Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study

ABSTRACT Background:: Approximately half of all asylum seekers suffer from trauma-related disorders requiring treatment, among them Posttraumatic Stress Disorder (PTSD), depression, anxiety, and somatic symptoms. There is a lack of easily accessible, low-threshold treatments taking the cultural background into account. Culturally Adapted CBT (CA CBT) is a well evaluated, transdiagnostic group intervention for refugees, using psychoeducation, meditation, and Yoga-like exercises. Objective: An uncontrolled pilot study with male Farsi-speaking refugees from Afghanistan and Iran was conducted to investigate feasibility with this ethnic group; a group for which no previous CBT trials have been reported. Method: The participants were nine Farsi-speaking, male refugees with M.I.N.I./DSM-IV diagnoses comprising PTSD, major depressive disorder, and anxiety disorders. Treatment components were adapted to the specific cultural framework of perception of symptoms, causes, ideas of healing, and local therapeutic processes. Before and after 12 weeks of treatment, the primary outcome was assessed using the General Health Questionnaire (GHQ-28). Secondary outcome measures were the Posttraumatic Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Affective Style Questionnaire (ASQ), and Emotion Regulation Scale (ERS). Results:: Seven participants completed treatment. In the completer analysis, improvements were found on almost all questionnaires. Large effect sizes were seen for the GHQ-28 (d = 2.0), WHOQOL-BREF scales (d = 1.0–2.3), ASQ tolerating subscale (d = 2.2), and ERS (d = 1.7). With respect to feasibility, cultural adaptation seemed to be a crucial means to promote effectiveness. Conclusion:: CA CBT may reduce general psychopathological distress and improve quality of life. Improvement in emotion regulation strategies may mediate treatment effects. More support should be provided to enhance coping with the uncertainty of asylum status and stressful housing conditions. CA CBT appears to be a promising transdiagnostic treatment, serving as an initial low-threshold therapy in a stepped care approach

Provision of mental health services in resource-poor settings: a randomised trial comparing counselling with routine medical treatment in North Afghanistan (Mazar-e-Sharif)

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan).</p> <p>Methods</p> <p>Help seeking Afghan women (N = 61), who were diagnosed with mental health symptoms by local physicians either received routine medical treatment<b/>(treatment as usual) or psychosocial counselling (5-8 sessions) following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms.</p> <p>Results</p> <p>At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment.</p> <p>Conclusion</p> <p>These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01155687">NCT01155687</a></p

Mental Health Consequences of War, Internal Conflict and Disrupting Living Conditions : The Case of Afghanistan

The Soviet occupation, the reign of terror under the Taliban and the armed conflict since 2001 have deeply scarred the Afghan nation and its people. The majority of Afghans face a set of permanent stressors and have to deal with painful and burdensome experiences and losses which often elicit somatic and psychosocial symptoms. At the same time, Afghan men and women almost invariably lack awareness and conceptual knowledge of psychological processes. In particular, the mental health consequences of stressful living conditions and traumatic memories, which they experience as being etched into their body, mind and soul, are unconscious to them. This condition evokes a feeling of helplessness in the people. Until recently, the Afghan public health system did not provide any mental health services. The population also did not receive any support in coping with the resource poor living conditions. In consequence, the breeding ground for further conflicts within families and the society grew.This situation served as the starting point of the present doctoral thesis. The research project aimed to systematically investigate the psychosocial consequences of living in an area of war and crisis by using the example of Afghanistan. For this purpose, it covers Afghans who still live in the burdensome living conditions of their home country and Afghans who decided to escape the situation and managed to flee to Germany in order to start a new life there. Furthermore, the doctoral thesis investigates in a randomised trial the efficacy of a psychosocial counselling approach which has recently been integrated into the Afghan public health system.The studies conducted in Afghanistan point out the high prevalence of mental health problems within the population. In particular, high rates of symptoms of depression and anxiety were found. The interviewed Afghan women reported a number of psychosocial stressors, such as poverty, domestic violence and family conflicts. The daily real fear as well as the insecurity and uncontrollability of the present situation often led to a traumatic stress reaction, which was delineated from the classic notion of PTSD. This sparked the idea of developing the concept of a “continuous traumatic stress” situation, which takes into consideration the time variable.The randomised trial investigating the efficacy of psychosocial counselling conducted in a health facility in Northern Afghanistan showed a significant reduction of mental health symptoms and psychosocial stressors in counselled Afghan women.A further study assessing the mental health status of asylum-seekers and refugees in Germany who had experienced the war in Afghanistan showed lower rates of symptoms of depression and anxiety. The participants in Germany reported less and different psychosocial stressors than people assessed in Afghanistan. Remarkably, Afghan women living in Germany reported significantly lower rates of domestic violence than those being interviewed in Afghanistan. At the same time, the study showed that Afghan men and women who live in Germany perceive the immigration process as exceedingly stressful.In sum, the present doctoral thesis demonstrates that the support of the Afghan health system plays a vital role in building up a civil society. The studies showed that the access to a qualified and profound mental health service is a precondition for regaining psychological functioning, coping with painful experiences and finally establishing healthy relationships within the family and the community