Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial

Tol, Wietse A.; Leku, Marx R.; Lakin, Daniel; Carswell, Kenneth; Augustinavicius, Jura; Adaku, Alex; Au, Teresa; Brown, Felicity L.; Bryant, Richard A.; Garcia-Moreno, Claudı́a; Musci, Rashelle J.; Ventevogel, Peter; White, Ross; Ommeren, Mark van

doi:10.1016/s2214-109x(19)30504-2

Cited by 142 publications

(218 citation statements)

References 42 publications

(61 reference statements)

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“…38 In addition, a cluster RCT of a self-help programme for trauma-exposed refugees in Uganda, guided only by briefly trained lay facilitators, demonstrated good feasibility and safety profiles for the intervention and indicated its effectiveness for reducing psychological distress in a population otherwise unlikely to receive formal psychological support. 39 A meta-analysis of internet-based psychological therapies for PTSD (mostly using cognitive-behavioural models) demonstrated an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD. 16 There have also been initially promising results of research into the quality and effectiveness of medical mobile applications in the treatment of mental health disorders, such as 'PTSD Coach', a mobile application comprising self-help techniques including relaxation for PTSD treatment that has already been downloaded by over 100 000 users across 74 countries worldwide.…”

Section: The Evidence For Other Self-help Psychotherapiesmentioning

confidence: 99%

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

Waterman

Cooper

2020

BJPsych open

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Background Post-traumatic stress disorder (PTSD) carries a high disease burden worldwide, yet significant barriers exist to providing and accessing treatment for PTSD, particularly in refugee populations and in low- and middle-income countries. There is emerging evidence that self-administered psychological therapies, such as those accessed via online and mobile applications, are efficacious for many mental illnesses and increase access to treatment. Online and mobile applications offering self-help tools for eye movement desensitisation reprocessing (EMDR) therapy, an internationally recommended treatment for PTSD, are already widely distributed to the public. Aims To present a commentary evaluating the potential benefits and risks of self-administered EMDR therapy: first, by conducting a search for existing peer-reviewed evidence relating to self-administered EMDR therapy; second, by presenting existing evidence for other self-help psychotherapies and evaluating what additional insight this could provide into the potential efficacy, safety, tolerability and accessibility of self-administered EMDR therapy; and, third, by describing the conflicting views of EMDR experts on the topic. Method A search was conducted for articles related to internet, mobile, book or computerised self-help EMDR therapy. The following databases were searched systematically: Medline, PsycInfo, EMBASE, AMED, CINAHL, Psychology and Behavioural Sciences, Cochrane Database and the EMDR Library. Results Only one small primary research study was found relating to self-administered EMDR therapy. The results indicated significantly reduced symptoms of PTSD, depression, anxiety, distress and disability between pre-treatment and 3 month follow-up. No serious adverse events were reported. However, substantial methodological issues were discovered. Conclusions There is evidence that self-administered psychotherapies, in general, can be safe, effective and highly accessible. However, controversies persist regarding the safety and potential efficacy of self-administered EMDR therapy, and more robust research is needed. It is vital that methods are found to improve worldwide access to effective PTSD treatment, particularly given the current scale of migration to flee civil unrest.

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Section: The Evidence For Other Self-help Psychotherapiesmentioning

confidence: 99%

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

Waterman

Cooper

2020

BJPsych open

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“…Such interventions should target psychological flexibility given the findings from the present study and those from other research indicating that psychological flexibility moderates the adverse impacts of COVID-19 contextual risk factors ( Pakenham et al, 2020 ). Public health ACT-based interventions designed to strengthen psychological flexibility have been shown to promote mental health in a variety of populations using flexible modes of delivery in various contexts: university students via online delivery ( Viskovich and Pakenham, 2020 ), cancer patients via phone ( Hawkes et al, 2014 ), Sudanese refugees using audio-recorded stress-management workshops and a self-help book ( Tol et al, 2020 ), and health anxiety patients via group delivery ( Eilenberg et al, 2016 ). An advantage of psychological flexibility informed interventions is that they have been shown to cultivate skills that foster resilience in the context of health-related adversities, such as chronic disease (e.g., multiple sclerosis, Giovannetti et al, 2020 ; diabetes, Ryan et al, 2020 ), and to mediate the beneficial effects of these programs ( Pakenham et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…ACT has also been effective in the context of community disasters. For example, an ACT-based self-help program effectively reduced psychological distress among war refugees ( Tol et al, 2020 ). In a randomized controlled trial, ACT intervention participants with severe health anxiety evidenced a greater reduction in symptoms compared to the control group, and these intervention effects were mediated by psychological flexibility ( Eilenberg et al, 2016 , 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

et al. 2020

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The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one’s chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown ( M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.

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“…Rahman and colleagues have examined the cost-effectiveness of a multicomponent behavioral intervention delivered by lay helpers with conflict-affected adults in Pakistan [ 16 ]. Tol and colleagues have evaluated a guided self-help intervention with South Sudanese female refugees in northern Uganda [ 17 – 20 ], and are adapting and evaluating this intervention for use with male refugees.…”

Section: R2hc-funded Mhpss Researchmentioning

confidence: 99%

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

et al. 2020

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Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

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Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial

Cited by 142 publications

References 42 publications

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

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