Torture survivors’ symptom load compared to chronic pain and psychiatric in-patients

Before their entry into the rehabilitation program at the Rehabilitation and Research Centre for Torture Victims (‘RCT’) in Copenhagen, the degree of symptoms of a group of resettled traumatized refugees was assessed by means of two rating scales: the Disability Rating Index (DRI) (n=197), measuring pain-related functional disability, and the Hospital Anxiety and Depression Scale (HADS) (n=147). The results obtained were compared with other patient populations, which included (1) a large Swedish mixed pain group and (2) various groups of pain patients previously investigated in the validation study of the DRI scale. The DRI scores of the refugee group were comparable to, or higher than, those of the pain groups, except for patients suffering from multiple sclerosis. The degree of anxiety and depression was found to be considerably greater in the refugee group than in the pain groups. Another recently published Danish study comparing traumatized refugees with psychiatric in-patients in terms of Health of Nation Outcome Scores (HoNOS) documented a higher degree of psychiatric disability for refugees. Based on the hypothesis that the observed differences in this study were underestimated due to the exclusion of refugees with psychotic symptoms and substance abuse, a partial re-analysis of the data was carried out by calculating effect sizes with and without the items measuring these symptoms. Controlling for the exclusion of the critical items resulted in a more pronounced difference between the refugees and psychiatric inpatients. Based on the data compared in this study, traumatized refugees are shown to suffer from multiple problems, including chronic pain, at a high symptom-level. This challenges prior clinical assumptions that single factors like PTSD can explain all symptoms

Education as Treatment for Chronic Pain in Survivors of Trauma in Cambodia: Results of a Randomized Controlled Outcome Trial

Based on the hypothesis that pain is a stand-alone problem, not just a symptom of Post-Traumatic Stress Disorder (PTSD), the effect of group psycho-education (“pain school”) for survivors of the Khmer Rouge regime with pain-PTSD comorbidity was tested in Cambodia in 2015. After baseline assessment comprising pain-related measures (Brief Pain Inventory, Disability Rating Index) and measures for PTSD, anxiety, depression, and distress, 113 subjects were randomized to a waitlist control group (CG, n = 58) and a treatment group (TG, n = 55). After treatment TG improved significantly, with clinically relevant effect size. Effect size was, however, substantially lower than in two prior pilot trials, and the improvement was not maintained at six-month follow-up. The main reason for this is hypothesized to be that the intervention had been delivered in too condensed a format. It is concluded that treatment addressing pain can also ameliorate mental health problems, implying that more attention should be paid to pain treatment for subjects suffering from pain/PTSD comorbidity

Testimonial Therapy: Impact on social participation and emotional wellbeing among Indian survivors of torture and organized violence

Introduction: Traumatizing events, such as torture, cause considerable impairments in psycho-social functioning. In developing countries, where torture is often perpetrated, few resources exist for the provision of therapeutic or rehabilitating interventions. The current study investigated the effectiveness of Testimonial Therapy (TT) as a brief psycho-social intervention to ameliorate the distress of Indian survivors of torture and related violence. Method: Three outcome measures (the WHO-5 Well-Being Scale, Social Participation-Scale and Pain and Anger Analogue) were compared before and after receiving TT, and semi-structured interviews were conducted with survivors who had previously received TT. Findings: Participants showed significant improvements in emotional well-being, social participation, and self-perceived pain and anger. Furthermore, three qualitative interviewswith survivors indicated that TT had a positive impact at the community level. Discussion: Although the study was conducted without a control group for comparison, TT appeared to be an effective method for improving well-being and ameliorating distress among survivors of torture. Furthermore, TT can potentially promote community empowerment. However, more research on this aspect is needed

The complex care of a torture survivor in the United States: The case of “Joshua”

Introduction: Torture is an assault on the physical and mental health of an individual, impacting the lives of survivors and their families.The survivor’s interpersonal relationships, social life, and vocational functioning may be affected, and spiritual and other existential questions may intrude. Cultural and historical context will shape the meaning of torture experiences and the aftermath. To effectively treat torture survivors, providers must understand and address these factors. The Complex Care Model (CCM) aims to transform daily care for those with chronic illnesses and improve health outcomes through effective team care. Methods: We conduct a literature review of the CCM and present an adapted Complex Care Approach (CCA) that draws on the Harvard Program in RefugeeTrauma’s five-domain model covering the Trauma Story, Bio-medical, Psychological, Social, and Spiritual domains.We apply the CCA to the case of “Joshua,” a former tortured child soldier, and discuss the diagnosis and treatment across the five domains of care. Findings: The CCA is described as an effective approach for working with torture survivors. We articulate how a CCA can be adapted to the unique historical and cultural contexts experienced by torture survivors and how its five domains serve to integrate the approach to diagnosis and treatment. The benefits of communication and coordination of care among treatment providers is emphasized. Discussion / Conclusions: Torture survivors’ needs are well suited to the application of a CCA delivered by a team of providers who effectively communicate and integrate care holistically across all domains of the survivor’s life

Testimonial Psychotherapy in Immigrant Survivors of Intimate Partner Violence: A Case Series

© The Author(s) 2018. Testimonial psychotherapy is a therapeutic ritual for facilitating the recovery of survivors of human rights violations that focuses on sharing the trauma narrative. Originally developed in Chile as a method for collecting evidence during legal proceedings, testimonial therapy has been widely applied transculturally as a unique treatment modality for populations that are not amenable to traditional Western psychotherapy. In this case report, we first review the literature on testimonial therapy to this date. We go on to describe how testimonial therapy has been specifically adapted to facilitate recovery for immigrant survivors of intimate partner violence (IPV). We present three Latin American women who underwent testimonial psychotherapy while receiving psychiatric treatment at a Northern Virginia community clinic affiliated with the George Washington University. The therapy consisted of guided trauma narrative sessions and a Latin- American Catholic inspired reverential ceremony in a Spanish-speaking women\u27s domestic violence group. In this case series we provide excerpts from the women\u27s testimony and feedback from physicians who observed the ceremony. We found that testimonial psychotherapy was accepted by our three IPV survivors and logistically feasible in a small community clinic. We conceptualize testimonial psychotherapy as a humanistic therapy that focuses on strengthening the person. Our case report suggests testimonial psychotherapy as a useful adjunct to formal psychotherapy for post-traumatic stress symptoms

Testimonial Psychotherapy in Immigrant Survivors of Intimate Partner Violence: A Case Series.

© The Author(s) 2018. Testimonial psychotherapy is a therapeutic ritual for facilitating the recovery of survivors of human rights violations that focuses on sharing the trauma narrative. Originally developed in Chile as a method for collecting evidence during legal proceedings, testimonial therapy has been widely applied transculturally as a unique treatment modality for populations that are not amenable to traditional Western psychotherapy. In this case report, we first review the literature on testimonial therapy to this date. We go on to describe how testimonial therapy has been specifically adapted to facilitate recovery for immigrant survivors of intimate partner violence (IPV). We present three Latin American women who underwent testimonial psychotherapy while receiving psychiatric treatment at a Northern Virginia community clinic affiliated with the George Washington University. The therapy consisted of guided trauma narrative sessions and a Latin- American Catholic inspired reverential ceremony in a Spanish-speaking women\u27s domestic violence group. In this case series we provide excerpts from the women\u27s testimony and feedback from physicians who observed the ceremony. We found that testimonial psychotherapy was accepted by our three IPV survivors and logistically feasible in a small community clinic. We conceptualize testimonial psychotherapy as a humanistic therapy that focuses on strengthening the person. Our case report suggests testimonial psychotherapy as a useful adjunct to formal psychotherapy for post-traumatic stress symptoms