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.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.     

Does Bullying Victimization Suppress IQ? The Effects of Bullying Victimization on IQ in Iraqi and African American Adolescents: A Traumatology Perspective

This study explored the effects of bullying victimization (BV), as a Type II traumatic stressor, on intelligence quotient (IQ), posttraumatic stress disorder (PTSD), and complex PTSD symptoms. Participants were 390 African American and Iraqi refugee adolescents. Measures of BV, cumulative life trauma, PTSD, discrimination, and IQ were administered. Correlational, multilevel regression, and path analyses were conducted. BV, independent of cumulative trauma, and discrimination were found to have significant direct effects on increased PTSD symptoms and significant direct and indirect negative effects on perceptual reasoning, processing speed, and working memory. BV was also associated with increases in the discrepancy between perceptual reasoning and verbal comprehension. The implications of these results for the prevention and treatment of bullying victims are discussed.     

Converting a Freudian analysis into a Jungian one: obsession,addiction, and an answer from Job

In his analyses of obsessional patients, Sigmund Freud suggested that they suffered from intrusive cognitions and compulsive activities. Early psychoanalysts delineated the phenomenology of obsessionality, but did not differentiate what is currently termed obsessive‐compulsive disorder from obsessional personality. However, it was widely recognized that the success of psychoanalysis with obsessional patients was limited due to rigid characterological defences and transference resistances. The present paper examines the case of a middle‐aged obsessional academic who had been treated for nearly twenty years in a ‘classical' Freudian psychoanalysis prior to entering Jungian analysis. It examines how persistent focus on Oedipal conflicts undesirably reinforced the transference resistance in this obsessional man, and suggests that focusing instead on diminishing the harshness of the super‐ego via the therapeutic alliance, and fostering faith in the salutary aspects of unconscious processing has led to salutary results in this case. The biblical book of Job is adopted as ancient instruction in how to address the scrupulosity and addictive mental structuring of obsessionality in analysis.     

Social networking site use: Linked to adolescents' social self‐concept,self‐esteem,and depressed mood

Adolescents spend a substantial amount of time using social networking sites (SNSs); however, little is known regarding whether such use is associated with indicators of adjustment. The present study employed a multidimensional measure of SNS use to investigate the link between Australian adolescent SNS use and indicators of adjustment. Youth (N = 1,819, 55% female) from 34 diverse high schools across Western Australia were surveyed. The results showed that frequency of SNS use was linked to higher social self‐concept while investment in SNSs was associated with lower self‐esteem and higher depressed mood. Furthermore, having an SNS was linked to more negative indicators for female adolescents compared with male adolescents, although the link between frequency of use and investment in SNSs to indicators of adjustment was not moderated by gender. The present study highlights the complexity of the relationship between adolescent SNS use and indicators of adjustment, and offers insight into the diverse types of adolescent use of SNSs.     

Should Inherent Human Dignity Be Considered Intrinsically Heuristic?

What are “human rights” supposed to protect? According to most human rights doctrines, including most notably the Universal Declaration of Human Rights (UDHR), human rights aim to protect “human dignity.” But what this concept amounts to and what its source is remain unclear. According to Glenn Hughes (2011), human rights theorists ought to consider human dignity as an “intrinsically heuristic concept,” whose content is partially understood but is not fully determined. In this comment, I criticize Hughes's account. On my view, understanding inherent human dignity as an intrinsically heuristic concept tethers it to an “indeterminateness of sense,” which leaves it open to exploitation from theorists unsympathetic to the moral salience of rights and what rights are supposed to protect.