Psychosocial Needs of Torture Survivors

Silove, Derrick; Tarn, Ruth; Bowles, Robin; Reid, Janice

doi:10.3109/00048679109064441

Cited by 66 publications

(34 citation statements)

References 18 publications

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“…PE has often been criticized on the grounds that people who have difficulties tolerating distress may not be able to manage the emotional demands of PE, and therefore will not benefit from PE (for discussion, see Herman, 2001; Neuner et al, 2008; Silove, 1996; Silove, Tarn, Bowles, & Reid, 1991). These cases, often called “complex PTSD,” can be conceptualized as more severe cases of PTSD or more comorbid cases in which the patient has marked difficulties with emotion regulation, leading to strong mood swings, difficulty stabilizing emotional reactions, impulsive behaviors, self-harm, and difficulties with interpersonal relationships (Cloitre, Miranda, Stovall-McClough, & Han, 2005).…”

Section: Targeting More Treatment-resistant Populationsmentioning

confidence: 99%

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Foa

Gillihan

Bryant

2013

Psychol Sci Public Interest

162

138

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Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.

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Section: Targeting More Treatment-resistant Populationsmentioning

confidence: 99%

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Foa

Gillihan

Bryant

2013

Psychol Sci Public Interest

162

138

View full text Add to dashboard Cite

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“…Observations following WWII suggested that psychotic-like symptoms and frank forms of psychosis were common amongst survivors of the Holocaust, although selection biases could have influenced these findings [16]. Since then, clinicians in the field of traumatic stress have argued that gross forms of human rights violations can lead to a fundamental loss of trust amongst survivors, resulting in a tendency towards suspicion and even paranoia, phenomena that are not encompassed by contemporary criteria for PTSD [17]. …”

Section: Introductionmentioning

confidence: 99%

Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey

et al. 2012

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BackgroundStudies in developed countries indicate that psychotic-like symptoms are prevalent in the community and are related to trauma exposure and PTSD. No comparable studies have been undertaken in low-income, post-conflict countries. This study aimed to assess the prevalence of psychotic-like symptoms in conflict-affected Timor Leste and to examine whether symptoms were associated with trauma and PTSD.MethodsThe Psychosis Screening Questionnaire and the Harvard Trauma Questionnaire (assessing trauma exposure and PTSD) were administered in an epidemiological survey of 1245 adults (response rate 80.6%) in a rural and an urban setting in Timor Leste. We defined PSQ screen-positive cases as those people reporting at least one psychotic-like symptom (paranoia, hallucinations, strange experiences, thought interference, hypomania).ResultsThe prevalence of PSQ screen-positive cases was 12 percent and these persons were more disabled. PSQ cases were more likely to reside in the urban area, experienced higher levels of trauma exposure and a greater prevalence of PTSD. PTSD only partially mediated the relationship between trauma exposure and psychotic-like symptoms.ConclusionsPsychotic-like symptoms may be prevalent in countries exposed to mass conflict. The cultural and contextual meaning of psychotic-like symptoms requires further inquiry in low-income, post-conflict settings such as Timor Leste.

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“…Many refugees are exposed to potentially traumatising situations during several phases of their journey: surviving war or organised violence, including imprisonment and torture; becoming fugitives; leaving their home country, often to stay in refugee camps before being granted a right to stay in a country of settlement; and experiencing the stresses of resettlement and discrimination (Silove, Tarn, Bowles, & Reid, 1991). Consequently, their chances of developing post-traumatic stress disorder (PTSD; American Psychiatric Association, 1994) are high: in western countries, refugees are 10 times more likely to have PTSD than general populations (Fazel, Wheeler, & Danesh, 2005).…”

mentioning

confidence: 99%

EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study

Heide

Mooren

Kleijn

et al. 2011

European Journal of Psychotraumatology

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BackgroundTraumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD) should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye Movement Desensitisation and Reprocessing (EMDR) should be applied, or whether a phased model starting with stabilisation is preferable. Some clinicians fear that trauma-focused interventions may lead to unmanageable distress or may be ineffective. While cognitive-behavioural interventions have been found to be effective with traumatised refugees, no studies concerning the efficacy of EMDR with this population have been conducted as yet.ObjectiveIn preparation for a randomised trial comparing EMDR and stabilisation with traumatised refugees, a pilot study with 20 participants was conducted. The objective was to examine feasibility of participation in a randomised trial for this complex population and to examine acceptability and preliminary efficacy of EMDR.DesignParticipants were randomly allocated to 11 sessions of either EMDR or stabilisation. Symptoms of PTSD (SCID-I, HTQ), depression and anxiety (HSCL-25), and quality of life (WHOQOL-BREF) were assessed at pre- and post-treatment and 3-month follow-up.ResultsParticipation of traumatised refugees in the study was found feasible, although issues associated with complex traumatisation led to a high pre-treatment attrition and challenges in assessments. Acceptability of EMDR was found equal to that of stabilisation with a high drop-out for both conditions. No participants dropped out of the EMDR condition because of unmanageable distress. While improvement for EMDR participants was small, EMDR was found to be no less efficacious than stabilisation. Different symptom courses between the two conditions, with EMDR showing some improvement and stabilisation showing some deterioration between pre-treatment and post-treatment, justify the conduct of a full trial.ConclusionWith some adaptations in study design, inclusion of a greater sample is justifiable to determine which treatment is more suitable for this complex population.

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Psychosocial Needs of Torture Survivors

Cited by 66 publications

References 18 publications

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey

EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study

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