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

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

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-organization (DSO), i.e., affect dysregulation, negative self-concept, and disturbances in relationships. Quantitative, etic research, which applies the same constructs and measures across cultural groups from an “outsider” perspective, supports the cross-cultural validity of CPTSD. At the same time, evidence from qualitative, emic research, which takes the viewpoint of the “insider,” reveals cultural variation in the phenomenology of PTSD, which most likely translates into cultural variation regarding DSO. This theoretical review aims to set the ground for future research on such cultural aspects in the DSO, by proposing a balanced, complementary use of etic and emic research. Evidence from etic and emic research related to PTSD and DSO suggests that the way that DSO symptoms manifest, and the underlying etiological processes, are closely intertwined with cultural notions of the self. We argue that it is important to consider potential variations in normative cultural scripts related to the self, emotion regulation and interpersonal relationships across cultures to better understand how DSO symptomatology deviates from such normative scripts. We propose directions for future research and implications for culturally sensitive clinical practice

Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial

People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact