Treating Maladaptive Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group‐Based Trauma‐Focused Cognitive–Behavioral Therapy

O’Donnell, Karen; Dorsey, Shannon; Gong, Wenfeng; Ostermann, Jan; Whetten, Rachel; Cohen, Judith A.; Itemba, Dafrosa; Manongi, Rachel; Whetten, Kathryn

doi:10.1002/jts.21970

Cited by 81 publications

(127 citation statements)

References 36 publications

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“…TF-CBT allows for flexibility in the application of skills to a variety of client-specific symptoms, allowing for inclusion of the unique symptoms identified. Evidence of this flexibility comes from our pilot and other studies in Africa (i.e., Zambia, Democratic Republic of Congo) demonstrating both acceptability of TF-CBT (Murray et al, 2014) and positive outcomes from treatment (McMullen et al, 2013; Murray et al, 2013: Murray et al, in press; O’Callaghan et al, 2013; O’Donnell et al, 2014). …”

Section: Discussionmentioning

confidence: 73%

“…Mental health services for children and adolescents in the area, other than case management in situations of child safety, were very limited. Our team conducted a feasibility study of TF-CBT in Moshi and the surrounding rural areas from 2009–2012 (O’Donnell et al, 2014). TF-CBT was selected for initial feasibility piloting because it targets mental health symptoms and experiences broadly identified as common among orphans (see Whetten, 2011a) and had substantial empirical support in high-income countries (e.g., Dorsey, Briggs, & Woods, 2011).…”

Section: Background and Settingmentioning

confidence: 99%

“…The intervention uses cognitive behavioral strategies (e.g., psychoeducation, emotion regulation skills, cognitive processing techniques, exposure) to treat PTS, depression, behavioral problems, and maladaptive grief. Prior to the initial pilot study, some adaptations were made based on focus group feedback and input from local, bilingual Tanzanians trained to be TF-CBT counselors (O’Donnell et al, 2014). These included calling the intervention a “class/program” (and not a mental health intervention), incorporating local stories and analogies, simplifying language, and providing extra, informal time for tea and participant-group leader interaction before groups.…”

Section: Background and Settingmentioning

confidence: 99%

“…These included calling the intervention a “class/program” (and not a mental health intervention), incorporating local stories and analogies, simplifying language, and providing extra, informal time for tea and participant-group leader interaction before groups. Feasibility outcomes were positive—counselors delivered the intervention with fidelity, youth and their guardians attended, and child outcomes improved by end of treatment and were maintained at 3- and 12-month posttreatment follow-ups (see O’Donnell et al, 2014). Before undertaking the next stage of our research testing TF-CBT as an intervention approach in a large randomized controlled trial of TF-CBT (NIMH-funded, R01 MH96633), our team believed that it was important to better understand the local context for mental health-related issues of orphans.…”

Section: Background and Settingmentioning

confidence: 99%

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A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

Dorsey¹,

Lucid²,

Murray³

et al. 2015

Journal of Nervous &Amp; Mental Disease

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Low- and middle-income countries (LMIC) have a high number of orphans, many of whom have unmet mental health needs. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived locally in order to tailor interventions and refine measurement of intervention effects. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of orphans and guardians to inform a subsequent randomized controlled trial of a Western-developed, evidence-based psychosocial intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT). Local, Kiswahili-speaking interviewers conducted 73 free list interviews and 34 key informant interviews. Results identified both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., lacking peace, being discriminated against) not typically targeted by the intervention or included on standardized measures of intervention effects. We discuss implications for adapting mental health interventions in LMIC and assessing effectiveness.

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Section: Discussionmentioning

confidence: 73%

Section: Background and Settingmentioning

confidence: 99%

Section: Background and Settingmentioning

confidence: 99%

Section: Background and Settingmentioning

confidence: 99%

See 2 more Smart Citations

A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

Dorsey¹,

Lucid²,

Murray³

et al. 2015

Journal of Nervous &Amp; Mental Disease

Self Cite

View full text Add to dashboard Cite

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“…However, there is also growing literature on group-based CBT interventions in school settings. School-based interventions have been implemented to reduce symptoms of grief and post-traumatic stress among student disaster survivors in Tanzania (O'Donnell et al, 2014) and Palestine (Barron, Abdallah, & Smith, 2013), and in post-earthquake Athens (Giannopoulou, Dikaiakou, & Yule, 2006). School-based interventions have also been implemented for survivors of man-made disasters, including children who have experienced a factory explosion (Rønholt, Karsberg, & Elklit, 2013), as well as those exposed to community violence (Berger, Gelkopf, & Heineberg, 2012;Gelkopf & Berger, 2009).…”

Section: Resilience Interventionsmentioning

confidence: 99%

Evaluation of a Group-Based Resilience Intervention for Typhoon Haiyan Survivors

Hechanova

Waelde

Ramos

2016

Journal of Pacific Rim Psychology

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T his study evaluated the impact of Katatagan, a culturally adapted, group-based, and mindfulnessinformed resilience intervention developed for disaster survivors in the Philippines. The intervention aimed to teach six adaptive coping skills: harnessing strengths, managing physical reactions, managing thoughts and emotions, seeking solutions and support, identifying positive activities, and planning for the future. Pre-and post-intervention assessments were conducted with 163 Typhoon Haiyan survivors. Six-month follow-up assessments were obtained for 37 participants. Pre-and post-results showed improvements in participants' self-efficacy on all six coping skills. The 6-month follow-up revealed significant improvements in four of the six coping skills. Focus group discussions conducted at follow-up revealed that mindfulness, self-care, strengths, and reframing were some of the topics that were most memorable to participants. Among these, participants identified mindfulness as a skill that they continued to use. Participants also shared that they felt stronger because of the intervention and have shared what they learned with others in their communities. Keywords: resilience, disaster, psychosocial interventions, Philippines, Typhoon HaiyanGiven climate change and environmental degradation, natural disasters have increased in regularity and intensity. Disasters can bring about destruction and the erosion of protective support systems in families and communities, thus causing pain and trauma. Although many survivors are able to recover after a disaster, there are those who experience difficulty in recovering and are at risk for developing post-traumatic stress disorder (PTSD). Meta-analytic studies report the prevalence of PTSD ranges from 19.5-28% among earthquake victims (Dai, Chen, Lai, Wang, & Liu, 2016), 11.5-16% among flood victims (Chen & Liu, 2015), and 15-24% across disaster victims in general (Utzon-Frank et al., 2014).Mental health and/or psychosocial support (MHPSS) interventions are particularly salient among communities located in the Pacific Rim Ring of Fire, who regularly contend with earthquakes, tsunamis, typhoons, floods, and bushfires (Paton, 2009). In the past 100 years, nine of ten of the worst natural disasters occurred in Asia (Udomratn, 2008). Furthermore, in developing countries, the impact of natural calamities is exacerbated by poverty, environmental degradation, inadequate infrastructure, and the poor delivery of government social services (Porio, 2014). Ave, Quezon City, 1108 Metro Manila, Philippines. Email: rhechanova@ateneo.edu) A review of related literature on the consequences of disasters in Asia reports that PTSD affects from 8.7-57.3% of survivors, which is higher than that reported in other global studies. However, the author cites limitations on the rigour, timing, and sampling of the studies on PTSD in Asia (Udomratn, 2008). Address for correspondence: Ma. Regina M. Hechanova, Department of Psychology, Ateneo de Manila University KatipunanRather than wait for the onset o...

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Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia

et al. 2015

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IMPORTANCE Orphans and vulnerable children (OVC) are at high risk for experiencing trauma and related psychosocial problems. Despite this, no randomized clinical trials have studied evidence-based treatments for OVC in low-resource settings.OBJECTIVE To evaluate the effectiveness of lay counselor-provided trauma-focused cognitive behavioral therapy (TF-CBT) to address trauma and stress-related symptoms among OVC in Lusaka, Zambia. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial compared TF-CBT and treatment as usual (TAU) (varying by site) for children recruited from August 1, 2012, through July 31, 2013, and treated until December 31, 2013, for trauma-related symptoms from 5 community sites within Lusaka, Zambia. Children were aged 5 through 18 years and had experienced at least one traumatic event and reported significant trauma-related symptoms. Analysis was with intent to treat. INTERVENTIONSThe intervention group received 10 to 16 sessions of TF-CBT (n = 131). The TAU group (n = 126) received usual community services offered to OVC. MAIN OUTCOMES AND MEASURESThe primary outcome was mean item change in trauma and stress-related symptoms using a locally validated version of the UCLA Posttraumatic Stress Disorder Reaction Index (range, 0-4) and functional impairment using a locally developed measure (range, 0-4). Outcomes were measured at baseline and within 1 month after treatment completion or after a waiting period of approximately 4.5 months after baseline for TAU.RESULTS At follow-up, the mean item change in trauma symptom score was −1.54 (95% CI, −1.81 to −1.27), a reduction of 81.9%, for the TF-CBT group and −0.37 (95% CI, −0.57 to −0.17), a reduction of 21.1%, for the TAU group. The mean item change for functioning was −0.76 (95% CI, −0.98 to −0.54), a reduction of 89.4%, and −0.54 (95% CI, −0.80 to −0.29), a reduction of 68.3%, for the TF-CBT and TAU groups, respectively. The difference in change between groups was statistically significant for both outcomes (P < .001). The effect size (Cohen d) was 2.39 for trauma symptoms and 0.34 for functioning. Lay counselors participated in supervision and assessed whether the intervention was provided with fidelity in all 5 community settings. CONCLUSIONS AND RELEVANCEThe TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma.

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Treating Maladaptive Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group‐Based Trauma‐Focused Cognitive–Behavioral Therapy

Cited by 81 publications

References 36 publications

A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

Evaluation of a Group-Based Resilience Intervention for Typhoon Haiyan Survivors

Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia

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