Exploring expectations of neurofeedback treatment among trauma-affected refugees

The use of Neurofeedback (NF) to assist individuals in learning to regulate their brain wave activity has shown promising results in reducing symptoms of posttraumatic stress disorder (PSTD). However, few studies have focused on the patients’ understandings of NF and even fewer explore the perspective of refugees. To evaluate NF treatment for trauma-affected refugees by focusing on their expectations and understanding of NF. This qualitative study was a part of a mixed method study carried out at an outpatient mental health centre in Denmark, offering 34 trauma-affected refugees 12 sessions of NF. In this qualitative study, a subsample of seven participants was interviewed. Using in-depth semi-structured interviews, the participants’ thoughts and expectations prior to participating in NF treatment were examined. The analysis was carried out in four steps, using a hermeneutic and phenomenological approach. The analysis resulted in two themes: (1) Rationale and working mechanisms of NF and (2) Motivators for participating in the study. The findings show that NF treatment for trauma affected refugees was challenged by difficulties in communicating the message about the NF equipment capabilities as well as the expected treatment outcome. These challenges included e.g. health professionals’ ability to explain and the participants’ cultural frame of reference. This is consistent with previous research, showing that compared to the native population, the dissemination of health information to refugees is more difficult and comprehensive. Further studies on how to ensure mutual understanding of the content of NF and expected treatment outcome are needed. ClinicalTrials.gov ID: NCT05055037. Retrospectively registered on the 06/07-2021.</p

Additional file 1: of Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial

SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 123 kb

Additional file 1: Table S1. of Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study

Score differences between pre-treatment and post-treatment ratings (rating completers). Overview over the pre-treatment and post-treatment rating scores rating for all patients who have completed a both pre-and post-treatment ratings. (DOCX 23 kb

Additional file 1 of The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*

Additional file 2 of The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

Additional file 2. CONSORT 2010 Flow Diagram

Summary of the sociodemographic characteristics of the sample.

Summary of the sociodemographic characteristics of the sample.</p

Awareness, help-seeking behavior, and treatment received.

Awareness, help-seeking behavior, and treatment received.</p

STROBE checklist.

Most descriptive data on individuals with bipolar disorder originate from high-resource settings. Very little is known about the accessibility and service provision of intensive mental health care to persons living with bipolar disorder in low-resource settings. This information is needed to inform health systems and guide practitioners to improve standard treatment options and access to treatment. This cross-sectional study explored the level of care for outpatients with bipolar disorder and their help-seeking patterns at the two national referral hospitals in Rwanda. The study found that the majority, 93%, of outpatients with bipolar disorder in Rwanda were on prophylactic psychopharmacological treatment, but mainly first-generation antipsychotics and just 3% received lithium treatment. Furthermore, there was a lack of psychosocial intervention; consequently, 44% were not aware that they had bipolar disorder. Moreover, 1 in 5 participants utilized or had previously used traditional medicine. Awareness of own diagnostic status was not associated with educational level or use of traditional medicine. The study’s sample size of 154 patients is relatively small, and the cross-sectional design does not provide causal inferences. The results demonstrate a considerable unmet need for improved mental health care services for individuals with bipolar disorder in Rwanda, including access to optimal medication and psychosocial interventions. Psychoeducation could be a possible starting point for improving the standard of care, informing the individual on their diagnosis and medication while empowering them to engage in their treatment plan.Trial registration: ClinicalTrials.gov NCT04671225. Registered on November 2020.</div

Flow diagram for inclusion and exclusion.

Most descriptive data on individuals with bipolar disorder originate from high-resource settings. Very little is known about the accessibility and service provision of intensive mental health care to persons living with bipolar disorder in low-resource settings. This information is needed to inform health systems and guide practitioners to improve standard treatment options and access to treatment. This cross-sectional study explored the level of care for outpatients with bipolar disorder and their help-seeking patterns at the two national referral hospitals in Rwanda. The study found that the majority, 93%, of outpatients with bipolar disorder in Rwanda were on prophylactic psychopharmacological treatment, but mainly first-generation antipsychotics and just 3% received lithium treatment. Furthermore, there was a lack of psychosocial intervention; consequently, 44% were not aware that they had bipolar disorder. Moreover, 1 in 5 participants utilized or had previously used traditional medicine. Awareness of own diagnostic status was not associated with educational level or use of traditional medicine. The study’s sample size of 154 patients is relatively small, and the cross-sectional design does not provide causal inferences. The results demonstrate a considerable unmet need for improved mental health care services for individuals with bipolar disorder in Rwanda, including access to optimal medication and psychosocial interventions. Psychoeducation could be a possible starting point for improving the standard of care, informing the individual on their diagnosis and medication while empowering them to engage in their treatment plan.Trial registration: ClinicalTrials.gov NCT04671225. Registered on November 2020.</div

Clinical rating scales.

Most descriptive data on individuals with bipolar disorder originate from high-resource settings. Very little is known about the accessibility and service provision of intensive mental health care to persons living with bipolar disorder in low-resource settings. This information is needed to inform health systems and guide practitioners to improve standard treatment options and access to treatment. This cross-sectional study explored the level of care for outpatients with bipolar disorder and their help-seeking patterns at the two national referral hospitals in Rwanda. The study found that the majority, 93%, of outpatients with bipolar disorder in Rwanda were on prophylactic psychopharmacological treatment, but mainly first-generation antipsychotics and just 3% received lithium treatment. Furthermore, there was a lack of psychosocial intervention; consequently, 44% were not aware that they had bipolar disorder. Moreover, 1 in 5 participants utilized or had previously used traditional medicine. Awareness of own diagnostic status was not associated with educational level or use of traditional medicine. The study’s sample size of 154 patients is relatively small, and the cross-sectional design does not provide causal inferences. The results demonstrate a considerable unmet need for improved mental health care services for individuals with bipolar disorder in Rwanda, including access to optimal medication and psychosocial interventions. Psychoeducation could be a possible starting point for improving the standard of care, informing the individual on their diagnosis and medication while empowering them to engage in their treatment plan.Trial registration: ClinicalTrials.gov NCT04671225. Registered on November 2020.</div