Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.     

Exploratory and confirmatory factor analyses of the structured interview for disorders of extreme stress

Two studies were conducted to provide the first empirical examination of the factor structure of a revised version of the clinically derived Structured Interview for Disorders of Extreme Stress, a structured interview designed to assess associated features of posttraumatic stress disorder (PTSD) thought to be related to early onset, interpersonal, and prolonged traumatic exposure. Five factors representing demoralization, somatic dysregulation, anger dysregulation, risk/self-harm, and altered sexuality were derived from an exploratory factor analysis conducted with adult trauma survivors in substance abuse treatment. They provided a good fit in a confirmatory factor analysis conducted in a second study with a nonclinical sample of ethnoculturally diverse, socioeconomically disadvantaged, incarcerated adults. Evidence of the derived factors' internal consistency and convergent and discriminant validity is reported. Evidence supported the association of these factors with interpersonal trauma (physical and/or sexual), its repetition, and its earlier onset. Implications for clinical assessment of complex posttraumatic stress disorder are discussed.     

Effects of social stress on tumor development in dominant male mice with diverse behavioral activity profiles

We examined the influence of individual psychological profile and social behavior on tumor development in dominant male mice. Male OF1 mice were subjected to an open field test (OFT) to observe their motor activity and latency. Subsequently, the animals were divided into three groups: Stress-Non-Inoculated (SNI), Stress-Inoculated (SI) and Control-Inoculated (CI). The SI and CI groups were inoculated with tumor cells and the SNI group with vehicle. SNI and SI were exposed to social stress with an anosmic intruder six (T1) and twenty one (T2) days after inoculation and their behavior was analyzed. After T2, subjects were put down and the pulmonary metastatic foci counted. SI developed greater pulmonary metastasis than CI, indicating an effect of stress despite the animal's dominant status. Active animals developed less pulmonary metastasis than their passive counterparts. No differences were found in social behavior at T1. Differences were found, however, in some behavioral categories at T2 between SI and SNI, and between active and passive animals. These differences indicate an effect of tumor development on social behavior that is more evident in passive subjects.     

Screening for trauma in children and adolescents: the validity of the Traumatic Stress Disorder Scale of the screen for child anxiety related emotional disorders

Examined the validity of the Traumatic Stress Disorder scale of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a recently developed self-report questionnaire measuring Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) defined anxiety disorders symptoms in children. A large sample of normal schoolchildren (N = 996) ages 7 to 19 years completed the SCARED. Children who scored high on the SCARED Traumatic Stress Disorder scale (i.e., trauma group; n = 43) and children who scored low on this scale (i.e., control group; n = 43) were then interviewed about their most aversive life event. In addition, children completed self-report questionnaires of traumatic experiences and posttraumatic stress disorder (PTSD) symptomatology. Results showed that children in the trauma group more frequently reported life events that independent judges considered to be 'potentially traumatic' than did control children. Furthermore, children in the trauma group reported having experienced more traumatic incidents and had higher scores on PTSD-related questionnaires compared with control children. Moreover, trauma group children more frequently fulfilled DSM-IV criteria for PTSD than did control children. The results of this study support the validity of the Traumatic Stress Disorder scale of the SCARED.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

T groups: An essential model in the training of group therapists

This paper argues for the T group (training group) model as the preferred experiential aspect of training in group psychotherapy. The rationale for preferring the T group model centers around aspects of: 1) contractual clarity; 2) the management of the learning regression; 3) the effectiveness of the T group as a professional holding environment; and 4) the development of a professional identity as a group therapist. Some difficulties with the model are also noted, and some case examples are offered to illustrate various aspects of the work within the T group model.     

An Integrative Model for Ethnocultural Counseling and Psychotherapy of Victims of Organized Violence

The author researched sociocultural factors related to psychotherapy with victims of organized violence from different perspectives: a refugee counseling center in a metropolis (Frankfurt, 1991–95) and refugee camps in neighboring countries (Uganda, 1994–96). At first the psychopathology of victims of organized violence is described. Then a review of treatment approaches follows and a conceptual model for integrative psychotherapy is developed. On the basis of qualitative analysis of client–therapist interactions, case discussions, supervision, evaluation of treatment, and literature review, an eclectic model for ethnocultural counseling and psychotherapy was developed. This eclectic model can be divided into (1) therapeutic relationship and transference, (2) modeling techniques, (3) extrapsychic techniques, (4) somatic techniques,(5) working through traumatic/grief/repressive experiences, and (6) reeducative and supportive techniques.     

Use of the Personality Assessment Inventory in Assessment of Posttraumatic Stress Disorder in Women

This study investigated the utility of the Personality Assessment Inventory (PAI) for the assessment of posttraumatic stress disorder (PTSD). Participants were 55 community-residing adult women who were administered a comprehensive battery that included the PAI and the Clinician-Administered PTSD Scale (CAPS). Participants were classified as either PTSD or non-PTSD based on the CAPS, and PAI profiles were compared between the two groups. Significant group differences were found for seven PAI clinical scales (Anxiety, Depression, Anxiety-Related Disorders, Somatic Complaints, Paranoia, Borderline Features, and Schizophrenia), one validity scale (Negative Impression), and two treatment scales (Nonsupport and Treatment Rejection). When all PAI scales and component subscales are considered, the largest group differences were found for the physiological subscale of the Depression scale (DEP-P) and the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T). ARD-T and DEP-P also demonstrated excellent diagnostic utility. Finally, correlations between PAI scales and four CAPS symptom clusters provided additional validity evidence, in particular supporting a distinction between effortful avoidance and numbing. Taken together, these results support the use of the PAI in the assessment of PTSD.This study was the basis of a Masters thesis for Meghan McDevitt-Murphy. Portions of this study were presented at the annual meeting of the Association for Advancement of Behavior Therapy, November 2000.     

Validating Regulatory Sensory Processing Disorders Using the Sensory Profile and Child Behavior Checklist (CBCL 1?–5)

The objective was to validate Regulatory Sensory Processing Disorders’ criteria (DC:0-3R, 2005) using empirical data on the presence and severity of sensory modulation deficits and specific psychiatric symptoms in clinical samples. Sixty toddlers who attended a child mental health unit were diagnosed by a clinical team. The following two groups were created: toddlers with RSPD (N?=?14) and those with “other diagnoses in Axis I/II of the DC:0-3R″(OD3R) (N?=?46). Independently of the clinical process, parents completed the Infant Toddler Sensory Profile (as a checklist for sensory symptoms) and the Achenbach Behavior Checklist for ages 1?–5 (CBCL 1?–5). The scores from the two groups were compared. The results showed the following for the RSPD group: a higher number of affected sensory areas and patterns than in the OD3R group; a higher percentage of sensory deficits in specific sensory categories; and a higher severity of behavioral symptoms such as withdrawal, inattention, other externalizing problems and pervasive developmental problems in CBCL 1?–5. The results confirmed our hypotheses by indicating a higher severity of sensory symptoms and identifying specific behavioral problems in children with RSPD. The results revealed convergent validity between the instruments and the diagnostic criteria for RSPD and supported the validity of RSPD as a unique diagnosis. The findings also suggested the importance of identifying sensory modulation deficits in order to develop an early intervention to enhance the sensory capacities of children who do not fully satisfy the criteria for some DSM-IV-TR disorders.     

Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status-and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student's paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.     

Science Literacy in School and Home Contexts: Kindergarteners’ Science Achievement and Motivation

We examined science learning and motivation outcomes as a function of children's participation in the classroom and classroom-plus-home components of the Scientific Literacy Project (SLP). The sample was comprised of kindergarten children in 4 low income, neighboring schools. Children in Schools 1 and 2 (n = 120) participated in the SLP science activities. Of these children, 79 participated in the classroom component of the SLP whereas 41 participated in both the classroom and home components. A comparison group of children in schools 3 and 4 (n = 74) participated in regular science activities. We identified science learning, achievement, and motivational benefits for the SLP groups. Additional benefits for children who participated in both the classroom and home components of the SLP were greater gains in general science knowledge, higher levels of positive self-competence beliefs for science, perceived family support for learning science, and independence for learning science.     

Editorial

Group dynamics are the elements that make group psychotherapy unique. When applied to the inpatient group, they illuminate various aspects of milieu treatment. Because of this linkage, the therapy group can be used to educate trainees about (1) systems dynamics on the psychiatric unit and their administrative implications, (2) the vicissitudes of the patient's treatment alliance with the hospital staff, and (3) the psychodynamics of severe psychopathology. In the group, individual defensive operations stand out with special clarity. Their expression is fueled by the group's dynamics. Here, internal object relations are reenacted and the defense of projective identification becomes vivid. The focus of this paper is not on the teaching of group psychotherapy itself, but rather on the use of this modality for the general training of future professionals.     

Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.     

Religious Attendance Serves as a Protective Variable Against Suicidal Ideation During Treatment

Several studies have proposed potential mediators of the association between religion and mental health, including social support (SS), locus of control (LOC), and substance abuse (SA), but have been limited by their use of non-clinical samples. The current study, therefore, drew from a clinical sample at risk of violence to self to test associations among these variables, specifically examining the effect of these variables on the relation between religious attendance (RA) and suicidal ideation (SI). A total of 144 adult outpatient psychotherapy clients evidencing SI during treatment were assessed pre-treatment for diagnostic presentation and frequency of RA. Subsequently, before each therapy session, SI, SS, SA, and external LOC (eLOC) during the preceding week were assessed via self-report. RA exerted a significant direct effect on SI within this clinical sample, with increased attendance associated with decreased SI. In contrast to prior reports based on non-clinical samples, SS, SA, or eLOC did not mediate the association of RA to SI. However, these variables did work in tandem, independent of RA, to affect SI. Findings support prior research suggesting that focusing on SS, SA, and LOC may be beneficial to clients experiencing SI. Additionally, for those clients who hold religious practices as a personal value, incorporating discussion of RA may help thwart SI.     

Hypnotic enhancement of cognitive-behavioral interventions for pain: an analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive-behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n = 135) and low (n = 150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically.     

Emotion Regulation Mediates the Association Between ADHD and Depressive Symptoms in a Community Sample of Youth

The purpose of this study was to examine the longitudinal relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms, emotion regulation (ER) ability, and depressive symptoms within a diverse community sample of 277 youth, ages 9–12 (56 % male). Participants were drawn from a larger study examining adolescent risk behaviors, and completed annual assessments over 3 years. Youth ADHD symptoms were assessed at Time 1 (T1) using the parent-reported Disruptive Behavior Disorders Rating Scale, ER was assessed with the parent-reported Emotion Regulation Checklist at Time 2 (T2), and youth depressive symptoms were assessed using the self-reported Revised Child Anxiety and Depression Scales at Time 3 (T3). Analyses examined T2 ER as a mediator between T1 ADHD symptoms (including the unique contributions of inattentive [IA] versus hyperactive/impulsive [HI] symptoms) and T3 depressive symptoms. Structural equation modeling (SEM) indicated the path model specified provided an excellent fit to the data. Tests of indirect effects suggested that T2 ER appears to be a significant mechanism that underlies the relationship between T1 ADHD and T3 depression, even when accounting for T1 oppositional defiant and depressive symptoms. Furthermore, while both T1 IA and HI symptoms had significant indirect effects on T3 depression through the mechanism T2 ER, HI proved a more robust predictor of T2 ER than IA. Results of this prospective study support cross-sectional findings pointing to ER as a potential mechanism linking ADHD and depressive symptoms in youth. Clinical implications and future directions are discussed.     

Rorschach changes in long-term and short-term psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 2 1/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

A meta-analysis of estimated effect sizes for group versus individual control treatments

A meta-analysis was conducted combining results from nine studies, using seventy-five outcome measures of 349 subjects. Only studies that contrasted group, individual, and control treatments with a pretest-posttest design were selected. Estimates of effect sizes were calculated for group, individual, and control treatments across all studies, according to treatment modality (psychotherapy, counseling, or psychoeducation), type of control (no treatment or some treatment), date of the study (1955-1969 or 1977-1982), and the subjects' age (adult, adolescent, or child). Results indicated that both group and individual treatments had a measurable effect that was consistently greater than that of controls. Further, (1) counseling produced much more of an effect than either therapy or psychoeducation; (2) the more recent treatments produced larger effects than the older studies; and (3) group treatments were more effective than individual methods in the treatment of adolescents, but were less effective in the treatment of children.     

Reliability and construct validity of the College Student Stress Scale

Reliability and construct validity of the 11-item College Student Stress Scale were investigated with exploratory (N = 273) and confirmatory factor analyses (N = 185) in undergraduate college students. Two factors were observed; however, reliability of the 3-item factor was too low and one item failed to load on either factor. A 7-item measure (Factor 1) had acceptable reliability (.81) and good convergence with the Perceived Stress Scale. This measure was significantly correlated with Neuroticism, Test Anxiety, and Self-efficacy for Learning, but not Social Desirability or age.