A systematic review of naturalistic interventions in refugee populations

Naturalistic interventions with refugee populations examine outcomes following mental health interventions in existing refugee service organisations. The current review aimed to examine outcomes of naturalistic interventions and quality of the naturalistic intervention literature in refugee populations with the view to highlight the strengths and limitations of naturalistic intervention studies. Database search was conducted using the search terms ‘refugee’, ‘asylum seeker’, ‘treatment’, ‘therapy’ and ‘intervention. No date limitations were applied, but searches were limited to articles written in English. Seven studies were identified that assessed the outcome of naturalistic interventions on adult refugees or asylum seekers in a country of resettlement using quantitative outcome measures. Results showed significant variation in the outcomes of naturalistic intervention studies, with a trend towards showing decreased symptomatology at post-intervention. However, conclusions are limited by methodological problems of the studies reviewed, particularly poor documentation of intervention methods and lack of control in the design of naturalistic intervention studies. Further examination of outcomes following naturalistic interventions is needed with studies which focus on increasing the rigour of the outcome assessment process

If You Want to Go Fast Go Alone, If You Want to Go Far Go Together: On Context-Sensitive Group Treatment of Asylum Seekers and Refugees Traumatized by War and Terror

This thesis presents a model for understanding psychological consequences of exposure to war, torture and political violence in asylum seekers and refugees. This contextual, developmental, and culture-sensitive model is based on theoretical and empirical findings and implies framing and interpreting of life events in “the ecological environment” and throughout the life-span of a survivor. The model investigates into both sources of damage and resilience in traumatized individuals in order to frame posttraumatic impacts in a comprehensive way. Based on this model, a group treatment approach aiming at helping asylum seekers and refugees with impacts of psychological trauma and resettlement stress has been designed and applied throughout 12 years. This group treatment is phase-based and trauma-focused, it combines group psychotherapy with non-verbal therapies (psychomotor therapy, art therapy, and music therapy), it is executed within a day treatment setting, and lasts for 1 year. The approach does not exclusively focus on treatment of posttraumatic stress disorder (PTSD) and other co-morbid axis I and II disorders, but includes interventions targeting damaged core-beliefs, guilt, shame, grief, marital and systemic problems, legal issues due to procedure of seeking asylum, and other resettlement stressors. The outcome studies presented in this thesis suggest that this group treatment approach improves mental health of asylum seekers and refugees with PTSD, both on the short and on longer terms. The PTSD, anxiety, and depression symptoms are reduced upon completion of the treatment. The trend of reduction of the examined psychopathology continues up to five years after the treatment. Over an even longer period of time, up to seven years, the treatment gains are maintained but reduced in strength. Both asylum seekers and refugees can benefit from the applied group treatment,irrespective of the absence of stable living arrangements. However, positive changes in the resettlement context lead to more favorable treatment outcomes. Asylum seekers who are granted a permanent refugee status during the treatment show larger symptom reductions upon termination of the treatment than the patients whose legal status did not change in the course of the treatment

If You Want to Go Fast Go Alone, If You Want to Go Far Go Together: On Context-Sensitive Group Treatment of Asylum Seekers and Refugees Traumatized by War and Terror

This thesis presents a model for understanding psychological consequences of exposure to war, torture and political violence in asylum seekers and refugees. This contextual, developmental, and culture-sensitive model is based on theoretical and empirical findings and implies framing and interpreting of life events in “the ecological environment” and throughout the life-span of a survivor. The model investigates into both sources of damage and resilience in traumatized individuals in order to frame posttraumatic impacts in a comprehensive way. Based on this model, a group treatment approach aiming at helping asylum seekers and refugees with impacts of psychological trauma and resettlement stress has been designed and applied throughout 12 years. This group treatment is phase-based and trauma-focused, it combines group psychotherapy with non-verbal therapies (psychomotor therapy, art therapy, and music therapy), it is executed within a day treatment setting, and lasts for 1 year. The approach does not exclusively focus on treatment of posttraumatic stress disorder (PTSD) and other co-morbid axis I and II disorders, but includes interventions targeting damaged core-beliefs, guilt, shame, grief, marital and systemic problems, legal issues due to procedure of seeking asylum, and other resettlement stressors. The outcome studies presented in this thesis suggest that this group treatment approach improves mental health of asylum seekers and refugees with PTSD, both on the short and on longer terms. The PTSD, anxiety, and depression symptoms are reduced upon completion of the treatment. The trend of reduction of the examined psychopathology continues up to five years after the treatment. Over an even longer period of time, up to seven years, the treatment gains are maintained but reduced in strength. Both asylum seekers and refugees can benefit from the applied group treatment,irrespective of the absence of stable living arrangements. However, positive changes in the resettlement context lead to more favorable treatment outcomes. Asylum seekers who are granted a permanent refugee status during the treatment show larger symptom reductions upon termination of the treatment than the patients whose legal status did not change in the course of the treatment

Seven-Year Follow-Up Study of Symptoms in Asylum Seekers and Refugees With PTSD Treated With Trauma-Focused Groups

Objective To examine sustainability of symptom outcomes of a 1-year phase-based trauma-focused, multimodal, and multicomponent group therapy in a day treatment program for posttraumatic stress disorder (PTSD) over an average period of 7 years. Method Iranian and Afghan patients (N = 69) were assessed with self-rated symptom checklists for PTSD, anxiety, and depression symptoms before (T1), after (T2), and up to 11 years upon completion of the treatment (T3). A series of mixed model regression analyses was applied to determine the course of the measured symptoms over time. Results At T2, all symptoms were reduced, but PTSD symptoms showed the strongest reduction. The trend of symptom reduction continued up to 5 years posttreatment and was similar for all the examined symptoms. After 5 years, all symptoms started to worsen, but remained under baseline levels at T3. Conclusions The applied treatment appears to improve mental health of the studied sample on both the short and longer term

Group Therapy With Male Asylum Seekers and Refugees With Posttraumatic Stress Disorder A Controlled Comparison Cohort Study of Three Day-Treatment Programs

Studies on group treatment of posttraumatic stress disorder (PTSD) in asylum seekers and refugees are scarce. The aim of this study was to evaluate the effectiveness of three different trauma-focused day-treatment group programs for treatment of PTSD in male asylum seekers and refugees. Three treatment groups (n = 56) and a waitlisted control group (n = 16) of help-seeking Iranian and Afghani patients were assessed with a set of self-rated symptom checklists for PTSD, anxiety, depression, and psychoticism 1 week before and 2 weeks after treatment. There are no indications that the 2 days' group program with three nonverbal and two group psychotherapy sessions per week is less effective in reducing symptoms than the program with the same amount of sessions spread over 3 days per week. The trauma-focused day-treatment group seems a promising approach for treatment of PTSD among asylum seekers and refugees in industrialized settings

Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan

Background The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. Methods In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. Results The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. Conclusion In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms