006X.72.4.579
Pearlman, L. A., & Ian, P. S. M. (1995). Vicarious Traumatization: An Empirical Study of the Effects of Trauma Work on Trauma Therapists. Professional Psychology: Research and Practice, 26(6), 8.
Porras-Segovia, A., Pérez-Rodríguez, M. M., López-Esteban, P., Courtet, P., Barrigón M, M. L., López-Castromán, J., Cervilla, J. A., & Baca-García, E. (2019). Contribution of sleep deprivation to suicidal behaviour: A systematic review. Sleep Medicine Reviews, 44, 37–47. https://doi.org/10.1016/j.smrv.2018.12.005
Refugee Processing Center. (2020). Refugee Admissions Report January 31, 2020. https://www.wrapsnet.org/admissions-and-arrivals/
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(6), 1083–1089. https://doi.org/10.1037/a0012720
Sandahl, H., Vindbjerg, E., & Carlsson, J. (2017). Treatment of sleep disturbances in refugees suffering from post-traumatic stress disorder. Transcultural Psychiatry, 54(5–6), 806–823. https://doi.org/10.1177/1363461517746314
Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy: A Short-Term Treatment for Traumatic Stress Disorders. Hogrefe Publishing GmbH. http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=5054343
Schweitzer, R., Melville, F., Steel, Z., & Lacherez, P. (2006). Trauma, Post-Migration Living Difficulties, and Social Support as Predictors of Psychological Adjustment in Resettled Sudanese Refugees. Australian & New Zealand Journal of Psychiatry, 40(2), 179–187. https://doi.org/10.1080/j.1440-1614.2006.01766.x
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. JAMA, 302(5), 537. https://doi.org/10.1001/jama.2009.1132
Stewart, M., Simich, L., Beiser, M., Makumbe, K., Makwarimba, E., & Shizha, E. (2011). Impacts of a social support intervention for Somali and Sudanese refugees in Canada. Ethnicity and Inequalities in Health and Social Care, 4(4), 186–199. https://doi.org/10.1108/17570981111250840
Tribe, R. H., Sendt, K.-V., & Tracy, D. K. (2019). A systematic review of psychosocial interventions for adult refugees and asylum seekers. Journal of Mental Health, 28(6), 662–676. https://doi.org/10.1080/09638237.2017.1322182
U.S. Department of Health & Human Services. (n.d.). Why Is Sleep Important? - Sleep Deprivation and Deficiency—Why Is Sleep Important? Retrieved February 25, 2020, from https://www.nhlbi.nih.gov/node/4605
van Dernoot Lipsky, L., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others (1st ed). Berrett-Koehler Publishers.
Vgontzas, A. N., & Kales, A. (1999). Sleep and Its Disorders. Annual Review of Medicine, 50(1), 387–400. https://doi.org/10.1146/annurev.med.50.1.387
Wirz-Justice, A., & Van den Hoofdakker, R. H. (1999). Sleep deprivation in depression: What do we know, where do we go? Biological Psychiatry, 46(4), 445–453. https://doi.org/10.1016/S0006-3223(99)00125-0
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2021-12-29
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Fondacaro, K. M., Mazzula, E. C., & Weldon, H. T. (2021). The chronic traumatic stress treatment (CTS-T): A resilience-focused, culturally responsive intervention for refugees and survivors of torture - including a mobile mental health application. Torture Journal, 31(2), 110–125. https://doi.org/10.7146/torture.v31i2.121222
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