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, University of Amsterdam, The Netherlands
Project group: Duane Booysen, University of Rhodes, South Africa; Chris Hoeboer, University of Amsterdam, The Netherlands; O. Jiaqing, University of Macau, Macao; Debra Kaysen, Stanford University, USA; Melody Kim, University of Auckland, New Zealand; Kristina Korte, Harvard Medical School, USA; Miranda Olff, University of Amsterdam, The Netherlands; Janne Punski-Hoogervorst, University of Haifa, Israel; Mohsen Rajabi, University of Bath, UK/Iran; Ulrich Schnyder, University of Zurich, Switzerland; Shivantika Sharad, University of Delhi, India; Alexandra Thelan, Veteran Affairs, USA; Luzimar Vega, Veteran Affairs, USA
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:
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What does "culturally-sensitive trauma training" mean across cultures?
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What kind of training is provided regarding best practices for trauma-informed care?
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Where do trainees learn about trauma-informed care- courses, workshops, seminars, direct patient contact?
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What areas do trainees feel like further guidance and training is needed?
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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.
3. Searching for expertise on mental health support for victims of severe intimate partner violence around the world
Project leader: Chris Hoeboer, University of Amsterdam, The Netherlands
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
5. VR-MH: Virtual Reality for Mental Health
Project Leader: Allen Olson-Urtecho, Studio Bahia, Tela, Honduras (www.studiobahia.org)
Project Group: Iva Georgieva - Studio Bahia, Sofia, Bulgaria; Tammy Hyde, Studio Bahia, Florida, USA; Cindy Dominique Studio Bahia, Maryland, USA; Sebit Martin John, Community Development Center, Rhino Refugee Camp, Uganda.
Background
VR-MH aims to address the global mental health crisis by leveraging virtual reality (VR) technology to provide accessible and effective therapy solutions. With the increasing prevalence of mental health disorders worldwide, especially among marginalized populations such as immigrants, refugees, and migrants, there is a critical need for innovative interventions that can overcome barriers to traditional mental health care. VR therapy has shown promising results in treating a variety of mental health conditions, offering immersive and engaging experiences that can be tailored to individual needs and preferences.
Aims
The project aims to develop and implement VR-based therapy programs to improve mental health outcomes among diverse populations, including immigrants, refugees, and migrants. By providing accessible and culturally responsive interventions, we aim to reduce stigma, increase access to care, and promote well-being in underserved communities.
Methods
The project will employ a mixed-methods approach, combining qualitative and quantitative research methodologies. Qualitative data will be collected through interviews and focus groups to explore participants' experiences, preferences, and perceived benefits of VR therapy. Quantitative data will be gathered through pre- and post-intervention assessments to measure changes in mental health symptoms, quality of life, and other relevant outcomes. The population will include individuals from diverse cultural backgrounds, with a focus on reaching underserved communities. The procedures will involve the development and implementation of VR therapy protocols, followed by data collection and analysis using validated measures.
Preregistration of the study protocol and analysis plan will be conducted through the Open Science Framework (OSF).
References
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Riva, G., & Gaggioli, A. (2018). Virtual reality in psychotherapy: Review. Cyberpsychology, Behavior, and Social Networking, 21(9), 497-506.
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Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 47(14), 2393-2400.
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Valmaggia, L. R., Latif, L., Kempton, M. J., & Rus-Calafell, M. (2016). Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence. Psychiatry Research, 236, 189-195.
6. eResilience: Cultural Adaptation of a Digital Trauma Intervention for Palestinians
Project Leader: Janaina V. Pinto, Sao Paulo, Brazil
Project Group:
Organization: Sync Body-Brain Health, Australian-registered charity organization. Currently looking for Palestinian collaborators. Please contact the project leader if interested.
Background
The ongoing humanitarian emergency in Gaza has created an urgent need for psychological support for Palestinians experiencing post-traumatic stress. Low-resource settings, particularly under attack, pose a great challenge for the delivery of evidence-based care, calling for brief and scalable solutions. The eResilience App is a self-guided digital intervention developed to aid large-scale trauma response efforts in low-resource settings. The 7-day clinical curriculum consists of body-based, cognitive, and interpersonal tools from mixed trauma treatment modalities. A clinical trial examining the preliminary efficacy of the individual curriculum version of the App among resettled African refugees documented significant reductions in clinical symptomatology sustained up to 12 months post-intervention (Pinto et al, 2021, 2022). Recently, the eResilience curriculum was also adapted for Ukrainians. This adaptation, accessible via a dedicated website, incorporates additional resources specifically designed to address the unique psychological hurdles encountered by users engaged with the program in the context of active conflict.
Aims
This project aims to culturally adapt the eResilience intervention for Palestinians exposed to the present emergency. Alongside web and mobile digital access, the adapted curriculum will be produced as audio files for radio broadcast due to the current limited access to electricity and data services in Gaza. When safe and ethically appropriate, additional research will be proposed to include the collection of field data pre and post intervention among users of the culturally-adapted curriculum.
Methods
The intervention adaptation will be guided by a 17-item framework outlined on a systematic review of 55 studies of cross-cultural adaptation of internet and mobile interventions (Spanhel et al., 2021). The first 10 items consist of content components, including illustrated characters, activities, environmental burdens, values and traditions; language translation, tailoring, and visualisation; difference in concepts of mental health and its treatment; goals of treatment; and methods of treatment. Four additional items in the adaptation framework relate to methodological components, including intervention structure (e.g, shorten intervention; eliminate repeating content; changes in texts; simplify introduction; add optional intervention elements); functionality (e.g., provide more explanations; simplify navigation; access with low internet quality); design and aesthetics (e.g., adjust illustrations; user interface) and guidance (e.g., person used as guide; format of guidance, amount of guidance). Lastly, the framework includes three procedural components including the methods used to obtain information, persons involved (professionals and target group), and theoretical framework. Palestinian consultants will participate in 12 meetings with researchers during a 6-month period to discuss the curriculum, adaptation components, terminology, fidelity, and ethical considerations. Feedback for the media content will be collected online. Amendments to the intervention will be made in accordance with the consensus of the consultation group.
Are you a researcher, clinician, or organization working in Palestine? Then contact Janaina V. Pinto.
References
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Pinto, J. V, Goninon, E. J., Sart (2021). Advancing PTSD Diagnosis, Treatment, and Dissemination of Trauma Care in Humanitarian Emergencies: Findings from the eResilience App Clinical Trial. https://doi.org/10.1037/TMS0000012
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Pinto, J. V., Hunt, C., & O’Toole, B. (2022). Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial. JMIR Research Protocols, 11(6). https://doi.org/10.2196/3822
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Spanhel, K., Balci, S., Feldhahn, F., Bengel, J., Baumeister, H., & Sander, L. B. (2021). Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digital Medicine, 4(1). https://doi.org/10.1038/S41746-021-00498-1
References
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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
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Olff, M. & Schnyder, U. (2021). The Global Collaboration on Traumatic Stress. ISTSS StressPoints, Jan 2021. https://istss.org/public-resources/trauma-blog/2021-january/the-global-collaboration-on-traumatic-stress
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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