A1. Neuroscience – Oral Paper Session

Thursday, 30 March 2017

Building an Evidence Based Practice: Use of Brain Imaging in Clinical Assessment and Evaluation of Treatment Outcomes

In this presentation we will explore the benefits of implementing use of brain imaging techniques such as Electroencephalogram (EEG) and Event Related Potentials (ERPs) to assess the refugee clients with trauma related complex and chronic symptoms. Preliminary data identifying abnormal brain patterns underlying Post-Traumatic Stress symptoms and data supporting the effectiveness of neurofeedback interventions aimed to alter these dysfunctional patterns will be presented. In addition, case vignettes will be used to illustrate how an ongoing data analysis can help us evaluate the outcomes of our interventions and contribute to the improvement in our clinical services.

Mirjana Askovic (STARTTS)

Event-related Potential in Trauma-affected Refugees

Background: Evidence of abnormalities in cognitive and information processing in post-traumaticstress disorder (PTSD) has been accumulating over the years. By means of electroencephalography (EEG) this study sets out to investigate these neural substrates to PTSD among trauma-affected refugees living in the capital region of Denmark. Trauma-affected refugees are typically characterized by an extensive trauma history, likelihood of torture and rape, and often conflict-related to death of family members.

Avoidance often takes the form of social isolation, making patients susceptible to depression and cognitive understimulation. In our clinical experience, patients will often display hyperarousal to unpredictable social situations, while being under engaged in relation to routine activities. We would expect this relegation of resources to reflect in deficits in psychophysiological measures.

Methods and materials: The design is a cross-sectional study of 25 trauma-affected refugees with PTSD and 25 healthy control refugees matched on gender, age and country of origin. Study participants undergo an interview and a psychophysiological assessment. The diagnosis and symptom severity are assessed using the Clinician Administered PTSD Scale (CAPS), a validated ‘golden standard’ structured interview, and Harvard Trauma Questionnaire (HTQ), a 16-item self-report rating scale. In the psychophysiological assessment participants will be examined using the Copenhagen psychophysiological test battery (CPTB), which has been developed and validated in the Glostrup laboratory. The battery includes paradigms which assess prepulse inhibition of the startle reflex paradigm (PPI), P50 suppression, selective attention and mismatch negativity (MMN).
Results/Discussion: The collection of data will be completed in October 2016 and results will be presented at the conference.

Jessica Carlsson (Competence Centre for Transcultural Psychiatry), Hanieh Meteran (Competence Centre for Transcultural Psychiatry, Denmark), Bob Oranje (Mental Health Centre Glostrup), Birte Glenthøj (Mental Health Centre Glostrup), Erik Vindbjerg (Competence Centre for Transcultural Psychiatry, Denmark)

The impact of torture of the fear processing in the brain

Torture is characterized by being severe, uncontrollable and interpersonal, and may have specific and long-term effects on brain function. Other groups who have experienced traumas that share these qualities (e.g. domestic violence, childhood maltreatment) have modelled distinct changes in neural responses to trauma reminders or fear-based cues, including overall reduced fear responsivity, reflected in over-activation of medial prefrontal regions. Furthermore, neuroimaging studies of PTSD tend to focus on associations between brain activity and clinical symptoms, without accounting for the effect of current stress – an important consideration for resettled refugees. In this series of functional magnetic resonance imaging (fMRI) studies, we examined the neural correlates of fear processing disruptions in a sample of 80 trauma-exposed refugees, 30 who are survivors of torture. In two tasks, participants viewed fear face stimuli or, or were instructed to engage in emotional regulation (i.e. cognitive reappraisal) strategies vs naturally viewing threat-related images. The findings indicate that PTSD symptoms, torture experiences and current levels of settlement stress had different effects on fear processing pathways: torture exposure was associated with heightened engagement of prefrontal regions during fear face and negative scene processing, mirroring patterns of emotion over-modulation, whereas current stress was correlated with arousal centre of the brain. Torture survivors also demonstrated reduced cognitive reappraisal success, supported by both behavioural data and increased activation of amygdala, ventral striatum and insula. The findings indicate that torture exposure may have a significant and long-term effect on fear processing mechanisms in the brain. Clinical implications and

Belinda Liddell (UNSW Australia/Refugee Trauma and Recovery Program)
Jessica Cheung, Miriam Den, Pritha Das, Tim Outhred, Kim Felmingham, Gin Malhi, Angela Nickerson, Mirjana Askovic, Jorge Aroche, Mariano Coello and Richard Bryant

Presentation currently unavailable.

The use of neurofeedback as a clinical intervention for refugee children and adolescents

This presentation will focus on the work of STARTTS Neurofeedback clinic in providing neurofeedback treatment to refugee children and young people in the school setting.

Neurofeedback is a specialised field of biofeedback therapy with more than 40 years of research and clinical applications. Research has shown neurofedback to be effective with a wide range of diverse conditions including attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders, anxiety, depression, post-traumatic stress disorder (PTSD), learning difficulties and sleep disturbances amongst others.

In this presentation we will explore different aspects of the clinical application of neurofeedback at schools and describe the assessment and therapy process. Several case vignettes will be used to illustrate the effectiveness of neurofeedback in addressing psychological and cognitive difficulties and improving learning outcomes for refugee children and adolescents. Pre to post treatment changes were measured using subjective and objective measures.

Trix Harvey (STARTTS)