STARC-SUD - Adaptation of a Transdiagnostic Intervention for Refugees With Substance Use Disorders.

Background: Refugees often suffer from multiple mental health problems, which transdiagnostic interventions can address. STARC (Skills-Training of Affect Regulation - A Culture-sensitive Approach) is a culturally sensitive transdiagnostic group intervention that has been developed for refugees to improve affect regulation. In refugees with substance use disorders (SUD), the consideration of SUD-specific elements might improve the acceptance and effectiveness of such an intervention. We aimed to adapt the STARC program for refugees with SUD in a culturally sensitive way. Method: The conceptual framework of Heim and Kohrt (2019) was used to culturally sensitively adapt the STARC program to the needs of Syrian refugees with SUD. The results of five focus group discussions with refugees on cultural concepts of SUD and their treatment informed the adaption. An expert group suggested adaptions and decided by consensus on their implementation. Two pilot groups were conducted with the adapted STARC-SUD program. Interviews with the therapists of these pilot groups informed further adaption. Results: The concepts related to SUD identified in focus groups and therapists' interviews that differed from Western concepts were integrated into the STARC intervention. Discussion: Further studies should assess the acceptance and effectiveness of the culturally sensitive STARC-SUD program for refugees with SUD.

Effectiveness of a transdiagnostic group intervention to enhance emotion regulation in young Afghan refugees: A pilot randomized controlled study.

There are several challenges to providing mental health care for refugees, including high comorbidity and structural barriers. Targeting transdiagnostic processes in a low-threshold group intervention appears particularly promising to meet these challenges. This study examined the feasibility, acceptability and effectiveness of a new transdiagnostic intervention, Skills-Training of Affect Regulation-A Culture-sensitive Approach (STARC), focusing on conveying strategies to improve emotional clarity and to regulate emotions. A parallel-group (STARC vs. waitlist) randomized-controlled study with 44 young male Afghan refugees was conducted in a routine clinical setting (NCT03162679). In intention-to-treat analyses, participants of STARC significantly improved in self-reported difficulties in emotion regulation (ΔdSTARC-Waitlist = 1.22), transdiagnostic symptom severity (ΔdSTARC-Waitlist = 1.69), posttraumatic stress symptoms (ΔdSTARC-Waitlist = 1.19), and caregiver-reported emotional competence (ΔdSTARC-Waitlist = -0.90), but not anger reactions (ΔdSTARC-Waitlist = 0.50) compared to waitlist. Effects were maintained over 3 months. STARC is a feasible transdiagnostic intervention in a routine clinical setting and effective for young Afghan refugees. If replicated in large-scale studies with active control groups, it might be promising as an initial low-threshold intervention offered in a phased-based and/or stepped care approach.

Emotion regulation as a transdiagnostic factor in Afghan refugees.

OBJECTIVE: In response to the high rates of comorbidity as well as the severe social impairment among refugees, the examination of transdiagnostic factors such as emotion regulation appears particularly promising in this group. This study investigates the contribution of difficulties in emotion regulation to the self-reported symptom levels of posttraumatic stress disorder (PTSD), depression, and anxiety/insomnia, which are highly prevalent symptoms among refugees. In addition, the link between emotion regulation and social impairment is examined. METHOD: Participants were 74 male Afghan refugees exposed to trauma. They completed measures of trauma exposure, difficulties in emotion regulation (Difficulties in Emotion Regulation Scale), PTSD (PTSD Checklist for DSM-5), depression, anxiety/insomnia, and social impairment (General Health Questionnaire-28). RESULTS: Higher symptom severities of PTSD, depression, and anxiety/insomnia were related to the Difficulties in Emotion Regulation Scale subscales nonacceptance, goals, impulse, strategies, and clarity, but none of our outcomes was related to lack of emotional awareness. Difficulties in emotion regulation accounted for significant variance in PTSD, depression, and anxiety/insomnia beyond demographics and trauma exposure. When predicting social impairment, difficulties in emotion regulation accounted for significant variance beyond PTSD and anxiety/insomnia but not beyond depression. CONCLUSION: The findings indicate that emotion regulation may be a transdiagnostic key factor contributing to symptoms of different mental disorders as well as social impairment in trauma-exposed refugees. It highlights the need and potential directions for transdiagnostic interventions that target these difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Quality of life and predictors of long-term outcome after severe burn injury.

The aim of this study was to identify the long-term quality of life after severe burn injury. In a prospective longitudinal design, N = 265 burn patients were examined 6, 12, 24, and 36 months after burn injury. A multilevel approach was used to measure stability and change in self-reported health status. Besides injury-related variables, self-report instruments included measures of quality of life, psychological distress, personality, and specific burn outcome measures. Fitting of unconditional growth models indicated that there was significant intra- and inter-individual variation in self-reported physical and mental health short form-12. Over the course of 3 years, participants reported on average a slight improvement of physical quality of life. Physical health was mainly predicted by mobility and level of burn severity. Variance in mental health status was mainly predicted by gender, mobility, neuroticism, level of depression and posttraumatic stress disorder (PTSD)-related avoidance. Thus mobility (i.e., simple abilities) seems a crucial variable for overall quality of life. An early identification and treatment of patients with high levels of depression and PTSD-related avoidance may contribute to better mental health.

Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design.

OBJECTIVE: Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees. DESIGN: In a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index. RESULTS: The CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group. CONCLUSION: Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need replication in a larger trial.

Posttraumatic growth, optimism and openness as outcomes of a cognitive-behavioural intervention for posttraumatic stress reactions.

The aim of this study was to examine the effect of an Internet-based CBT intervention on posttraumatic growth, openness and optimism. Ninety-six participants suffering from posttraumatic stress reactions were randomly assigned to either the treatment or a waiting-list control condition. We assessed posttraumatic stress reactions, depression and anxiety, posttraumatic growth, optimism and openness to new experiences. We found significant changes in posttraumatic growth in the treatment group. In addition regression analysis revealed that symptom improvements in posttraumatic stress reactions significantly predicted posttraumatic growth post-treatment. Our findings indicate the potential of psychotherapy to stimulate posttraumatic growth.

Chronic pain and PTSD: the Perpetual Avoidance Model and its treatment implications.

Posttraumatic Stress Disorder (PTSD) and chronic pain are frequently seen in the aftermath of a traumatic experience. Torture survivors have an increased risk to suffer from these two disorders. Although many studies report high comorbidity,there is still insufficient knowledge on the mechanisms of the development and maintenance of PTSD and chronic pain. After providing an overview of the current literature concerning the comorbidity of these two disorders, we will present the "Perpetual Avoidance Model" (PAM). This model provides an explanation of the reciprocal maintenance of both disorders and offers treatment implications.