A Case Study of Interpreter-Mediated Prolonged Exposure Therapy for Posttraumatic Stress Disorder: Challenges and Recommendations for Effective Implementation

Woodward, Matthew J.; Orengo-Aguayo, Rosaura; Stewart, Regan W.; Rheingold, Alyssa A.

doi:10.1177/1534650119881787

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…Indeed, articles on interpreting recommend interpreters switch to the third person as a strategy to reduce the emotional impact of traumatic content (Miller et al, 2005). An additional recommendation that can help with vicarious trauma is to use in-person simultaneous interpreting for initial imaginal exposures and limit interpretation for subsequent repetitions once clinicians are familiar with the detailed narrative (Woodward et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Interpreter perspectives on working with trauma patients: Challenges and recommendations to improve access to care.

Villalobos¹,

Orengo-Aguayo²,

Castellanos³

et al. 2021

Professional Psychology: Research and Practice

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Given the growing number of immigrant and limited-English-proficiency individuals in the U.S., accessing language-congruent services can be a significant barrier for many seeking mental health treatment. The use of spoken-language interpreters can help address this barrier; however, the interpretation in the context of trauma therapy can be particularly challenging for interpreters without mental health training. This quality improvement study explores issues identified by interpreters assisting in the provision of trauma-focused treatment for primarily immigrant populations. Ten certified medical interpreters (nine Spanish-language interpreters and one American Sign Language interpreter) participated in a focus group at a specialty trauma clinic in the southeastern U.S. Core findings concerned the challenges of interpreting (i.e., use of mental health terminology, little time to process emotionally charged sessions, the impact of vicarious trauma, difficulties related to the speed of interpreting and interpreting for multiple patients at once, logistical difficulties, and the availability of interpreters). Interpreters also identified perceived needs and provided recommendations for overcoming challenges (i.e., holding presession meetings with clinicians, ensuring breaks between trauma patients, creating a support group for interpreters, ensuring a direct telephonic line between interpreters and the trauma clinic, providing interpreters with session materials before appointments, and training clinicians on the use of interpreters specifically for trauma treatment). Specific recommendations for agencies and clinicians new to the use of interpreters for trauma-focused services can ultimately enhance service provision for trauma patients in need of language-congruent services.

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Section: Discussionmentioning

confidence: 99%

Interpreter perspectives on working with trauma patients: Challenges and recommendations to improve access to care.

Villalobos¹,

Orengo-Aguayo²,

Castellanos³

et al. 2021

Professional Psychology: Research and Practice

Self Cite

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“…A noteworthy finding was the increase in the number of ‘any other white’ ethnic referrals, an increase in the number of sessions requiring the use of interpreters and an association between poorer recovery rates and interpreter-facilitated sessions compared to non-interpreter sessions. As outlined by Woodward et al [ 36 ], use of interpreters can be challenging. Therefore, the service needs to further explore the causal-factors associated with these variables.…”

Section: Discussionmentioning

confidence: 99%

How has our primary-care NHS-IAPT provision for PTSD adapted to the pandemic? A service evaluation of recovery pre-COVID-19 and peri-COVID-19

Skilbeck,

Antonie,

Crane

2024

BMC Prim. Care

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Background Mental health issues have been an ongoing major cause of global disability exacerbated by the COVID-19 pandemic. The unique challenges have been the high contagiousness of COVID-19 and atypical PTSD presentations e.g., ICU-PTSD. This has led to increased demand on mental health services which have had to vary their provision for example working remotely vs. the traditional face-to-face. The pandemic has also exposed the preexisting health inequalities related to sociodemographic variables. In the UK, NHS-IAPT is the main primary-care provider which has suffered these repercussions. Research from COVID-19 and previous viral outbreaks has estimated an increase in the prevalence of PTSD. Although services have been urged to monitor their provision, research on PTSD remains scanty. The current NHS-IAPT service was concerned about these ramifications of the pandemic and also wished to address the gap in the research. The aim was to conduct an evaluation of the impact of the COVID-19 on PTSD recovery. The first question evaluated the impact, and the second question evaluated the associated variables. Methods The study employed a quantitative data analysis method. Data were extracted and analysed from the electronic database, IAPTus. The study evaluated PTSD recovery rates during pre-pandemic and peri-pandemic periods. The comparisons determined the impact of the pandemic as well as what recovery variables were significant. The data were analysed statistically using both descriptive statistics and inferential statistics (t-test and Chi-square). The data were analyzed in reference to the national NHS-IAPT standards via NHS-Digital. Results The findings suggest that the pandemic had no significant impact on overall PTSD recovery rates, which also aligned with the national standards. These recovery rates fell below the target national standard of 50% regardless of the pandemic. Several client, service and treatment variables were shown to be associated with PTSD recovery rates. Conclusions This evaluation highlights a pre-existing problem around the persistently low PTSD recovery rates. It also identifies variables that warrant further research in order to improve PTSD service-provision and mitigate any long-term pandemic impacts. This study also provides information for other services wishing to enhance their PTSD recovery rates.

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“…There is also a shortage of bilingual mental health providers at all levels of training, meaning that interpreters would be required for expanding care access, even with efforts to expand Spanish-speaking providers. As has been highlighted in anecdotal evidence and qualitative research, working with interpreters presents many challenges in empirically supported PTSD treatments (d’Ardenne et al, 2007; Sander et al, 2019; Woodward et al, 2020). For example, in Prolonged Exposure, a clinician must actively listen as a client recounts the traumatic event only interrupting to redirect the client or collect ratings of distress (Foa et al, 2007).…”

Section: Ptsd Treatment and Barriers Among Latinx Immigrantsmentioning

confidence: 99%

Examining recipient and provider perceptions of mental health treatments and written exposure therapy for posttraumatic stress disorder with a Spanish-speaking sample.

Acosta¹,

Canchila²,

Reyes³

et al. 2023

Psychological Services

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Treatments of Posttraumatic Stress Disorder (PTSD) often evidence high rates of dropout, ranging from 25% to 40%, among English-speaking samples. Written Exposure Therapy (WET), a novel manualized treatment for PTSD, evidences lower dropout rates and noninferiority to CPT, one of the most efficacious interventions for PTSD. Spanish-speaking Latinxs often experience greater dropout and barriers to care. WET appears promising for this population, but acceptability and perceived barriers to WET have not been examined among Spanish-speaking Latinxs. The present study assessed perceptions and acceptability of a Spanish-language version of WET among Spanish-speaking Latinxs who scored greater than 45 on the Spanish-language version of the PCL-IV, indicating likely PTSD (n = 20) and providers (n = 12). Participants completed a mixed-methods interview regarding reasons they/clients would not want to receive the treatment, why they/clients would want to receive the treatment, potential solutions for any identified barriers, and reasons for not seeking mental health services generally. Providers, but not potential recipients, identified low literacy as a barrier for WET. Providers and potential recipients identified time as a barrier to WET and other mental health services, but the time reduction was perceived as a potential facilitator of WET. Results also suggest no specific cultural barriers were identified for WET (e.g., provider cultural competency) and that Spanish WET may reduce time-related barriers and is perceived as effective and acceptable among Spanish-speaking Latinxs. Additional work is needed to expand the reach of the intervention, given that mental health services were often perceived as untrustworthy. Impact StatementThis study suggests that a Spanish-language adaptation of Written Exposure Therapy, a novel manualized treatment for PTSD symptoms, may be effective in reducing some structural barriers that Spanish-speaking Latinx populations encounter when using mental health services.

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A Case Study of Interpreter-Mediated Prolonged Exposure Therapy for Posttraumatic Stress Disorder: Challenges and Recommendations for Effective Implementation

Cited by 8 publications

References 31 publications

Interpreter perspectives on working with trauma patients: Challenges and recommendations to improve access to care.

Interpreter perspectives on working with trauma patients: Challenges and recommendations to improve access to care.

How has our primary-care NHS-IAPT provision for PTSD adapted to the pandemic? A service evaluation of recovery pre-COVID-19 and peri-COVID-19

Examining recipient and provider perceptions of mental health treatments and written exposure therapy for posttraumatic stress disorder with a Spanish-speaking sample.

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