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Interventions and treatments for trauma-related disorders across cultures

Theme leaders
Debra Kaysen (contact: Cedra Wright)Luzimar Vega

Trauma exposure and related responses are major contributors to the global burden of disease. There are evidence-based interventions for addressing trauma-related symptoms like PTSD, depression, and anxiety, they have predominantly been developed in Western countries. More research has been conducted recently into how to adapt these interventions for other communities and populations, and whether these adapted interventions are effective.

 

1. Cultural Adaptations of PTSD Interventions: A Narrative Review  

Project leader: Stefanie Freel

Project group: currently looking for partners

Background 

The literature has demonstrated support for brief, effective interventions to treat PTSD (Bisson et al., 2019) and the World Health Organization has affirmed that these approaches are recommended (WHO, 2013). However, most of these treatments were developed in, and for, individuals in Western, educated, industrialized, rich and democratic (WEIRD) countries. This becomes problematic given the disproportionate mental health burden amongst populations living in low- and middle-income countries (LMICs) (e.g., due to ongoing armed conflict and war, lack of access to mental health care) and those ethically or culturally underrepresented and/or otherwise historically marginalized in high-income countries (HICs). While increasing evidence demonstrates both the need for, and potential complementarity of, evidence-based psychological treatment and cultural competency, ongoing challenges exist concerning the cultural adaptation of these interventions.

Aims

Through a narrative review, this project seeks to outline the ongoing tensions, dichotomies, and opportunities in the field of culturally competent mental health care for PTSD. The project has four specific objectives. First, it aims to establish the need, and rationale for, culturally adapted interventions to support individuals following exposure to a traumatic event, as well as those living with PTSD or trauma-related symptoms. Second, the project seeks to provide an overview of how the cultural adaptation of evidence-based treatments for PTSD have evolved over time, outlining key challenges and lessons learned. Third, it aspires to address ongoing tensions in the field of cultural adaptation, including cultural specificity and adaptation vs. intervention applicability and flexibility; community-driven, bottom-up vs. evidence-based, top-down approaches; and cultural vs. contextual adaptations. Finally, it seeks to provide clinical, policy and implementation recommendations regarding how to approach PTSD treatment adaptation in order to preserve essential and effective therapeutic elements while placing these within broader family, community, social, and political dynamics and systems.

Current status 

The project is currently seeking co-authors interested in contributing to the narrative review, which is being shaped by a small, core group of researchers. A particular focus is being set on geographical, gender, cultural, and ethnic representation amongst co-authors. This review article may in turn provide the basis for follow-on publications and research projects.​​

How to get involved

This project will be coordinated online via zoom and email, on a monthly basis. We are currently actively looking for partners.

For more information, please contact : Stéfanie Fréel at stefanie.freel@mail.utoronto.ca

STUDENT PROJECT*

2. Global Perspectives on Culturally Sensitive Trauma Training


Project leader: Krithika Prakash


Project group: Trainees - Graduate students in relevant fields, post-docs, medical residents


Aims & Method

Bring together a team of student researchers across the world with the goal of understanding the quality of culturally sensitive trauma training provided to them, and answer the following questions: 

  • What does "culturally-sensitive trauma training" mean across cultures?

  • What kind of training is provided regarding best practices for trauma-informed care?

  • Where do trainees learn about trauma-informed care- courses, workshops, seminars, direct patient contact?

  • What areas do trainees feel like further guidance and training is needed?

  • Do trainees feel ready to independently assess and treat traumatic stress cases in their communities?

Please find the preliminary project plan here.

How to get involved

Please contact: Krithika Prakash

*Student projects are projects run by students.

The Global Collaboration on Traumatic Stress emphasizes the importance to bring together trainees, graduate students, medical residents or post-docs across the world to work together on topic of global importance. Students are the future!

Read more on Student projects.

People and Flower Graffiti

3. Searching for expertise on mental health support for victims of severe intimate partner violence around the world


Project leader: Chris Hoeboer


Project group: Remco Wijn, Victor Kallen, Miranda Olff


Background

Victims of severe intimate partner are likely to experience mental health complaints such as (complex) posttraumatic stress disorder. However, these victims may be socially isolated and experience difficulties in accessing regular support organizations.

 

Aims

To enhance our skills and expertise it is our aim to get in touch with, and learn from, initiatives across the world providing mental healthcare support to victims of severe intimate partner violence. We are specifically interested in collaborations between mental healthcare organizations, the police and other support organizations for victims of intimate partner violence and in cross-cultural differences in the treatment and process of establishing contact with these victims.

 

​How to get involved?

Please contact: Chris Hoeboer

4. Acceptability of a two-week intensive treatment program of EMDR with therapist rotation for treating complex PTSD in a Latin American country

 

Project leader: Rodrigo A. Figueroa , Pontificia Universidad de Chile School of Medicine, Chile

Project group: Tamara Galleguillos Ugalde, Juan Pastén Valencia, Félix Bacigalupo Izquierdo, Cristian Starck Méndez 

 

Background

Complex Post-Traumatic Stress Disorder (CPTSD) leads to functional impairment and a decrease in the quality of life for those affected. Treatment strategies involve trauma-focused psychotherapies. Intensive treatment with therapist rotation is a novel and effective approach for treating CPTSD. This approach has been tested in European countries, but we do not know whether it will be accepted in Chile, a Latin American country.

Aims

To assess the local acceptability of a two-week intensive treatment program for adult inpatients diagnosed with CPTSD in a Chilean acute psychiatry unit and the need for a cross-cultural adaptation.

Methods

This will be a pilot clinical trial without a control group in which eight adults diagnosed with CPTSD, hospitalised in an acute psychiatry inpatient unit, will be treated with a two-week intensive program of daily Eye Movement Desensitisation and Reprocessing (EMDR), psychoeducation, and physical exercise with therapist rotation. Based on the Theoretical Framework of Acceptability (i.e., affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy), the patient’s acceptability will be assessed qualitatively and quantitatively at the end of the intervention with a semi-structured-interview-, a thematic analysis, and a self-administered Likert-scale questionnaire. We expect that participants’ opinions regarding “affective attitude” (i.e., how an individual feels about the intervention) and “ethicality” (i.e., the extent to which the intervention has a good fit with an individual’s value system”) will be informative regarding the need of cross-cultural adaptation of intensive treatment.

OSF Registry: https://osf.io/nu5vt/?view_only=cbecc50326eb43549932e451fefb6ae3

References

  • Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., . . . Survey, W. W. M. H. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(1). https://doi.org/10.1080/20008198.2017.1353383

  • Schnyder, U., Schafer, I., Aakvaag, H. F., Ajdukovic, D., Bakker, A., Bisson, J.I., Brewer, D., Cloitre, M., Dyb, G.A., Frewen,P., Lanza, J., Le Brocque, R., Lueger-Schuster, B., Mwiti, G.K., Oe, M., Rosner, R., Schellong, J., Shigemura, J., Wu, K., & Olff, M. (2017). The global collaboration on traumatic stress. European Journal of Psychotraumatology, 8(1) .https://doi.org/10.1080/20008198.2017.1403257

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