The feasibility of prolonged exposure therapy for PTSD in low- and middle-income countries: a review

Booysen, Duane D.; Kagee, Ashraf

doi:10.1080/20008198.2020.1753941

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…The majority of these studies reported on mental health programs in low- and middle-income countries generally 10,11,20,23,27,29–31,37–39,41,42,44,47,49,51,52,54,56,58,60,61,63,73 . Other reviews focused on specific continents (Africa, 32,36,64 Asia 28,68 ), countries or sovereign states (Brazil, 33 China, 50,53 Colombia, 72 Georgia, 55 Ghana, 46,59 India, 22,45 Jordan, 48 Kenya, 66 Lebanon, 21,71 Palestine, 69 Peru, 43 Philippines, 70 Solomon Islands, 35 South Africa, 25,40 Uganda 34 ), regions (Latin America, 57 the Middle East, 26,62 countries neighboring Syria 65 ), or specific contexts (humanitarian or conflict settings 24,67 ).…”

Section: Resultsmentioning

confidence: 99%

“…Low- and middle-income countries were defined using the World Bank’s country and lending groups 19 . We extracted information on determinants of mental health services implementation and the relationship between determinants from included studies, which are detailed in Supplemental Table 2, http://links.lww.com/HRP/A163 10,11,20–73 . Determinants were defined as the barriers and facilitators of mental health services implementation.…”

Section: Methodsmentioning

confidence: 99%

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Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries

Greene

Huang

Giusto

et al. 2021

Harv Rev Psychiatry

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Advancements in global mental health implementation research have revealed promising strategies for improving access to evidence-based mental health care. These advancements have not translated, however, into a reduced prevalence of mental disorders. In this review we examine the relationships between determinants (i.e., barriers and facilitators) and outcomes of mental health services in low- and middle-income countries to identify opportunities for improving the population-level impact and sustainability of innovations in global mental health. We identified three key implementation and services outcomes that influenced the prevalence of mental disorders in the 56 included review articles: supply (access, implementation), demand (help seeking, utilization), and quality (effectiveness, quality of care) of mental health services. Determinants of these outcomes revealed seven themes: community stakeholder engagement; cultural relevance; stigma; human resource capacity; organization of services; governance, policy, and financing; and sociopolitical and community context. We developed a causal loop diagram to illustrate the relationships among these determinants and outcomes. The causal loop diagram revealed the central role of community stakeholder engagement in bridging implementation and patient outcomes, the importance of addressing stigma and social determinants of mental health, and the need to complement supply-side implementation strategies with approaches to equilibrate demand and improve the quality of services. Applying systems science methodologies to global mental health research presents an opportunity to examine the complex relationships among community and health system factors that influence implementation of evidence-based interventions in order to identify sustainable approaches to improve the population-level impact of mental health services in low- and middle-income countries.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries

Greene

Huang

Giusto

et al. 2021

Harv Rev Psychiatry

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“…The psychological treatment of post-traumatic stress disorder (PTSD) in low-and middleincome countries (LMICs) is a global mental health priority (Booysen & Kagee, 2020a;Koenen et al, 2017). Yet, the dissemination and implementation of trauma-focused treatments in LMICs are hindered by socio-political instability and limited access to evidence-based mental health care (Chen et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

The double burden of treating traumatic stress in low-resource communities: experiences and perspectives of non-specialist health workers in South Africa

Booysen

Kagee

2021

South African Journal of Psychology

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Considering the global trend towards the dissemination and implementation of trauma-focused treatments in the majority of the world, it is imperative to ascertain the contextual factors which affect the treatment of traumatic stress, especially in low- and middle-income countries characterised by ongoing adversity such as poverty and increased levels of trauma exposure. We explored the experiences of non-specialist health workers whose work involved providing trauma-focused services in low-resource communities in South Africa. Participants ( n = 18) worked at four non-governmental organisations in the Eastern Cape and Western Cape of South Africa. Semi-structured individual interviews were conducted and analysed using a phenomenologically informed thematic analysis. Two superordinate themes were identified, namely, adjusting to trauma-focused work and trauma in the social context. Five themes that made up the superordinate themes were Encountering Trauma Narratives, Support and Resilience, Going the Extra Mile, Helplessness, and Social Factors. The findings are not only in keeping with the psychological risks of trauma-focused work (e.g., vicarious traumatisation) but also highlighting the impact of the social context on the provision of trauma-focused work. Participants reported experiencing an added burden of helplessness due to social factors, such as poverty and high levels of trauma exposure, which affect the process of treating traumatic stress in low-resource settings. We discuss how these findings can contribute to efforts to implement trauma-focused services in low- and middle-income countries.

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“…For example, structural limitations such as limited health infrastructure and trained professionals can impede the implementation of effective therapies such as PE. 26 Moreover, on an epistemological and ideological level, critical psychology and cultural relativity perpetuate a parochial dichotomy between empirical psychology (i.e. PE) and what is a so-called relevant psychology (i.e.…”

Section: Discussionmentioning

confidence: 99%

Trauma survivors’ perceptions and experiences of prolonged exposure for PTSD at a psychology clinic

Booysen¹,

Kagee²

2023

S. Afr. J. Psych.

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Background: Several trauma-focused treatments have been developed to treat post-traumatic stress disorder (PTSD). Yet there are limited studies on how trauma survivors perceive and experience trauma-focused treatments such as prolonged exposure therapy (PE) for PTSD, especially in low- and middle-income countries (LMIC).Aim: The study aimed to explore the perceptions and experiences of trauma survivors receiving prolonged exposure therapy for PTSD and the general acceptability of PE for PTSD in a LMIC.Setting: The study was conducted at a community psychology clinic in the Eastern Cape, South Africa.Method: Using a qualitative method, seven adult trauma survivors who completed six sessions of brief PE for PTSD were interviewed. Thematic analysis was used to identify relevant themes and to understand how participants perceived and experienced PE for PTSD.Results: The analysis yielded five themes, namely structure, obstacles, gender, exposure and experiences of recovery.Conclusion: The findings suggested that participants perceived and experienced PE to be generally beneficial for the treatment of PTSD. Moreover, the study suggested that PE is an acceptable trauma therapy in a contextually diverse setting such as the Eastern Cape, South Africa. Overall, considering the evidence base of PE for PTSD, this study contributed to the literature on the acceptability of PE in a South African setting.Contribution: The findings of the study are in keeping with the extant literature on how persons perceive and experience PE for PTSD. The findings of the study suggests that PE is an acceptable and beneficial trauma therapy for PTSD in a contextually diverse setting such as South Africa. It is recommended that large scale implementation studies be conducted to further investigate the effectiveness, feasibility, and acceptability of PE in South Africa.

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The feasibility of prolonged exposure therapy for PTSD in low- and middle-income countries: a review

Cited by 14 publications

References 35 publications

Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries

Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries

The double burden of treating traumatic stress in low-resource communities: experiences and perspectives of non-specialist health workers in South Africa

Trauma survivors’ perceptions and experiences of prolonged exposure for PTSD at a psychology clinic

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