Building Resilience through Culturally Grounded Practices in Clinical Psychology and Higher Education

There is no “one size fits all” approach when it comes to the process of healing, particularly for individuals who are continuously affected by the many barriers and impacts of systemic oppres- sion. This reality demands the sustained development of a praxis rooted in trauma-informed and culturally grounded care so that we may better serve our most-impacted communities (such as Black, Indigenous and People of Color [BIPOC], disability, queer, and survivor communities). As practitioners in the fields of Clinical Psychology and Higher Education, we engage in cross-disciplinary analysis so that we may amplify and share our tools for collective healing. We highlight the importance of sup- porting client and student development through multisystemic and resilience-oriented frameworks. Specifically, we discuss the implications of the Minority Stress Model (Meyer, 2003) and Bronfenbrenner’s Ecological Systems Theory (1979) in serving our communities more effectively to enhance positive clinical and academic outcomes

Identifying resilience-promoting factors for refugee survivors of torture

Introduction: There are 1.3 million refugee survivors of torture currently living in the United States today. While a substantial body of research has been growing on refugee mental health, few studies have focused on refugee resilience. Objective: The current study focuses on a clinical sample of refugee survivors of torture to examine resilience-promoting factors, including community engagement, employment, English fluency, and psychological flexibility. Specifically, our study conducted moderation and mediation analyses to better understand how these resilience-promoting factors impact the torture-mental health relationship. Results: Findings showed that torture severity was significantly and positively associated with all mental health symptoms, and psychological flexibility was significantly and negatively associated with all mental health symptoms, including PTSD, depression, and anxiety. Psychological flexibility also emerged as a significant mediator of the torture-mental health relationship, such that individuals with a history of greater torture severity reported higher mental health symptoms via lower psychological flexibility. Additionally, English fluency and employment, but not community engagement, showed significant negative correlations with mental health symptoms. However, resilience-promoting factors did not interact with torture severity to predict mental health symptoms. Conclusion: The findings from this study identified variables that may have a meaningful impact on the mental health of refugee survivors of torture and provide insights and implications in treating this population from resilience-oriented clinical frameworks.    

HE ROLE OF ZIC1 IN CRANIAL SUTURE FORMATION

The zic1 gene plays an important role in embryonic development, in part by regulating the expression of many other genes including the engrailed gene. Previous investigators have reported that abnormal engrailed expression shifts the location of cranial suture formation and affects gene expression in the developing sutures (Deckelbaum et al. 2012). Such defects may cause a premature fusion of cranial sutures, leading to a serious birth defect known as craniosynostosis. Dr. Andrew Wilkie (Oxford University) has found that mutations in the human ZIC1 gene cause craniosynostosis.  He hypothesizes that the engrailed gene is abnormally regulated in patients with these ZIC1 mutations. In collaboration with the Wilkie lab, we are testing this hypothesis by injecting RNA derived from the human ZIC1 mutants into Xenopus frog embryos. The goal of our experiments is to observe whether the mutated human ZIC1 genes affect the expression of the engrailed gene in frog embryos, which we were able to show by in situ hybridization.  The degree of abnormality of engrailed expression caused by the various human ZIC1 mutations corresponds to the severity of the patients’ phenotypes. These findings provide a better understanding of the molecular mechanisms underlying craniosynostosis and suggest possible gene regulatory pathways

Types of Torture as a Predictor of PTSD Symptomology

Background and Purpose/Objectives: Among refugees diagnosed with post-traumatic stress disorder (PTSD), previous exposure to torturehas been found to be the strongest predictor of symptoms related to PTSD (Steel et al., 2009). Several studies have shown the relationship between torture type and psychopathology, such that sexual abuse has been particularly associated with higher rates of PTSD in refugee and non-refugee samples (Hooberman et al., 2011; Kira et al., 2013; Gaskell, 2005). To investigate such findings, we hypothesized that in our clinical sample, refugee torture survivors who have experienced sexual trauma/rape would display a greater risk of PTSD in comparison to those with different types of torture experiences. Methodology:Participants included 170 refugee torture survivors seen at a U.S. Northeastern outpatient clinic. As part of a larger study, measures included a demographic questionnaire assessing torture experiences and the Harvard Trauma Questionnaire (HTQ). Results:Logistic regression was performed using different torture categories to evaluate the independent association of each torture variable with risk for meeting a PTSD-related clinical cutoff score. We found that accounting for the other torture categories experienced, psychological torture significantly predicted meeting PTSD cutoff criteria, OR = 3.79, p = .008, 95% CI [1.42, 10.08]. Discussion: Contrary to the existing literature, our results highlight the impact of psychological torture in refugee patients seeking services at a mental health clinic. We will present on the importance of providing culturally sensitive and responsive PTSD assessments and treatments to those who have experienced different types of torture

Trauma And Resilience Mechanisms During Political Violence: Survivors Of The 2021 Military Coup In Myanmar

According to the United Nations (2023), global armed conflicts and violence are rising, the highest on record since World War II. In the context of political violence, how can we understand trauma reactions and resilience through a culturally-sensitive lens? The current study addressed this question by examining Myanmar trauma survivors of the 2021 coup d’etat. We followed the World Health Organization (WHO)’s forward-backward translation guidelines in designing this mixed-methods study and established community-based partnerships for sample recruitment in Myanmar (Robine & Jagger, 2003). The existing literature demonstrates a strong relationship between the degree of exposure to political violence and the likelihood of developing psychopathology including post-traumatic stress disorder (PTSD), anxiety, depression, and alcohol use (Al-Krenawi & Graham, 2012; Braun-Lewensohn et al., 2009). While political violence increases the risk of mental health problems, research also suggests that survivors exhibit remarkable resilience amid humanitarian crises (Jordans et al., 2007; Pedersen, 2002; Pettigrew, 2004). In this research, we examined trauma as well as resilience mechanisms through a clinical framework (using gold-standard quantitative psychological questionnaires) and a sociocultural lens applied to qualitative data (i.e.., a hybrid deductive and inductive analysis of open-ended responses). Our analyses explored gender differences in psychological symptoms, illustrated the dose-response relationship between trauma and psychopathology, and highlighted the moderating role of resilience in the significant association of PTSD and alcohol use. Findings showed that women participants reported greater internalizing symptoms (PTSD, depression, and anxiety) while men reported greater alcohol use. Alongside these expressions, we observed a significant dose-response relationship of trauma and psychopathology: greater trauma correlated with stronger PTSD (r[178] = .37, p \u3c .001) and increased alcohol use (r[178] = .22, p \u3c .001). Higher PTSD also predicted more pronounced comorbidity with depression, anxiety, and alcohol use (r[178] = .45, .36, .24, p \u3c .001).The interaction term between PTSD symptoms and resilience in predicting alcohol use was significant, B = –0.16, SE = 0.07, t(169) = –2.48, p = .013, suggesting that as resilience increased, the relationship between PTSD symptoms and alcohol use weakened. We also identified Myanmar participants’ unique cultural expressions of distress regarding trauma reactions (e.g., “burning rage”) and contextually meaningful sources of resilience (e.g., “political commitment”). Both psychological and cultural considerations were included to highlight clinical, research, and policy implications of studying underserved global communities, such as Myanmar survivors

Testing Resilience as a Moderator of the Torture-Mental Health Relationship in Refugee Survivors of Torture

There may be as many as 1.3 million refugee survivors of torture currently living in the United States (Center for Victims of Torture, 2015). Torture is a unique predictor of various debilitating mental health conditions including post-traumatic stress disorder (PTSD), depression, and anxiety (Quiroga & Jaranson, 2005). The current study focuses on a clinical sample of refugee survivors of torture to examine resilience-promoting factors including external protective factors, community engagement, employment, and English fluency, and an internal protective factor, psychological flexibility. This study conducted moderation analyses utilizing the PROCESS program in SPSS (Hayes, 2013) to better understand the moderating impacts of resilience-promoting factors on the torture-mental health relationship. Findings showed that torture severity was significantly and positively associated with all mental health symptoms including PTSD, depression, and anxiety. For all models of mental health symptoms, psychological flexibility was revealed as a significant and negative predictor, which provides clinical utility. Additionally, English fluency and employment, but not community engagement, were significantly and negatively associated with mental health symptoms. There were no significant interaction effects observed in the study. Overall, the results from the present study identified variables that may have a meaningful impact on the mental health of refugee survivors of torture, and these findings provide future insights and implications in treating this patient population from the strengths-based and resilience-oriented clinical frameworks

Practitioners’ perspectives on barriers and benefits of telemental health services: The unique impact of COVID-19 on resettled U.S. Refugees and asylees

The COVID-19 pandemic and associated sequelae have disproportionately exacerbated refugee mental health due to health disparities, poverty, and unique risk factors. In response to the pandemic, most mental health providers have shifted to virtual platforms. Given the high need for services in this population, it is essential to understand the effectiveness and potential barriers to serving refugees via telehealth. This study is one of the first to examine the extent that socio-cultural and structural barriers impact telemental health services received by resettled refugees during the COVID-19 pandemic. This study also addresses the potential benefits of telemental health service delivery to refugees. We surveyed 85 providers serving refugee and non-refugee clients in the United States. Statistical analyses revealed that more significant socio-cultural and structural barriers, including access to technology, linguistic challenges, and privacy limitations, exist for refugees compared to non-refugee clients. Potential benefits of telemental health for refugees during the pandemic included fewer cancellations, fewer transportation concerns, and better access to childcare. These results highlight the need to address the disparity in telemental health service delivery to refugees to limit inequities for this population.</p