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Successfully treating refugees’ post-traumatic stress symptoms in a Ugandan settlement with group cognitive behaviour therapy

Published online by Cambridge University Press:  01 September 2020

Elsa J. Goninon ,
Lee Kannis-Dymand ,
Robi Sonderegger ,
Doddy Mugisha  and
Geoff P. Lovell Open the ORCID record for Geoff P. Lovell [Opens in a new window]
Elsa J. Goninon*
Affiliation:
School of Social Sciences, University of the Sunshine Coast, Queensland, Australia
Lee Kannis-Dymand
Affiliation:
Sunshine Coast Mind & Neuroscience – Thompson Institute, School of Social Sciences, University of the Sunshine Coast, Queensland, Australia
Robi Sonderegger
Affiliation:
Family Challenge Australia, Queensland, Australia
Doddy Mugisha
Affiliation:
Tutapona, Uganda
Geoff P. Lovell
Affiliation:
School of Social Sciences, University of the Sunshine Coast, Queensland, Australia Department of Sport, Hartpury University, UK
*
*Corresponding author. Email: elsa.goninon@gmail.com
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Abstract

Background:

High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations.

Aims:

To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees’ post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes.

Method and Results:

Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes.

Discussion:

A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees’ PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.

Keywords

AfricaCBTgrouppost-traumatic stressPTSDrefugeesettlementtraumaUganda
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 1 , January 2021 , pp. 35 - 49
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Andrew, A. K. (2016). Health status and quality of health care services of Congolese refugees in Nakivale, Uganda. Journal of Food Research, 5, 39–54. doi: 10.5539/jfr.v5n3p39 CrossRefGoogle Scholar
Bhugra, D., & Becker, M. A. (2005). Migration, cultural bereavement and cultural identity. World Psychiatry, 4, 18–24. Retrieved from: www.ncbi.nlm.nih.gov/pmc/articles/PMC1414713/ Google ScholarPubMed
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90. doi: 10.1007/BF02105408 CrossRefGoogle ScholarPubMed
Bogic, M., Njoku, A., & Priebe, S. (2015). Long-term mental health of war-refugees: a systematic literature review. BioMed Central International Health and Human Rights, 15, 1–41. doi: 10.1186/s12914-015-0064-9 Google ScholarPubMed
Buhmann, C., Mortensen, E. L., Nordentoft, M., Ryberg, J., & Ekstrøm, M. (2015). Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees. Torture Journal, 25, 1–16. doi: 10.7146/torture.v25i1.109505 Google Scholar
Carlson, E. B. (2001). Psychometric study of a brief screen for PTSD: assessing the impact of multiple traumatic events. Assessment, 8, 431–441. doi: 10.1177/107319110100800408 CrossRefGoogle ScholarPubMed
Čavić, T., & Pejović, M. (2005). Evaluation of group cognitive psychotherapy of post-traumatic stress disorder. Psihijatrija Danas, 37, 307–322. Retrieved from: http://scindeks.ceon.rs/article.aspx?artid=0350-25380502307C Google Scholar
Cloitre, M., Petkova, E., Su, Z., & Weiss, B. J. (2016). Patient characteristics as a moderator of posttraumatic stress disorder treatment outcome: combining symptom burden and strengths. British Journal of Psychiatry Open, 2, 101–106. doi: 10.1192/bjpo.bp.115.000745 CrossRefGoogle Scholar
Cohen, J. (1973). Eta-squared and partial eta-squared in fixd factor ANOVA designs. Educational and Psychological Measurement, 33, 107–112. doi: 10.1177/001316447303300111 CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behaviors Science (2nd edn). Hillsdale, NJ, USA: Laurence Erlbaum Associates.Google Scholar
Crisp, J. (2010). Forced displacement in Africa: dimensions, difficulties, and policy directions. Refugee Survey Quarterly, 29, 1–27. doi: 10.1093/rsq/hdq031 CrossRefGoogle Scholar
Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., … & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141. doi: 10.1016/j.cpr.2015.10.003 CrossRefGoogle ScholarPubMed
Dückers, M. L., Alisic, E., & Brewin, C. R. (2016). A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. British Journal of Psychiatry, 209, 300–305. doi: 10.1192/bjp.bp.115.176628 CrossRefGoogle ScholarPubMed
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345. doi: 10.1016/S0005-7967(99)00123-0 CrossRefGoogle ScholarPubMed
Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., … & Manley, J. (2013). Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51, 742–752. doi: 10.1016/j.brat.2013.08.006 CrossRefGoogle Scholar
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet, 365, 1309–1314. doi: 10.1016/S0140-6736(05)61027-6 CrossRefGoogle ScholarPubMed
Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451. doi: 10.1037/1040-3590.9.4.445 CrossRefGoogle Scholar
Garcia, H. A., Kelley, L. P., Rentz, T. O., & Lee, S. (2011). Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans. Psychological Services, 8, 1–11. doi: 10.1037/a0022705 CrossRefGoogle Scholar
Gerritsen, A. A., Bramsen, I., Devillé, W., van Willigen, L. H., Hovens, J. E., & Van Der Ploeg, H. M. (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 41, 18–26. doi: 10.1007/s00127-005-0003-5 CrossRefGoogle ScholarPubMed
Glass, G. V., Peckham, P. D., & Sanders, J. R. (1972). Consequences of failure to meet assumptions underlying the fixed effects analyses of variance and covariance. Review of Educational Research, 42, 237–288. doi: 10.3102/00346543042003237 CrossRefGoogle Scholar
Haagen, J. F., ter Heide, F. J. J., Mooren, T. M., Knipscheer, J. W., & Kleber, R. J. (2017). Predicting post-traumatic stress disorder treatment response in refugees: multilevel analysis. British Journal of Clinical Psychology, 56, 69–83. doi: 10.1111/bjc.12121 CrossRefGoogle ScholarPubMed
IBM Corporation (2016). IBM SPSS Statistics for Windows (version 24.0). Armonk, NY, USAr.Google Scholar
Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric Disease and Treatment, 7, 167–181. doi: 10.2147/NDT.S10389 CrossRefGoogle ScholarPubMed
Karunakara, U. K., Neuner, F., Schauer, M., Singh, K., Hill, K., Elbert, T., & Burnha, G. (2004). Traumatic events and symptoms of post-traumatic stress disorder amongst Sudanese nationals, refugees and Ugandans in the West Nile. African Health Sciences, 4, 83–93. Retrieved from: www.ncbi.nlm.nih.gov/pmc/articles/PMC2141616/ Google ScholarPubMed
Khawaja, N. G., White, K. M., Schweitzer, R., & Greenslade, J. H. (2008). Difficulties and coping strategies of Sudanese refugees: a qualitative approach. Transcultural Psychiatry, 45, 489–512. doi: 10.1177/1363461508094678 CrossRefGoogle ScholarPubMed
Lambert, J. E., & Alhassoon, O. M. (2015). Trauma-focused therapy for refugees: meta-analytic findings. Journal of Counseling Psychology, 62, 28–37. doi: 10.1037/cou0000048 CrossRefGoogle ScholarPubMed
Najavits, L. M. (2015). The problem of dropout from “gold standard” PTSD therapies. F1000prime Reports, 7. doi: 10.12703/P7-43 CrossRefGoogle Scholar
Neuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008). Treatment of posttraumatic stress disorder by trained lay counsellors in an African refugee settlement: a randomised controlled trial. Journal of Consulting and Clinical Psychology, 76, 686–694. doi: 10.1037/0022-006X.76.4.686 CrossRefGoogle Scholar
Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72, 579–587. doi: 10.1037/0022-006X.72.4.579 CrossRefGoogle Scholar
Onyut, L. P., Neuner, F., Ertl, V., Schauer, E., Odenwald, M., & Elbert, T. (2009). Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study. Conflict and Health, 3, 6–22. doi: 10.1186/1752-1505-3-6 CrossRefGoogle Scholar
Otto, M. W., Hinton, D., Korbly, N. B., Chea, A., Ba, P., Gershuny, B. S., & Pollack, M. H. (2003). Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behaviour Research and Therapy, 41, 1271–1276. doi: 10.1016/S0005-7967(03)00032-9 CrossRefGoogle ScholarPubMed
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement of refugees and internally displaced persons. Journal of the American Medical Association, 294, 610–612. doi: 10.1001/jama.294.5.602 Google ScholarPubMed
Sloan, D. M., Bovin, M. J., & Schnurr, P. P. (2012). Review of group treatment for PTSD. Journal of Rehabilitation Research & Development, 49, 689–702. doi: 10.1682/JRRD.2011.07.0123 CrossRefGoogle ScholarPubMed
Small, E., Kim, Y. K., Praetorius, R. T., & Mitschke, D. B. (2016). Mental health treatment for resettled refugees: a comparison of three approaches. Social Work in Mental Health, 14, 342–359. doi: 10.1080/15332985.2015.1080205 CrossRefGoogle Scholar
Sonderegger, R. (2011). EMPOWER: Making Life the Best It Can Be (3rd edn). Mooloolaba, Australia: Family Challenge Charitable Trust.Google Scholar
Sonderegger, R., Rombouts, S., Ocen, B., & McKeever, R. S. (2011). Trauma rehabilitation for war-affected persons in northern Uganda: a pilot evaluation of the EMPOWER programme. British Journal of Clinical Psychology, 50, 234–249. doi: 10.1348/014466510X511637 CrossRefGoogle ScholarPubMed
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Journal of the American Medical Association, 302, 537–549. doi: 10.1001/jama.2009.1132 CrossRefGoogle ScholarPubMed
Stenmark, H., Guzey, I. C., Elbert, T., & Holen, A. (2014). Gender and offender status predicting treatment success in refugees and asylum seekers with PTSD. European Journal of Psychotraumatology, 5, 20803. doi: 10.3402/ejpt.v5.20803 CrossRefGoogle ScholarPubMed
Thompson, C. T., Vidgen, A., & Roberts, N. P. (2018). Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: a systematic review and meta-analysis. Clinical Psychology Review, 63, 66–79. doi: 10.1016/j.cpr.2018.06.006 CrossRefGoogle ScholarPubMed
United Nations High Commissioner for Refugees (UNHCR) (2018). Global Trends: Forced Displacement in 2017. Retrieved from: https://www.unhcr.org/5b27be547#_ga=2.120267853.454341789.1545759826-2065567210.1545048163 Google Scholar
Van Dyk, G. A. J., & Nefale, M. C. (2005). The split-ego experience of Africans: Ubuntu Therapy as a healing alternative. Journal of Psychotherapy Integration, 15, 48–66. doi: 10.1037/1053-0479.15.1.48 CrossRefGoogle Scholar
van Wyk, S., Schweitzer, R., Brough, M., Vromans, L., & Murray, K. (2012). A longitudinal study of mental health in refugees from Burma: the impact of therapeutic interventions. Australian and New Zealand Journal of Psychiatry, 46, 995–1003. doi: 10.1177/0004867412443059 CrossRefGoogle ScholarPubMed
Wilker, S., Pfeiffer, A., Kolassa, S., Koslowski, D., Elbert, T., & Kolassa, I. T. (2015). How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population. European Journal of Psychotraumatology, 6, 1–10. doi: 10.3402/ejpt.v6.28306 CrossRefGoogle Scholar
Yalom, I. D., & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy (5th edn). New York, USA: Basic Books.Google Scholar
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