Cultural concepts of distress and complex PTSD: Future directions for research and treatment

Complex post-traumatic stress disorder (CPTSD) was introduced as a new diagnostic category in ICD-11. It encompasses PTSD symptoms along with disturbances in self-organisation (DSO), i.e., affect dysregulation, negative self-concept, and disturbances in relationships. Quantitative research supports the validity of CPTSD across different cultural groups. At the same time, evidence reveals cultural variation in the phenomenology of PTSD, which most likely translates into cultural variation with regard to DSO. This theoretical review aims to set the ground for future research on such cultural aspects in the DSO. It provides a theoretical introduction to cultural clinical psychology, followed by a summary of evidence on cultural research related to PTSD and DSO. This evidence suggests that the way how DSO symptoms manifest, and the underlying etiological processes, are closely intertwined with cultural notions of the self, emotions, and interpersonal relationships and interpersonal relationships. We propose directions for future research and implications for culturally sensitive clinical practice

Metaphors and Related Expressions in Older Adults in the Field of Trauma and Stress-related Disorders: A Scoping Review

A scoping review was conducted to explore the metaphors and related expressions older adults use to describe extremely stressful events that may lead to Post-Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Prolonged Grief Disorder (PGD), or Adjustment Disorder (AjD). Relevant databases from psychology, gerontology, and related fields were searched. In addition, relevant references found in included papers were considered. Inclusion criteria were: qualitative study, sample of older adults (age 65+), and focus on maladaptive rather than adaptive psychological aspects. Eleven studies focusing on PTSD, 5 on CPTSD, 13 on PGD, and 10 on AjD were included. Metaphors and other expressions related to extremely stressful events were then extracted and analyzed. Multiple linguistic expressions to describe extremely stressful events and stress-related symptoms were identified. Metaphors and related expressions often referred to the body and the theme of moving on with one’s life

Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework

Background: The worldwide mental health treatment gap calls for scaling-up psychological interventions, which requires effective implementation in diverse cultural settings. Evidence from the field of global mental health and cultural clinical psychology indicates cultural variation in how symptoms of common mental disorders are expressed, and how culturally diverse groups explain the emergence of such symptoms. An increasing number of studies have examined to what extent cultural adaptation enhances the acceptability and effectiveness of psychological interventions among culturally diverse groups. To date, this evidence is inconclusive, and there is a lack of studies that dismantle the multiple types of modifications involved in cultural adaptation. Method: Based on empirical evidence from ethnopsychological studies, cultural adaptation research, and psychotherapy research, the present paper offers a new conceptual framework for cultural adaptation that lays the groundwork for future empirical research. Results: The cultural adaptation framework encompasses three elements: i) cultural concepts of distress; ii) treatment components; and iii) treatment delivery. These three elements have been discussed in literature but rarely tested in methodologically rigorous studies. Innovative research designs are needed to empirically test the relevance of these adaptation elements, to better understand the substantial modifications that enhance acceptability and effectiveness of psychological interventions. Conclusion: Using a theory-driven approach and innovative experimental designs, research on cultural adaptation has the potential not only to make psychological treatments more accessible for culturally adverse groups, but also to further advance empirical research on the basic question about the “key ingredients” of psychotherapy

Culturally sensitive grief interventions: a scoping review protocol

Objective: The objective of this scoping review is to understand the extent and type of evidence in relation to culturally sensitive interventions for bereaved individuals. A particular aim is to inform future research on the development of grief interventions. Introduction: Prolonged grief disorder is associated with a range of negative psychosocial consequences, making treatment crucial for affected individuals. Culture plays a large role in the expression of grief, mourning rituals and practices or the meaning of and beliefs about death. Although there is growing interest in culturally sensitive interventions for grief, the current literature lacks a comprehensive synthesis of evidence. A scoping review is considered appropriate to fill this gap. Inclusion criteria: This review will include sources with participants having experienced bereavement following the loss of a loved one and having taken part in a culturally sensitive psychosocial grief intervention. Studies conducted in non-WEIRD (Western, Educated, Industrialized, Rich, Democratic) contexts or studies targeting a cultural or subcultural group outside the majority group (regarding age, religion, sexual orientation, etc.) will be included. Methods: This review will be conducted following the JBI methodology for scoping reviews. Searches will be conducted in 11 databases (Scopus, Embase, Cochrane, Sociological Abstracts, IBSS, PTSDpubs, PsycINFO, MEDLINE, CINAHL, SocINDEX and Web of Science). Limits include language (English and German) and publication date (from 2000). The two-step screening process (titles and abstracts, full text) will be piloted, data extracted and collated. Results from the data extraction will be presented in a narrative summary and tabular form

PTSD and complex PTSD manifestations in Sub-Saharan Africa: A systematic review of qualitative literature

Complex post-traumatic stress disorder (CPTSD) was introduced in the ICD-11 as a new diagnosis and was framed in accordance with WHO guidelines of clinical utility and cross-cultural applicability. CPTSD diagnosis comprises PTSD symptoms in addition to specific symptoms related to the organization of the self (DSO). Cross-cultural validity of the DSO symptoms is still being debated as cultural norms significantly influence how individuals perceive themselves and manage their emotions and relationships. The aim of this systematic review was to understand how PTSD and DSO symptoms were experienced and expressed by individuals from Sub-Saharan Africa (SSA) by exploring qualitative literature. Searches were conducted on nine databases using search terms for countries, methods, symptoms, and trauma exposure. Fifty studies were included. Results confirmed the presence of the three DSO clusters. However, their manifestation differed significantly from the defined diagnostic criteria, highlighting the importance of considering cultural factors in the diagnostic process. Additionally, the review indicated that structural factors played significant roles in shaping the interpretation of traumarelated distress in this cultural context. Thus, we propose to create and implement a cultural module as an add on to the actual CPTSD assessment tools to account for cultural and structural variations in the SSA population and improve diagnosis accuracy. In this perspective, more emic research is needed to gain a deeper understanding of how trauma-related distress is perceived, experienced, and interpreted in SSA

Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study

Objectives: Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland. Methods: Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software. Findings: Study participants showed bicultural identities, which caused value conflicts and a feeling of being “caught” between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism. Conclusion: Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy

Culturally sensitive grief treatment and support: A scoping review

Objective The goal of this scoping review was to assess the scope and nature of evidence concerning culturally sensitive grief treatment and support interventions, aiming to provide valuable insights for future research on grief intervention development. Introduction Prolonged grief disorder (PGD), associated with adverse psychosocial outcomes, requires treatment. The norms of a person’s culture influence grief expression, mourning rituals, and perspectives on death. Despite increasing interest in culturally sensitive grief interventions, a comprehensive synthesis of evidence is lacking. A scoping review was deemed fitting to address this gap. Inclusion criteria This review included studies featuring participants experiencing clinically relevant grief and engaged in culturally sensitive psychosocial grief interventions. It included studies conducted in non-WEIRD contexts or those focusing on sociocultural (sub)groups distinct from the majority (in terms of age, religion, sexual orientation, etc). Methods Following JBI methodology for scoping reviews, 13 databases were searched (Scopus, Embase, Cochrane, Sociological Abstracts, IBSS, PTSDpubs, PsycINFO, PsycArticles, PSYNDEX, MEDLINE, CINAHL, SocINDEX, and Web of Science). Limits included language (English and German), peer-reviewed articles and publication date (from 2000). The two-step screening process (titles and abstracts, full text) was piloted, and data were extracted and collated. Results Eighteen studies were included, displaying diversity in geographical location, methodology, and target populations. Interventions targeted various forms of clinically relevant grief, lost relationships, and sociocultural groups. Cultural adaptation processes varied, with seven studies using a top-down approach. Sources of information for formative research involved theoretical models and empirical data, while local experts and qualitative research (e.g., key informant interviews) informed cultural adaptation. Outcome measures were diverse, with 15 studies showing significant pre-post intervention changes, while two did not. Conclusions The review highlighted the emerging significance of culturally sensitive interventions for PGD, emphasizing the need for standardized approaches and further research. By shedding light on gaps and providing recommendations, it offers insights for future researchers in this field

Feasibility, acceptability, and preliminary efficacy of an internet-based CBT intervention for loneliness in older adults: A pilot RCT

Background Older adults are an important target group for loneliness interventions. However, most existing interventions aimed at older individuals do not focus on the strategy that has proven most effective (i.e., modifying maladaptive social cognition). Additionally, given the low mental health service use in this population, innovative treatment approaches are needed in order to provide support to this age cohort. The aim of the current study was to investigate the feasibility, acceptability, and preliminary efficacy of a newly developed internet-based cognitive behavioral therapy intervention for loneliness in older individuals using a pilot randomized controlled trial (RCT). Methods In the current study N = 36 older adults aged between 65 and 87 years were randomly assigned to either a 7-week internet-based intervention or a wait-list condition. Treatment satisfaction, usability, attrition, and adherence were assessed as indicators for feasibility and acceptability. To investigate preliminary treatment effects, measures on loneliness, depression, anxiety, self-efficacy, and life-satisfaction were administered. Results Overall, the intervention program was found to be acceptable and feasible. No significant difference between conditions on loneliness were observed; however, results indicated a trend towards lower reported loneliness levels in the treatment compared to the control group. Regarding secondary outcomes, results pointed at age-specific treatment effects, such that improvements on depression, anxiety, and life satisfaction were observed in the young-old, but not old-old adults in our sample. Limitations The sample was small and no follow-up assessment was included. Conclusions An internet-based CBT intervention for loneliness seems to be feasible and acceptable in older individuals

Caseness and comorbidity of probable (complex) post-traumatic stress disorder and depression in survivors of genocide against Tutsi in Rwanda: the role of social determinants

<jats:p> Numerous studies have been conducted among survivors of the genocide against the Tutsi on the prevalence of depression and post-traumatic stress disorder. However, thus far, no studies provide information on the frequency of comorbidity of these disorders, the prevalence of the new trauma-related diagnostic disorder known as complex post-traumatic stress disorder, and the role of social determinants, such as age, sex, marital status, employment category, education, and location, in the occurrence of these disorders. The present study was conducted to address these gaps. Genocide survivors ( N = 261 participants; M = 46.30, SD = 11.95, females = 52.9%) took part in the study. They completed the International Trauma Questionnaire, the Public Health Depression Questionnaire, and the Harvard Trauma Questionnaire. Descriptive statistical analyses, bivariate analyses with two-tailed chi-square tests, and logistic regression were used to determine the prevalence of the above-mentioned disorders, comorbidity, and the associations between the social determinants and the assessed psychopathologies. Of the total sample, 47.1% presented with at least one of the assessed probable mental health disorders: 15.3% ( n = 40) met the criteria for probable post-traumatic stress disorder, 15.3% ( n = 40) for probable complex post-traumatic stress disorder, and 38.7% ( n = 101) for probable depression. Of the participants with probable post-traumatic stress disorder and complex post-traumatic stress disorder, nearly half met the criteria for probable depression. Being married but not living with the partner was associated with probable complex post-traumatic stress disorder, and unemployment was associated with probable depression. Our findings suggest clinicians and policymakers that they should consider comorbidity and social determinants in their interventions. </jats:p&gt

Caseness and comorbidity of probable (complex) post-traumatic stress disorder and depression in survivors of genocide against Tutsi in Rwanda: the role of social determinants

Numerous studies have been conducted among survivors of the genocide against the Tutsi on the prevalence of depression and post-traumatic stress disorder. However, thus far, no studies provide information on the frequency of comorbidity of these disorders, the prevalence of the new trauma-related diagnostic disorder known as complex post-traumatic stress disorder, and the role of social determinants, such as age, sex, marital status, employment category, education, and location, in the occurrence of these disorders. The present study was conducted to address these gaps. Genocide survivors ( N = 261 participants; M = 46.30, SD = 11.95, females = 52.9%) took part in the study. They completed the International Trauma Questionnaire, the Public Health Depression Questionnaire, and the Harvard Trauma Questionnaire. Descriptive statistical analyses, bivariate analyses with two-tailed chi-square tests, and logistic regression were used to determine the prevalence of the above-mentioned disorders, comorbidity, and the associations between the social determinants and the assessed psychopathologies. Of the total sample, 47.1% presented with at least one of the assessed probable mental health disorders: 15.3% ( n = 40) met the criteria for probable post-traumatic stress disorder, 15.3% ( n = 40) for probable complex post-traumatic stress disorder, and 38.7% ( n = 101) for probable depression. Of the participants with probable post-traumatic stress disorder and complex post-traumatic stress disorder, nearly half met the criteria for probable depression. Being married but not living with the partner was associated with probable complex post-traumatic stress disorder, and unemployment was associated with probable depression. Our findings suggest to clinicians and policymakers that they should consider comorbidity and social determinants in their interventions