The treatment of PTSD in refugees and asylum seekers using imagery rescripting within an NHS setting.

BACKGROUND: Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service. AIMS: To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers. METHOD: Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression. RESULTS: Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors. CONCLUSIONS: Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.

A paradigm for the study of paranoia in the general population: the Prisoner's Dilemma Game.

A growing body of research shows that paranoia is common in the general population. We report three studies that examined the Prisoner's Dilemma Game (PDG) as a paradigm for evaluation of non-clinical paranoia. The PDG captures three key qualities that are at the heart of paranoia--it is interpersonal, it concerns threat, and it concerns the perception of others' intentions towards the self. Study 1 (n=175) found that state paranoia was positively associated with selection of the competitive PDG choice. Study 2 (n=111) found that this association was significant only when participants believed they were playing the PDG against another person, and not when playing against a computer. This finding underscores the interpersonal nature of paranoia and the concomitant necessity of studying paranoia in interpersonal context. In Study 3 (n=152), we assessed both trait and state paranoia, and differentiated between distrust- and greed-based competition. Both trait and state paranoia were positively associated with distrust-based competition (but not with greed-based competition). Crucially, we found that the association between trait paranoia and distrust-based competition was fully mediated by state paranoia. The PDG is a promising paradigm for the study of non-clinical paranoia.