Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Otto, Michael W.; Hinton, Devon E.; Korbly, Nicole B.; Chea, Andrea; Ba, Phalnarith; Gershuny, Beth S.; Pollack, Mark H.

doi:10.1016/s0005-7967(03)00032-9

Cited by 190 publications

(148 citation statements)

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“…It is notable that among the treatment effects observed in our small pilot study of Cambodian women with PTSD (Otto et al, 2003), we obtained particularly large effect sizes for the benefits of CBT relative to the control condition for measures of fears of somatic sensations.…”

Section: Providing New Information Relative To Culturally-specific Bementioning

confidence: 67%

“…Also, we restricted our sample to women, who, among Southeast Asian refugees, have been found to have higher symptom levels than men (Chung, Bemak, & Kagawa-Singer, 1998), although we encountered no reasons to believe our treatment efforts would not be appropriate for Cambodian men. In a very small randomized trial for this distressed and treatment-resistant cohort, we found that our modified CBT offered benefit over a comparison treatment on the order of large effect sizes (Otto et al, 2003). Similar treatment elements were also applied successfully to a sample of Vietnamese refugees with PTSD and panic disorder (Hinton, Pham, Bird, Tran, & Otto, submitted for publication).…”

mentioning

confidence: 83%

“…We conceptualized our project on modifying CBT for the treatment of PTSD in Cambodian refugees as both a small clinical trial (Otto et al, 2003) and a dissemination project to ensure that empirically supported psychotherapy was being offered to patients in particular need.…”

Section: Concluding Commentsmentioning

confidence: 99%

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Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

Otto

Hinton

2006

Cognitive and Behavioral Practice

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Cambodian refugees represent a severely traumatized population living in the United States. In this paper, we describe the modification of a cognitive-behavior therapy program to facilitate delivery of an exposure-based treatment for posttraumatic stress disorder while addressing some of the challenges brought by differences in language and culture between providers and patients. Our treatment modifications include the use of metaphors and culturally relevant examples to aid the communication of core concepts by interpreters, an emphasis on teaching the "process" of exposure therapy rather than relying on specific exposure practice in the group setting, a focus on interoceptive exposure to allow more effective group practice and to address culturally specific symptom interpretations, attention to the way in which treatment procedures interacted with culturally specific beliefs, and efforts to integrate treatment services within the community. Although data are limited, results to date suggest that this modified treatment was acceptable to patients and offered benefits on the order of large effect sizes.

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Section: Providing New Information Relative To Culturally-specific Bementioning

confidence: 67%

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confidence: 83%

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Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

Otto

Hinton

2006

Cognitive and Behavioral Practice

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“…PARTICIPANTS-In the second study, we pooled the results from two published CBT outcome studies [for details, see Hinton et al, 2005a;Otto et al, 2003] and one just completed study in order to obtain a large sample with PTSD and comorbid orthostatic panic. The sample size consisted of 56 patients, with 28 in waitlist, 28 in active treatment.…”

Section: Study II Methodsmentioning

confidence: 99%

The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

Hinton

Hofmann

Pitman

et al. 2008

Cognitive Behaviour Therapy

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This article examines the ability of the "Panic Attack-PTSD Model" to predict how panic attacks are generated and how panic attacks worsen posttraumatic stress disorder (PTSD). The article does so by determining the validity of the Panic Attack-PTSD Model in respect to one type of panic attacks among traumatized Cambodian refugees: orthostatic panic (OP) attacks, that is, panic attacks generated by moving from lying or sitting to standing. Among Cambodian refugees attending a psychiatric clinic, we conducted two studies to explore the validity of the Panic Attack-PTSD Model as applied to OP patients, meaning patients with at least one episode of OP in the previous month. In Study 1, the "Panic Attack-PTSD Model" accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis-associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious-depressive distress (SCL subscales), and OP severity significantly mediated the effect of anxious-depressive distress on CAPS severity. In Study 2, as predicted by the Panic Attack-PTSD Model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a CBT study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.

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“…166 A group psychosocial intervention for mothers displaced by war was associated with gains in terms of mother and child mental health. 126 CBT and medication were effective in the management of PTSD in refugees 165 and CBT was effective in the management of PTSD and panic among refugees. 137 Home visits by school nurses and bilingual teachers reduced depression in South East Asian refugees.…”

Section: Asylum Seekersmentioning

confidence: 99%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Cited by 190 publications

References 10 publications

Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

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