Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally-sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the U.S. reporting elevated posttraumatic stress (N=63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well-being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2- and 4-month follow-ups. Treatment participation (95.1% completion) and study retention (98.4% provided follow-up data) were very high. Significant condition by time interactions showed that brief NET led to greater posttraumatic growth (Effect size; ES=0.83) and well-being (ES=0.54) through 4 months than the control. Brief NET reduced symptoms of posttraumatic stress (ES=-0.48) and depression (ES=-0.46) compared to control, but only at 2 months; symptoms of controls decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of NET increased growth and well-being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Middle Eastern refugees.

Objective Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict. Methods We developed and conducted a preliminary, uncontrolled test of novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up. Results Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain. Conclusion This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.

International university students often experience acculturative stress, and culturally appropriate techniques to manage stress are needed. This randomized trial tested the effects of group assertiveness training, private expressive writing, their combination, and a wait-list control on the acculturative stress, affect, and health of 118 international students at an urban, American university. Interventions were conducted at the start of a semester, and assessments were conducted at baseline and the end of the semester. Group assertiveness training was rated positively by students and led to lower negative affect, whereas expressive writing was less well received and led to higher homesickness and fear, but also higher positive affect. The combined intervention had no effects, perhaps because the two components negated each other. It is concluded that group assertiveness training improves emotional adjustment of international students, but expressive writing has mixed effects and needs further development and study.Keywords assertiveness training; expressive writing; international students; acculturative stress; randomized clinical trial Undergraduate or graduate education can be stressful, particularly for international students who sojourn to study in another country. Unlike native students, international students need to develop bicultural competence, or second culture acquisition, as they maintain their own values while adjusting to the practical, interpersonal, and emotional challenges encountered in the host country (Mori, 2000;Noh & Kaspar, 2003;Poyrazli & Grahame, 2007;Zahi, 2002). As a result, many international students experience acculturative stress, which is a physiological and emotional reaction to a new environment that has unfamiliar cultural values, customs, and expectations (Berry, 2005), and such stress may contribute to the increased incidence of mental and physical health problems found among international students (Ryan & Twibell, 2000).International students in the U.S. increasingly coming from cultures that espouse communal or interdependent goals, such as India and China, rather than individuality, which is more Shedeh Tavakoli-Moayed and George P. Parris, Department of Counselor Education. Mark A. Lumley, Alaa M. Hijazi, and Olga M. Slavin-Spenny, Department of Psychology. Shedeh Tavakoli-Moayed is now at Argosy University, Chicago, Illinois. Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/cou. commonly found in Western students. As a result, many international students tend to av...

Background and purpose Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. Methods Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. Results On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. Conclusions Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from emotional expression versus emotional reduction approaches to chronic pain.

Existing research has extensively investigated the psychologically adverse effects of witnessing and participating in war violence on combat veterans, but few studies have investigated adaptive outcomes such as posttraumatic growth, which refers to positive psychological changes resulting from struggling with traumatic events. This study investigated the prevalence and predictors of posttraumatic growth in a clinical sample of combat veterans (N = 167: 35.9% Vietnam; 37.2% Operation Enduring Freedom/Operation Iraqi Freedom; 26.9% other wars). Veterans completed measures of various personality and psychological functioning as part of a routine screening for admission to a Veteran’s Administration (VA) posttraumatic stress disorder (PTSD) treatment program. Sixty-nine percent of the sample endorsed at least a moderate degree of posttraumatic growth on at least 1 dimension, with increased appreciation of life being the most frequently endorsed dimension. Hierarchical multiple regression indicated that minority ethnicity, higher cognitive flexibility, and greater perception of moral wrong doing were significantly associated with greater posttraumatic growth, whereas greater anger was marginally associated with lower growth, and PTSD symptoms were not associated with growth in the final model. It is possible that being an ethnic minority is associated with increased discrimination and life adversity, which may facilitate overall benefit finding and posttraumatic growth. Psychological interventions may seek to explicitly promote cognitive flexibility and provide veterans with the opportunity to work through anger, as well as their sense of wrong doing, to help foster growth.

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Refugee men’s experiences as parents have been one of the least explored areas of psychosocial interventions with refugee families, yet there is a great need for engagement with men, including in their role as fathers. “Engaging Men” interventions seek to challenge the social norms, attitudes, and practices that increase the risk of gender-based violence against girls and women while also harnessing positive male power to prevent violence and promote safety. This chapter examines the impact of an “Engaging Men” intervention in Lebanon that involved 1028 Syrian refugee and 440 Lebanese men in a 12-week training course structure with the aims of promoting peaceful family and community relations, reducing violence and gender-based violence, and enhancing child protection and caregiving. The chapter focuses on the impact of the intervention on Syrian refugee children and adolescents through men’s reflections on the stressors in their own lives and how this impacted their role as fathers. The challenges of addressing child-specific protection risks of early marriage and child labor are discussed.

Acculturative stress is a common experience for international students and is associated with psychological and physical problems. In a previous study, the authors reported that two stress reduction interventions—expressive writing (EW) and assertiveness training (AT)—had limited overall benefits among international students at an American University. The current analyses of data from that study investigated whether individual differences moderated the effects of EW and AT. Results indicate that greater acculturative stress at baseline predicted greater improvement from both interventions, compared with control. Women benefited more from AT than EW, except that EW improved women’s physical symptoms. Men benefited more from EW than AT. Students with limited emotional awareness and expression tended to benefit from both interventions, relative to control. Finally, nation of origin cultural differences generally did not predict outcomes. It is concluded that the benefits of EW and AT and can be enhanced by targeting these interventions to specific subgroups of international students.