Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees: description and evaluation

Abstract

Introduction: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail.
 Purpose: To describe and evaluate a manualized cognitive behavioral therapy for traumatized refugees incorporating exposure therapy, mindfulness and acceptance, and commitment therapy.
 Material and methods: 85 patients received six months’ treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient was monitored in detail. The changes in mental state and the treatment components associated with change in state were analyzed statistically.
 Results: Despite the low level of functioning and high co-morbidity of patients, 42% received highly structured CBT, which was positively associated with all treatment outcomes. The more methods used and the more time each method was used, the better the outcome. The majority of patients were able to make homework assignments and this was associated with better treatment outcome. Correlation analysis showed no association between severity of symptoms at baseline and the observed change.
 Conclusion: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must be adapted to the special needs of refugees and trauma exposure should be further investigated.

Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

“…The Reliable Change Index (RCI) is a measure of the minimum individual change in pre-to post-treatment ratings, which is statistically significant. 20 In addition to descriptive statistics, linear univariate and multivariate regression models were used to investigate possible associations between change in the patient's state and potential predictors of change. Change was measured as the difference between ratings at baseline and at follow-up, and all regression models were adjusted for baseline scores.…”

“…The strength of the study is the detailed description of the patients at baseline, and of the treatment they received. 20,23 This study is one of the first to evaluate a standardized treatment described in detail in manuals and documented thoroughly during treatment. This has enabled us to ensure that the group actually receives the same intervention,…”

“…The psychotherapy-related variables are described in detail in a separate article. 20 The treatment at the clinic was standardized and described in manuals which all physicians and clinical psychologists followed to the extent possible (see Figure 1).…”

Somatic comorbidity among migrants with posttraumatic stress disorder and depression – a prospective cohort study

“…Nonetheless, two published papers describing the trauma-affected refugees at the time of referral to CTP, from the same period find that the mean number of years since the first trauma was 22 years and the mean number of years with mental health problems as recalled by the patients were 14.7 years, similar to the time of arrival in Denmark. From these studies we expect that the number of years with mental health problems is substantial when admitted to treatment [51, 52]. …”

The importance of using reflective practice when working with refugees, asylum seekers and survivors of torture within IAPT

“…PTSD is arguably the most prevalent and researched psychological disorder identified in refugee populations (Johnson and Thompson, 2008). Furthermore, the clinical presentation of comorbid symptoms is common and can include somatic or pain symptoms (Buhmann et al ., 2015), depression (Rasmussen et al ., 2012; Naja et al ., 2016) and anxiety disorders (Heeren et al ., 2014).…”