Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

The evolution of the primates: Anglicanism,primacy and conciliarity

Contemporary debate about the relationship between civil and religious law, highlighted by the Archbishop of Canterbury's 2008 lecture on ‘Civil and Religious Law in England’, prompts a reassessment of the place of ius divinum in the understanding of the nature of law. This article questions the assumption of modernity that there is no place for divine law, and briefly surveys the different role played by divine law in Judaism, Islam and Christianity. It examines the contrasting Christian perspectives of Aquinas and Duns Scotus, which leads to a critique of the relationship between personal welfare and the common good. Since, in the context of post-modernism, questions related to divine law are once again being addressed, the article criticises aspects of a fundamentalist approach to it in both Islam and Christianity. It argues that, from a Christian perspective, the personal truth of Jesus Christ embodies the place where the divine freedom comes into relation with human freedom. It concludes that in reflecting on a common praxis for humanity, it is this embodied relationship which provides the basic perspective for practitioners of canon law to contribute in a significant way to the debate now gathering momentum.     

From state church to faith community: an analysis of worldly and spiritual power in the Church of Sweden

The aim of this article is to discuss the current legislation, and power structures in and between different levels of the Church of Sweden in terms of church–state relations and secularisation, with the help of theories from sociology of religion and ecclesiology drawn from José Casanova, Grace Davie and Avery Dulles. With themes from Lutheran theology, including the two regiments and the common priesthood of all believers, we analyse the current legislation and power structures from the perspective of the so-called ‘dual line of responsibility’. The underlying hypothesis is that the structures of the former state church are still deciding the power structures in the Church of Sweden. This creates obscurity concerning the role of the church in public society and negatively affects the ecclesiastical development of the church now that it has lost its earlier status as a state church.     

The Atheist Surge: Faith in Science,Secularism, and Atheism

This essay examines the recent publication of seven books that attack faith, belief, and religion and affirm atheism; inquires why they are appearing now; explores the meaning of atheism; and examines the history of atheism in the Western tradition. It is suggested that all people have worldviews (whether they are aware of them or not), including the atheists, and that cases can be made for most worldviews, but that no worldview can be proven to anyone who does not already affirm it. Therefore atheists are in the same situation as believers in other worldviews.     

Gender,Interdependent Self-construals,and Collective Self-esteem: Women and Men Are Mostly the Same

Women and men may differ in how they define themselves in reference to their social world. Baumeister and Sommer () suggest that women prefer close relationships whereas men prefer large-group memberships. We examined how this hypothesized gender difference relates to collective self-esteem from three interdependent groups: friends, family, and gender. Study 1 revealed that women and men report equivalent levels of collective self-esteem from both relational and collective groups. Study 2 replicated this finding, and further revealed that the importance of group membership to individuals is more crucial to understanding collective self-esteem than is a gender differences approach. We discuss the implications of these results in terms of contingencies of social self-worth and potential cognitive processes involved in self-construal.     

Culture and Context-sensitive Self: The Amount and Meaning of Context-sensitivity of Phenomenal Self Differ Across Cultures

Self-concepts change from context to context. The experience that one's self is context-sensitive may be universal, however the amount and meaning of context-sensitive self vary across cultures. Cross-cultural differences in the amount and meaning of context-sensitive self were investigated in three Western cultures (Australia, Germany, and UK) and two East Asian cultures (Japan and Korea). The amount of context-sensitivity of self was greater in Japan than in Western cultures and Korea. The meaning of context-sensitive self also varied across cultures. In the Western cultures, a context-invariant self was seen to be clear and true; however, these patterns were not observed in the East Asian cultures. In Korea, a context-invariant self was interpreted to be exhibiting a relational self, which adheres to the ethics of care. In Japan, it was a context-sensitive self that was seen to be true, implying that the true self in Japan may mean to be true to the self-in-context, rather than the transcendental, decontextualized self. The results suggest the importance of differentiating East Asian cultures such as Japan and Korea. The utility of quantitative methods in explicating cultural meaning was highlighted.     

Alternative-based thresholding with application to presurgical fMRI

Functional magnetic reasonance imaging (fMRI) plays an important role in pre-surgical planning for patients with resectable brain lesions such as tumors. With appropriately designed tasks, the results of fMRI studies can guide resection, thereby preserving vital brain tissue. The mass univariate approach to fMRI data analysis consists of performing a statistical test in each voxel, which is used to classify voxels as either active or inactive—that is, related, or not, to the task of interest. In cognitive neuroscience, the focus is on controlling the rate of false positives while accounting for the severe multiple testing problem of searching the brain for activations. However, stringent control of false positives is accompanied by a risk of false negatives, which can be detrimental, particularly in clinical settings where false negatives may lead to surgical resection of vital brain tissue. Consequently, for clinical applications, we argue for a testing procedure with a stronger focus on preventing false negatives. We present a thresholding procedure that incorporates information on false positives and false negatives. We combine two measures of significance for each voxel: a classical p-value, which reflects evidence against the null hypothesis of no activation, and an alternative p-value, which reflects evidence against activation of a prespecified size. This results in a layered statistical map for the brain. One layer marks voxels exhibiting strong evidence against the traditional null hypothesis, while a second layer marks voxels where activation cannot be confidently excluded. The third layer marks voxels where the presence of activation can be rejected.     

Individual differences in spatial configuration learning predict the occurrence of intrusive memories

The dual-representation model of posttraumatic stress disorder (PTSD; Brewin, Gregory, Lipton, & Burgess, Psychological Review, 117, 210-232 2010) argues that intrusions occur when people fail to construct context-based representations during adverse experiences. The present study tested a specific prediction flowing from this model. In particular, we investigated whether the efficiency of temporal-lobe-based spatial configuration learning would account for individual differences in intrusive experiences and physiological reactivity in the laboratory. Participants (N = 82) completed the contextual cuing paradigm, which assesses spatial configuration learning that is believed to depend on associative encoding in the parahippocampus. They were then shown a trauma film. Afterward, startle responses were quantified during presentation of trauma reminder pictures versus unrelated neutral and emotional pictures. PTSD symptoms were recorded in the week following participation. Better configuration learning performance was associated with fewer perceptual intrusions, r = ?.33, p < .01, but was unrelated to physiological responses to trauma reminder images (ps > .46) and had no direct effect on intrusion-related distress and overall PTSD symptoms, rs > ?.12, ps > .29. However, configuration learning performance tended to be associated with reduced physiological responses to unrelated negative images, r = ?.20, p = .07. Thus, while spatial configuration learning appears to be unrelated to affective responding to trauma reminders, our overall findings support the idea that the context-based memory system helps to reduce intrusions.     

Probabilities on Sentences in an Expressive Logic

Automated reasoning about uncertain knowledge has many applications. One difficulty when developing such systems is the lack of a completely satisfactory integration of logic and probability. We address this problem directly. Expressive languages like higher-order logic are ideally suited for representing and reasoning about structured knowledge. Uncertain knowledge can be modeled by using graded probabilities rather than binary truth values. The main technical problem studied in this paper is the following: Given a set of sentences, each having some probability of being true, what probability should be ascribed to other (query) sentences? A natural wish-list, among others, is that the probability distribution (i) is consistent with the knowledge base, (ii) allows for a consistent inference procedure and in particular (iii) reduces to deductive logic in the limit of probabilities being 0 and 1, (iv) allows (Bayesian) inductive reasoning and (v) learning in the limit and in particular (vi) allows confirmation of universally quantified hypotheses/sentences. We translate this wish-list into technical requirements for a prior probability and show that probabilities satisfying all our criteria exist. We also give explicit constructions and several general characterizations of probabilities that satisfy some or all of the criteria and various (counter)examples. We also derive necessary and sufficient conditions for extending beliefs about finitely many sentences to suitable probabilities over all sentences, and in particular least dogmatic or least biased ones. We conclude with a brief outlook on how the developed theory might be used and approximated in autonomous reasoning agents. Our theory is a step towards a globally consistent and empirically satisfactory unification of probability and logic.