Psychotherapeutic Group Intervention for Traumatized Male Refugees Using Imaginative Stabilization Techniques—A Pilot Study in a German Reception Center

Abstract

Background: Due to persecution, human rights violations and armed conflicts, the prevalence of post-traumatic stress disorder (PTSD) is high in refugee populations. Previous studies indicate that trauma-focused treatments are highly effective in treating PTSD in refugees. However, these approaches rely on the stability of the therapeutic setting, treatment continuity, and safe housing. Although early treatment of PTSD is recommended, these requirements are not met in reception centers. Therefore, we conducted a pilot study to examine the effect of imaginative stabilization techniques derived from psychodynamic psychotraumatology therapy for the early stabilization of traumatized refugees in a reception center.Methods: From May 2017 to April 2018, 86 imaginative stabilization group therapy sessions have taken place. A sample of 43 out of 46 traumatized refugees completed self-report questionnaires assessing PTSD, depression, and anxiety symptoms prior to attending open imaginative stabilization group therapy sessions. Furthermore, participants filled in self-report questionnaires on distress and emotional state (valence/arousal/dominance) before and after each session. After having participated in four consecutive sessions, a sub-group of 17 participants completed a follow-up assessment of PTSD, depression, and anxiety symptoms. Follow-up interviews were conducted with 25 participants 2 weeks after their last session attendance to explore self-practice habits post intervention.Results: The pre-post-intervention comparison of scores indicated a significant reduction of distress (z = −3.35, p < 0.001, r = −0.51) and an improvement of affective reports for valence (z = −4.79, p < 0.001, r = −0.82) and dominance (z = −3.89, p < 0.001, r = −0.59), whereas arousal scores were not affected. We found a significant reduction of anxiety symptoms (z = −2.04, p < 0.05, r = −0.49), whereas PTSD and depression scores remained unchanged. Follow-up interviews revealed that 80% of the participants continued to practice the imaginative stabilization techniques after redistribution to other accommodation.Conclusion: The results indicate that imaginative stabilization techniques are a promising and feasible approach to treat refugees in unstable reception center settings. In regular imaginative stabilization group therapy sessions, we were able to reduce the participants' distress and anxiety symptoms while strengthening their internal resources and increasing their emotional stability.

Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study

“…The MP3 format appears to be a robust and simple format available offline for everyone. In a study by Zehetmair et al [ 14 ] assessing stabilizing and guided imagery techniques in a group setting, participating refugees voiced a desire for instructions to facilitate practicing the techniques between the face-to-face group sessions. By developing an audio-based approach in this study, every participant always had the technique instructions with them.…”

“…The audio file consisted of three parts, namely (1) mindful breathing, (2) the body scan, and (3) the guided imagery technique “The Inner Safe Place,” which are described in more detail elsewhere [ 13 , 14 ]. The audio files were available in English, Arabic, Farsi, French, Turkish, and Serbian (spoken by about 80% of the refugee population in the PHV).…”

“…Evidence is growing that stabilization techniques positively affect refugees’ mental health [ 7 - 9 ]. In this context, stabilizing and guided imagery techniques in line with Reddemann [ 10 ] are promising treatment approaches for adult and minor refugees with PTSD in individual and group therapy approaches [ 11 - 14 ]. The use of stabilizing and guided imagery techniques seems helpful in securing an initial emotional stabilization even under unstable conditions [ 13 , 14 ].…”

“…In this context, stabilizing and guided imagery techniques in line with Reddemann [ 10 ] are promising treatment approaches for adult and minor refugees with PTSD in individual and group therapy approaches [ 11 - 14 ]. The use of stabilizing and guided imagery techniques seems helpful in securing an initial emotional stabilization even under unstable conditions [ 13 , 14 ]. However, all face-to-face therapeutic interventions with refugees face problems of language heterogeneity and the need for space, time, and human resources.…”

“…This study builds on earlier studies using stabilizing and guided imagery techniques in newly arrived refugees [ 13 , 14 ] to evaluate traumatized refugees’ self-practice of stabilizing and guided imagery techniques via digital audio files using in-depth qualitative analysis. Our research questions were the following: (1) What kind of practicing behavior is shown?…”