Imagery rehearsal therapy and/or mianserin in treatment of refugees diagnosed with PTSD: Results from a randomized controlled trial

Abstract

Sleep disturbances are frequently part of the symptomatology in refugees with post‐traumatic stress disorder (PTSD). It has been suggested that targeting sleep disturbances may enhance the outcome of PTSD treatment. However, randomized studies on the effect of treatment focusing on sleep disturbances in refugees with PTSD are lacking. The aim of this study was to examine add‐on treatment with imagery rehearsal therapy (IRT) and/or mianserin against treatment as usual (TAU) alone in a sample of trauma‐affected refugees with PTSD at 8–12 months follow‐up. In a randomized controlled trial, 219 adult refugees diagnosed with PTSD and suffering from sleep disturbances were randomized to four groups (1:1:1:1) receiving, respectively, TAU, TAU + mianserin, TAU + IRT, and TAU + IRT + mianserin. The primary outcome was subjective sleep quality (Pittsburgh Sleep Quality Index) and the secondary outcomes included PTSD and depression symptoms, level of functioning and subjective well‐being. The data were analysed using mixed models. The only significant effect of IRT was on level of functioning (p = .040, ES 0.44), whereas there was no significant effect of mianserin on any of the measured outcomes. Low adherence to both IRT (39%) and mianserin (20%) was observed. Contrary to our hypothesis, we did not find IRT or mianserin to be superior to TAU. The low adherence may potentially cause an underestimation of the effect of IRT and mianserin and indicates a necessity to further analyse the complex factors that may impact the motivation and ability of trauma‐affected refugees to participate in and profit from available treatment options.

Cross-cultural validity and psychometric properties of the International Trauma Questionnaire in a clinical refugee sample

“…The bias varies from negligible (−0.04 scale points) to substantial overestimation for the group of female patients with 5–10 years since trauma (0.40 scale points). In particular, the latter is an issue for further investigation, as the effect size with regard to improvement in PTSD in Danish treatment-seeking refugees measured with the HTQ has been found to be 0.33 for a group receiving imagery reversal therapy compared to treatment as usual (Sandahl et al, 2021 ) – an effect that may be contaminated by gender and/or time since trauma bias. The degree to which the bias discovered in this study would affect the prevalence PTSD in females is also an issue for further research, as previous research has shown higher prevalence rates in, for example, UK and Israeli trauma-exposed females than in males (McGinty et al, 2021 ), i.e.…”

The Effect of an Integrated Care Intervention of Multidisciplinary Mental Health Treatment and Employment Services for Trauma-affected Refugees; Study Protocol for a Randomised Controlled Trial

“…Data are exclusively collected at the CTP, and the municipalities are not involved in data collection and processing of the RCT. Five randomised controlled trials aiming to increase knowledge on the treatment of trauma-affected refugees been carried out at the CTP (17)(18)(19)(20)(21). The trauma-affected refugees referred to the CTP derive from various countries, the majority originating from Syria, Iraq, Afghanistan, Iran, and Lebanon.…”

“…Both studies stress that the quality of evidence for their ndings is moderate as the studies included are small with limited methodological quality. Five randomised controlled trials (RCTs) carried out at the mental health clinic of this trial protocol have investigated the outcomes of different treatment modalities for traumaaffected refugees (psychotherapy, psychopharmacological treatment, physical activity, and sleep disturbance targeted therapy) (17)(18)(19)(20)(21). All ve studies found a limited treatment effect on PTSD symptoms, which could be explained by the often chronic state of PTSD in refugees.…”

The structure of ICD‐11 post traumatic stress disorder in a clinical sample of refugees based on the International Trauma Interview

“…The TRIM has demonstrated a high-inclusion rate, at over 85% of the patients receiving treatment at the CTP, and has enabled an unprecedented series of randomized trials with trauma-affected refugees. [16][17][18][19][20] Anticipating the advent of the ICD-11, the CTP has integrated the first part of the ITI into the standard assessment for PTSD. This covers the ICD-11 PTSD symptoms and can typically be administered within a single session.…”