A group-based approach to stabilisation and symptom management in a phased treatment model for refugees and asylum seekers

BACKGROUND: Traumatised asylum seekers and refugees may present with significant and complex mental health problems as a result of prolonged, extreme, and multiple traumatic events. This is further complicated by ongoing complex social circumstances. CONCEPTS: In our work at the Traumatic Stress Clinic (TSC), the understanding afforded by the concept of complex posttraumatic stress disorder (PTSD) together with the related notion of a phased treatment model, provides a useful framework for organising our work with this population. CLINICAL APPLICATIONS: An explication of complex PTSD as it applies to our client group is presented, followed by a description of our phased treatment model and an outline of the core principles, which guide our clinical approach. Our symptom management and stabilisation groups have been developed and refined over time and draw on techniques from a variety of cognitive behavioural therapies. These are described in some detail with illustrative clinical case vignettes. CONCLUSION: This paper concludes with some reflections on the challenges inherent to working with this complex client group

Mental health and conflict:a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women

Background: The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists. Purpose: To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD).Methods: 83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy.Results: PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment.Conclusion: In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained

Exploring the sense of Coherence and Coping Strategies of Therapists and their impact on Working Alliance and Therapeutic Outcome

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Can sense of coherence predict therapeutic outcome of a brief guided self-help intervention?

Background: The construct sense of coherence (SOC) is proposed to explain the variation in the way people cope and it has been linked with positive mental health. Evidence suggests that level of SOC may be able to predict therapeutic outcome. There is a lack of evidence regarding individual predictors for treatment response of guided self-help services. Therefore, SOC is an important construct to consider. Objectives: The purpose of this study was to investigate whether a client’s sense of coherence at the start of a guided self-help intervention could predict their therapeutic outcome. The possibility that coping style mediated this relationship was also examined. Method: The study employed a longitudinal survey design. Participants were patients aged 30-64 years attending a guided self-help service for mild-moderate psychological difficulties. Participant data was collected pre and post intervention (3 weeks to 3 months after initial appointment). Results: A significant negative association was found between SOC and pre intervention anxiety and depression scores. No significant relationship was found between SOC and post intervention anxiety and depression scores (therapeutic outcome). Multiple regression analysis found that sense of coherence and coping style were not significant predictors of therapeutic outcome. Conclusions: It is important to determine the causality of SOC’s relationship with mental health because if SOC can be influenced via psychological intervention this may promote positive mental health and effective coping. Therefore, further research is required to determine if SOC has clinical application.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study

Objective We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD). Methods We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded. Results Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = −3.99, p < 0.001], depressive symptoms [t(58) = −4.41, p < 0.001], functional impairment [t(58) = −2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment. Conclusions This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.</p