Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response

Abstract

Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure-the systolic blood pressure response to orthostasis (d = 1.31)-as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment.

Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study

“…CA CBT has been evaluated for various ethnic groups but not for Afghan refugees (Hinton et al, 2005, 2009; Jalal et al, 2017), and to our knowledge this is the first treatment study with a Farsi-speaking refugee sample outside Afghanistan. Due to specific cultural barriers in the utilization of psychotherapy (Alemi et al, 2016; Yaser et al, 2016) and the high comorbidity of PTSD with other trauma-related disorders (Alemi et al, 2014) in refugees, CA CBT is conceptualized as a low-threshold transdiagnostic treatment programme.…”

“…The ERS (Hinton et al, 2009) is a 10-item scale, each item rated on a 0–4 Likert scale assessing the ability to distance from dysphoric affects, higher scores indicating greater ability to distance from negative affect. The measure has shown good test-retest reliability and high internal consistency in samples of Cambodian refugees with PTSD (Hinton et al, 2009) and female Latino patients with treatment-resistant PTSD (Hinton et al, 2011).…”

“…The measure has shown good test-retest reliability and high internal consistency in samples of Cambodian refugees with PTSD (Hinton et al, 2009) and female Latino patients with treatment-resistant PTSD (Hinton et al, 2011). …”

“…The structure and content was based on the manual used by Hinton and colleagues, who have applied these techniques for refugees from Cambodia and Vietnam for Latino groups, for Egyptians, and for South African tribal groups (Hinton et al, 2005, 2009; Jalal et al, in press, 2017). In each session, there was psychoeducation: symptoms related to depression, anxiety disorders, and PTSD were discussed with the participants.…”

“…Emotion regulation is taught in CA CBT by such means as imagery techniques, mindfulness, loving kindness meditation, and applied stretching. CA CBT has proven its effectiveness with various cultural groups, for example, Cambodians, Egyptians, Latinos, South African tribal groups, and Vietnamese (Hinton et al, 2005; Hinton, Hofmann, Pollack, & Otto, 2009, 2011, in press; Jalal, Samir, & Hinton, 2017). …”