Rehabilitation for torture survivors: Six evidence myths and their implications for future research
DOI:
https://doi.org/10.7146/torture.v32i1-2.131776Palabras clave:
Rehabilitation, research, evidence, Torture, Torture JournalResumen
Whilst it is established that torture survivors suffer from complex, multiple and often severe and enduring physical, psychological, social, welfare and many other difficulties; and that rehabilitation as reparation should be holistic, interdisciplinary and specialist, majority of the research on rehabilitation focuses increasingly and almost exclusively on psychological interventions. Further, assumptions that this research provides evidence of which are effective psychological interventions may underpin and skew services funded and provided to torture survivors. In this paper we challenge some of those assumptions, and discuss the conceptual, theoretical, epistemological and methodological limitations of this research and implications for future research.
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Amris, K., Jones, L. E. & Williams, A. C. de C.
(2019). Clinical update. Pain from torture:
assessment and treatment. Pain Reports, 4(6),
e794. 10.1097/PR9.0000000000000794
Arnett, J. (2008). The neglected 95%. Why American
psychology needs to become less American.
American Psychologist, 63(7), 602-614. doi:
1037/0003-066X.63.7.602
Baier, A. L., Kline, A. C. & Feeny, N. C. (2020).
Therapeutic alliance as a mediator of change:
a systematic review and evaluation of research.
Clinical Psychology Review, 82, 101921. doi:
1016/j.cpr.2020.101921
Baird, E., Williams, A. C. de C., Hearn, L. & Amris,
K. (2017). Interventions for treating persistent
pain in survivors of torture (Review). Cochrane
Database of Systematic Reviews, Issue 8, Art. No.
CD012051. doi: 10.1002/14651858.CD012051.
pub2.
Barkham, M., Connell, J., Stiles, W. B., Miles, J. N.
V., Margison, F., Evans, C. & Mellor-Clark, J.
(2006). Dose-effect relations and responsive
regulation of treatment duration: the good
enough level. Journal of Consulting & Clinical
Psychology, 74(1), 160-167. doi: 10.1037/0022-
X.74.1.160
Boyle, M. (2003). The problem with diagnosis.
The Psychologist, 20(5), 290-292. doi:
1177/0706743718802799
Burnett, A. & Peel, M. (2001). The health of
survivors of torture and organised violence.
British Medical Journal, 322(7286), 606–609. doi:
1136/bmj.322.7286.606
Campbell, T. (2007). Psychological assessment,
diagnosis, and treatment of torture survivors: a
review. Clinical Psychology Review, 27(5), 628-
doi: 10.1016/j.cpr.2007.02.003
Carlsson, J., Sonne, C. & Silove, D. (2014). From
pioneers to scientists: Challenges in establishing
evidence-gathering models in torture and trauma
mental health services for refugees. Journal of
Nervous & Mental Disease, 202(9), 630-637. doi:
1097/NMD.0000000000000175
Chamberlain, K. (2015). Epistemology and
qualitative research. In Rohleder, P. & Lyons, A.
C. (Eds.), Qualitative research in clinical and health
psychology (pp. 9–28). Basingstoke, UK: Palgrave
Macmillan.
Cloitre, M., Brewin, C. R., Bisson, J. I., Hyland, P.,
Karatzias, P., Lueger-Schuster, B., Maercker,
A., Roberts, N. P. & Shevlin, M. (2020).
Evidence for the coherence and integrity of the
complex PTSD (CPTSD) diagnosis: response
to Achterhof et al., (2019) and Ford (2020).
European Journal of Psychotraumatology, 11(1),
doi: 10.1080/20008198.2020.1739873
Crumlish, N. & O’Rourke, K. (2010). A
systematic review of treatments for posttraumatic
stress disorder among refugees and
asylum-seekers. Journal of Nervous & Mental
Disease, 198(4), 237–251. doi: 10.1097/
NMD.0b013e3181d61258
Cybulski, L., Mayo-Wilson, E. & Grant, S. (2016).
Improving transparency and reproducibility
through registration: the status of intervention
trials published in clinical psychology journals.
Journal of Consulting & Clinical Psychology, 84(9),
doi: 10.1037/ccp0000115
DeAngelis, C. D., Drazen, J. M., Frizelle, F. A.,
Haug, C., Hoey, J., Horton, R. et al. (2004).
Clinical trial registration: a statement from
the International Committee of Medical
Journal Editors. Journal of the American Medical
Association, 292(11), 2436-2438. doi: 10.1001/
jama.292.11.1363
Dechartres, A., Altman, D. G., Trinquart, L.,
Boutron, I. & Ravaud, P. (2014). Association
between analytic strategy and estimates of
treatment outcomes in meta-analyses. Journal
of the American Medical Association, 312(6), 623-
doi: 10.1001/jama.2014.8166.
Dechartres, A., Trinquart, L., Boutron, I. & Ravaud,
P. (2013). Influence of trial sample size on
treatment effect estimates: meta-epidemiological
study. British Medical Journal, 346, f2304. doi:
1136/bmj.f2304.
Fernando, S. (2003). Cultural diversity, mental health
and psychiatry. Hove: Brunner-Routledge.
Galatzer-Levy, I. R. & Bryant, R. A. (2013). 636,120
ways to have posttraumatic stress disorder.
Perspectives on Psychological Science, 8(6), 651-
doi: 10.1177/1745691613504115
Glasziou, P. & Chalmers, I. (2018). Research waste
is still a scandal – an essay by Paul Glasziou
and Iain Chalmers. British Medical Journal, 363,
k4645. doi: 10.1136/bmj.k4645
Goldacre, B., Drysdale, H., Dale, A., Milosevic, I.,
Slade, E., Hartley, P., Marston, C., Powell-Smith,
A., Heneghan, C. & Mahtani, K. R. (2019).
COMPare: a prospective cohort study correcting
and monitoring 58 misreported trials in real
time. Trials, 20(1), 118. doi: 10.1186/s13063-
-3173-2
Grant, S., Mayo-Wilson, E., Montgomery, P.,
Macdonald, G., Michie, S., Hopewell, S. &
Moher, D. (2018). CONSORT-SPI 2018
explanation and elaboration: guidance for
reporting social and psychological intervention
trials. Trials, 19(1), 1-8. doi: 10.1186/s13063-
-2735-z
Greenhalgh, T., Howick, J. & Maskrey, N. (2014).
Evidence-based medicine: a movement in crisis?
British Medical Journal, 348, g3725. doi: 10.1136/
bmj.g3725
Hamid, A., Patel, N. & Williams, A. C. de C. (2019).
Psychological, social and welfare interventions for
torture survivors: a systematic review and metaanalysis
of randomised controlled trials. PLoS
Medicine, 16(9), e1002919. doi: 10.1371/journal.
pmed.1002919
Heinonen, E. & Nissen-Lie, H. A. (2020). The
professional and personal characteristics of
effective psychotherapists: A systematic review.
Psychotherapy Research, 30(4), 417-432. doi:
1080/10503307.2019.1620366
Henrich J. (2021). The WEIRDest people in the world:
How the West became psychologically peculiar and
particularly prosperous. Penguin UK
Horowitz, A. (2015). The DSM-5 and the continuing
transformation of normal sadness into depressive
disorder. Emotion Review, 7(3), 209-215. doi:
1177/1754073915575401
Howick, Jeremy. (2011). The Philosophy of Evidence-
Based Medicine. Chichester, UK: Wiley-Blackwell.
Hyland, P., Shevlin, M., Fyvie, C. & Karatzias,
T. (2018). Posttraumatic stress disorder and
complex posttraumatic stress disorder in DSM-5
and ICD-11: clinical and behavioural correlates.
Journal of Traumatic Stress, 31(2), 174-180. doi:
1002/jts.22272
Jaranson, J. & Quiroga, J. (2011). Evaluating the
series of torture rehabilitation programmes:
history and recommendations. Torture, 21(2),
-140.
John, A. (2017). Equipoise in research: integrating
science and ethics in human research. Journal of
the American Medical Association, 317(5), 525-526.
doi: 10.1001/jama.2017.0016.
Johnson, H., Thompson, A. & Downs, M. (2008).
The development and maintenance of posttraumatic
stress disorder (PTSD) in civilian adult
survivors of war trauma and torture: a review.
Clinical Psychology Review, 28(1), 36-47. doi:
1016/j.cpr.2007.01.017
Johnson, T. P. (2006). Methods and frameworks
for cross-cultural measurement. Medical Care,
(11 Suppl 3), S17-S20. doi: 10.1097/01.
mlr.0000245424.16482.f1
Johnstone, K. (2009). Users and abusers of psychiatry:
A critical look at psychiatric practice. London:
Routledge.
Kelly, M. P., Heath, I., Howick, J. & Greenhalgh, T.
(2015). The importance of values in evidencebased
medicine. BMC Medical Ethics, 16(1), 69.
doi: 10.1186/s12910-015-0063-3
Kerridge, I. (2010). Ethics and EBM: acknowledging
bias, accepting difference and embracing
politics. Journal of Evaluation in Clinical
Practice, 16(2), 365–373. doi: 10.1111/j.1365-
2010.01412.x
Kim, D.-M., Wampold, B. E. & Bolt, D. M. (2006).
Therapist effects in psychotherapy: a randomeffects
modeling of the National Institute
of Mental Health Treatment of Depression
Collaborative Research Program data.
Psychotherapy Research, 16(2), 161-172. doi:
1080/10503300500264911
Kirk, S. and Kitchings, H. (1992). The selling of DSM:
The rhetoric of science in psychiatry. Aldine de
Gruyter: X
Little, R. & Kang, S. (2015). Intention‐to‐treat
analysis with treatment discontinuation and
missing data in clinical trials. Statistics in
Medicine, 34(16), 2381-2390. doi: 10.1002/
sim.6352
Maassen, E., van Assen, M. A. L. M., Nuijten, M. B.,
Olsson-Collentine, A. & Wicherts, J. M. (2020).
Reproducibility of individual effect sizes in
meta-analyses in psychology. PLoS One, 15(5),
e0233107. doi: 10.1371/journal.pone.0233107
McFarlane, C. A. & Kaplan, I. Evidence-based
psychological interventions for adult survivors
of torture and trauma: a 30-year review. (2012).
Transcultural Psychiatry, 49(3-4), 539-567. doi:
1177/1363461512447608
McHorney, C. A. & Fleishman, J. A. (2006).
Assessing and understanding measurement
equivalence in health outcome measures.
Medical Care, 44(11 Suppl 3), S205-S210. doi:
1097/01.mlr.0000245451.67862.57
Miles, A. (2009). On a Medicine of the Whole
Person: away from scientistic reductionism
and towards the embrace of the complex in
clinical practice. Journal of Evaluation in Clinical
Practice, 15(6), 941-949. doi: 10.1111/j.1365-
2009.01354.x
Montgomery, E. & Patel, N. (2011). Torture
rehabilitation: reflections on outcome studies.
Torture, 21(2), 141-145.
Morley, S. (2018). Single Case Methods in Clinical
Psychology: A Practical Guide. Routledge,
Abingdon UK, 2018.
Munafò, M. R., Nosek, B. A., Bishop, D. V. M.,
Button, K. S., Chambers, C. D., du Sert, N.
P., Simonsohn, U., Wagenmakers, E.-J., Ware, J.
J. & Ioannidis, J. P. A. (2017). A manifesto for
reproducible science. Nature Human Behavior,
(1), 1-9. doi: 10.1038/s41562-016-0021
Nicholl, C. & Thompson, A. (2004). The
psychological treatment of Post Traumatic Stress
Disorder (PTSD) in adult refugees: a review
of the current state of psychological therapies.
Journal of Mental Health, 13(4), 351-362. doi:
1080/09638230410001729807
Patel, N. (2011). The psychologisation of torture. In
Rapley, M., Moncrieff, J. & Dillon, J. (Eds.). De-
Medicalising Misery: Psychiatry, psychology and the
human condition (pp.239-255). London: Palgrave
Macmillan.
Patel, N. (2019). Conceptualising rehabilitation
as reparation for torture survivors: A
clinical perspective. International Journal
of Human Rights, 23(9), 1546-1568.
doi: 10.1080/13642987.2019.1612373
Patel, N. (2020) Psychological care for torture
survivors, their families and communities.
In Evans, M. & Modvig, J. (Eds.) Research
Handbook on Torture. Cheltenham: Edward Elgar.
Patel, N., Kellezi, B. & Williams, A. C. de C. (2014).
Psychological, social and welfare interventions
for psychological health and well-being of
torture survivors. Cochrane Database of Systematic
Reviews, Issue 11, Art. No. CD009317. doi:
1002/14651858.CD009317.pub2.
Patel, N., Williams, A. C. de C. & Kellezi, B.
(2016). Reviewing outcomes of psychological
interventions with torture survivors: conceptual,
methodological and ethical issues. Torture, 26(1),
-16.
Pérez-Sales, P. (2017). Editorial: Psychotherapy
for torture survivors – suggested pathways for
research. Torture, 27(1), 1-12.
Rapley, M., Moncrieff, J. & Dillon, J. (2011). De-
Medicalising Misery: Psychiatry, psychology and
the human condition. Basingstoke: Palgrave
Macmillan.
Rashed, M. A. & Bingham, R. (2014). Can psychiatry
distinguish social deviance from mental disorder?
Philosophy, Psychiatry & Psychology, 21(3), 243-
doi: 10.1353/ppp.2014.0043
Rasmussen, O. (1990). Medical aspects of torture.
Danish Medical Bulletin, 37(Suppl 1), 1-88.
Sackett, D. L. (2000). Equipoise, a term whose time
(if it ever came) has gone. Canadian Medical
Association Journal, 163(7), 835-836.
Salo, C. D. & Bray, E. M. (2016). Empirically tested
interventions for torture survivors: A systematic
review through an ecological lens. Translational
Issues in Psychological Science, 2(4), 449. doi:
1037/tps0000097
Spivak, G. (1998). Can the subaltern speak? In
Nelson, C. & Grossberg, L. (Eds.). Marxism and
the interpretation of culture. University of Illinois
Press.
Sousa, V. D. & Rojjanasrirat, W. (2011). Translation,
adaptation and validation of instruments or
scales for use in cross-cultural health care
research: a clear and user-friendly guideline.
Journal of Evaluation in Clinical Practice, 17(2),
-274. doi: 10.1111/j.1365-2753.2010.01434.x
Summerfield, D. (1999). A critique of seven
assumptions behind psychological trauma
programmes in war-affected areas. Social Science
& Medicine, 48(10), 1449-1462. doi: 10.1016/
s0277-9536(98)00450-x
Summerfield, D. (2001). The invention of posttraumatic
stress disorder and the social
usefulness of a psychiatric category. British
Medical Journal, 322(7278), 95-98. doi: 10.1136/
bmj.322.7278.95
Summerfield, D. (2008). How scientifically valid
is the knowledge base of global mental health?
British Medical Journal, 336(7651), 992-994. doi:
1136/bmj.39513.441030.AD
Sveaass, N. (2013). Gross human rights
violations and reparation under international
law: approaching rehabilitation as a
form of reparation, European Journal of
Psychotraumatology, 4. doi: 10.3402/ejpt.
v4i0.17191
UN Committee Against Torture. (2012). General
Comment no.3, 2012: Convention against
Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment: implementation of
article 14 by States parties. 13 December 2012.
https://digitallibrary.un.org/record/740554
Vlaeyen, J. W. S., Wicksell, R. K., Simons, L. E.,
Gentili, C., De, T. K., Tate, R. L., Vohra, S.,
Punja, S., Linton, S. J., Sniehotta, F. F. &
Onghena, P. (2020). From Boulder to Stockholm
in 70 years: Single case experimental designs in
clinical research. The Psychological Record, 70(4),
–670. doi: 10.1007/s40732-020-00402-5
Wampold, B. E. & Brown, G. S. J. (2005). Estimating
variability in outcomes attributable to therapists:
a naturalistic study of outcomes in managed care.
Journal of Consulting & Clinical Psychology, 73(5),
-923. doi: 10.1037/0022-006X.73.5.914
Webb, C. A., DeRubeis, R. J. & Barber, J. P. (2010).
Therapist adherence/competence and treatment
outcome: a meta-analytic review. Journal of
Consulting & Clinical Psychology, 78(2), 200-211.
doi: 10.1037/a0018912
Weiss, W. M., Ugueto, A. M., Mahmooth, Z.,
Murray, L. K., Hall, B. J., Nadison, M. et al.
(2016). Mental health interventions and priorities
for research for adult survivors of torture and
systematic violence: a review of the literature.
Torture, 26(1), 17-45.
Williams, A. C. de C. (2017). Literature reviews are
not all the same. Torture, 27(2), 109-110.
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