Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims.

Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

Random intercept cross-lagged relations among trauma coping self-Efficacy, trauma coping, and PTSD symptoms among rural hurricane survivors.

BACKGROUND AND OBJECTIVES: The trajectories of recovery and non-recovery following a disaster are well-documented, but the mechanisms of post-disaster adaptation remain poorly understood. Rooted in social cognitive theory and the transactional model of stress and coping, this study longitudinally investigated the reciprocal relations among coping self-efficacy (CSE), coping behaviors (approach and avoidant), and posttraumatic stress symptoms (PTSS) among highly exposed hurricane survivors. DESIGN: 261 Hurricane Florence survivors completed measures of hurricane-related CSE, coping behaviors, and hurricane-related PTSS across three timepoints, beginning 5-8.5 months after Hurricane Florence. METHOD: Random-intercept cross-lagged panel models investigated the relations among study variables. RESULTS: Reciprocal, cross-lagged relations were identified between higher CSE and approach coping from T2 to T3. The lagged relations between approach coping at T1 and T2 were significant, as well as between avoidant coping at T2 and T3. Significant cross-sectional relations were also present for CSE, coping behaviors, and PTSS at T3. CONCLUSIONS: Results provide partial support for the positive feedback loop involving CSE and approach coping, but not for the negative feedback loop involving avoidant coping. CSE may be an important mechanism in longer-term disaster recovery, in part by increasing use of approach coping.

Examining the Second-Order Factor Structure of the Gender Minority Stress and Resilience Scale.

The gender minority stress and resilience (GMSR) theory and associated measure are widely utilized in research investigating the stress, resilience, and psychological health experiences of gender nonconforming (GNC) individuals. GMSR theory specifies that distal stress and proximal stress experiences adversely affect the psychological health of GNC individuals, while resilience factors help buffer against these deleterious impacts. Moreover, GMSR theory clearly specifies a second-order factor structure such that distal stress experiences are comprised of gender-based victimization, rejection, discrimination, and non-affirmation; proximal stress experiences are comprised of internalized transphobia, negative expectations for the future, and gender identity nondisclosure; and pride and community connectedness constitute resilience factors. However, despite widespread use of the GMSR measure, including validating its use among Italian, Spanish, and adolescent GNC individuals, all research to date has only queried the first-order factor structure of the measure. The present study therefore evaluated the second-order factor structure of the GMSR measure among a sample of 234 GNC college students. Results suggested that the second-order factor structure provided a reasonable fit to the data but did not fit the data exceptionally well. Moreover, results suggested that the first-order factor structure with correlated factors provided a better fit to the data than did the second-order model. Thus, while this study found support for the second-order factor structure, it appears that the first-order structure may be better suited for research use. Secondarily, the GMSR measure appears valid for use among GNC undergraduates. Additional research is needed to further validate the measure's second-order factor structure, and future research should consider trimming redundant items from the GMSR to address known fit issues.

WhatsApp supervision for a lay-led Islamic trauma-focused intervention in Somaliland: Qualitative content analysis.

Clinical supervision is critical for the uptake of psychotherapy but difficult to facilitate in countries with limited providers, resources, and internet infrastructure. Innovative supervision approaches are needed to increase access to mental health treatments in low-to-middle income countries (LMICs). This study examined the content and feasibility of remote WhatsApp text supervision conducted as part of an open clinical trial in Somaliland. Islamic Trauma Healing ITH) is a brief, group, lay-lead, trauma-focused, mosque-based intervention that has demonstrated initial efficacy in pilot studies in the United States and Somaliland. After a 2-day, in-person training, lay leaders led four groups of five to seven members focused on trauma-related psychopathology and community reconciliation. Somali lay leaders trained in ITH (n = 9) and the research team (n = 6) attended weekly WhatsApp supervision during the intervention. Content was logged and subjected to qualitative analysis by two coders. Comments related to intervention implementation indicated that lay leaders understood the treatment rationale, adhered to treatment procedures, and believed the intervention components to be helpful and culturally relevant. Themes related to engagement suggested perfect attendance across groups and high levels of participation. Lay leader psychoeducation and skill development; supervisor praise, support, and encouragement; and supervisee gratitude emerged as additional themes. Remote text supervision conducted via WhatsApp was technologically feasible and may have facilitated skill development and the effective implementation of this lay-led intervention. When tailored to the local context, remote supervision approaches hold promise for increasing access to services in LMICs with limited resources.

The role of social connectedness in buffering the effects of discrimination on post-trauma cognitions in forcibly displaced Muslims.

INTRODUCTION: Among trauma-exposed, forcibly displaced Muslims, very little is known about how social connectedness, or perceived interpersonal connection and belonging, may alter the relationship between discrimination and negative posttraumatic cognitions. Discrimination may aggravate trauma psychopathology (Helms et al., 2010); however, social connectedness may buffer its negative effects (Juang & Alvarez, 2010). OBJECTIVE: We examined whether higher religious and racial/ethnic discrimination would be associated with stronger negative posttraumatic cognitions and whether stronger social connectedness may adaptively buffer this relationship. METHOD: Trauma exposed individuals (N = 99) who identified as Muslim and as a refugee, asylum seeker, or internally displaced person participated in the study. Measures of discrimination, social connection, and posttraumatic cognitions were completed. RESULTS: Higher discrimination was moderately associated with stronger negative trauma-related cognitions (r = .40, p < .001) and with lower social connectedness (r = -.32, p = .001). Social connectedness moderated the relationship between discrimination and posttraumatic cognitions, such that at lower levels of social connectedness there was a stronger relationship between discrimination and posttraumatic cognitions (-2SD: b = .32, -1SD: b = .23, M: b = .14), this was not present at higher levels of social connectedness. CONCLUSIONS: Connectedness to one's minority group may be an important protective factor by modulating the effects of discrimination on posttrauma adjustment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War.

Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors (N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD (g = 1.91), depression (g = 2.00), somatic symptoms (g = 2.73), and well-being (g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs. ClinicalTrials.gov Identifier: NCT03761732.

Islamic Trauma Healing: Integrating Faith and Empirically Supported Principles in a Community-Based Program.

Access to adequate, much less state-of-the-art, mental health care is a global problem. Natural disasters, civil war, and terrorist conflict have forcibly displaced millions of Muslims and have resulted in a remarkable level of individual and communitywide trauma exposure. As a result, many are at risk for posttraumatic stress and other trauma-related disorders. Many religiously oriented Muslims traditionally rely on Islamic principles and teachings, as well as their community, to cope with and address trauma-related distress. Islamic Trauma Healing is a six-session, lay-led group intervention developed within a Somali Muslim community that integrates evidence-based trauma-focused cognitive-behavioral therapy principles with cultural and religious practices aimed to enhance uptake and create an easily up-scalable intervention for a wide range of trauma. In sessions, narratives of prophets who have undergone trauma (e.g., Prophet Ayyub, faith during hard times) present Islamic principles and facilitate cognitive shifts. Group members spend individual time turning to Allah in dua (i.e., informal prayer), focused on exposure to trauma memories. Program themes arc across suffering to healing to growth following trauma. This paper describes the core theoretical principles and methods in the Islamic Trauma Healing program. We also describe leader perspectives and the program's train-the-trainer model, in which lay leaders are trained to further disseminate the program and allow Islamic Trauma Healing to be owned and sustained by the Muslim community.

Differences in Posttraumatic and Psychosocial Outcomes Among Refugees, Asylum Seekers, and Internally Displaced Persons.

Refugees, asylum seekers, and internally displaced persons differ in their experiences, potentially affecting posttraumatic outcomes such as posttraumatic stress disorder (PTSD) symptoms, posttraumatic cognitions, and posttraumatic growth (PTG), as well as psychosocial outcomes such as social connection, discrimination, and well-being. We explored these differences in a sample of N = 112 Muslim displaced persons. Results from planned contrasts indicated that refugees reported more PTSD symptoms (t[46.63] = 3.04, p = 0.004, d = 0.77) and more PTG (t[94] = 2.71, p = 0.008, d = 0.61) than asylum seekers. Higher posttraumatic cognitions predicted less social connections across displacement immigration category. The strength of this relationship was more pronounced for asylum seekers than refugees (b = -0.43, p = 0.014). Refugees may focus more on direct threats from others, resulting in more PTSD symptoms, whereas asylum seekers' uncertainty may pose a greater threat, exacerbating posttraumatic beliefs that drive social disconnection.