B1. Post Traumatic Stress – Oral Paper Session

Friday, 31 March 2017

The effects of torture controllability on symptom severity of posttraumatic stress disorder, depression and anger in refugees and asylum seekers: A path analysis

Refugees and asylum seekers are exposed to extreme violations of human rights. Among these traumatic events, torture represents one of the most common types of trauma exposure experienced by refugees and asylum seekers. Studies have demonstrated that there is a high correlation between torture exposure and poor mental health outcomes, including greater symptoms of posttraumatic stress disorder (PTSD), depression, anger, and somatic complaints. Despite this, research remains scarce regarding the mechanisms underlying the effects of torture exposure on psychopathology. Theoretical models of PTSD suggest that the uncontrollable nature of a traumatic event, rather than the exposure to trauma itself, influences the development and maintenance of PTSD. This study therefore explored the relationship between torture controllability, emotional responses during torture, and long-term symptoms of PTSD, depression and anger. Data was collected from a convenience sample of 108 adult refugees and asylum seekers in treatment at two psychiatric clinics in Zurich and Bern, Switzerland. A path analysis revealed that torture controllability was negatively associated to PTSD, depression and anger. Furthermore, the effects of torture controllability on psychological symptoms were mediated by anger, but not fear, responses during torture. The present findings provide support for the notion that the uncontrollability, and not the frequency, of torture exposure contribute to the expression of psychopathological symptoms in the long-term.

Lillian Le (The University of New South Wales AUSTRALIA)

Presentation currently unavailable

Predictors of positive treatment outcomes for trauma-affected refugees – results from two randomised trials

Background: The treatment effects in trials with trauma-affected refugees vary considerably between studies, but also between patients within the single studies. However, we know little about why some patients benefit more from treatment than others, as few studies have analysed predictors of treatment outcome. Identifying predictors of positive treatment outcomes is however important in order to be able to improve treatment results for refugee patients.

Objective: To identify predictors of treatment outcome for trauma-affected refugees.

Method: Data was derived from two trials, with a total number of 320 adult refugees with PTSD, who had all participated in a six-seven months bio-psycho-social treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Associations were analysed between pre- to post-treatment HTQ score changes and the following baseline variables: age, gender, refugee status (refugee versus being family reunified), torture exposure, previous stays in refugee camps (outside Denmark) or asylum centres (in Denmark), duration of the stay in Denmark, presence of psychotic symptoms at baseline and depression and anxiety symptom level at baseline measured by Hamilton rating scales.

Results: Preliminary bivariate analyses have shown HTQ changes to be associated with female gender, younger age, being family reunited with a refugee (vs. being a refugee), shorter duration of stay in Denmark, and lower levels of depression and anxiety at baseline. More analyses including multiple regression analyses are currently undertaken and final results will be presented at the conference.

Conclusion: Results will identify subgroups of refugee patients who do and do not benefit from a bio-psycho-social treatment programme and form the base for providing effective personalised treatment programmes for refugees on an evidence base.

Charlotte Sonne (Competence Centre for Transcultural Psychiatry, Denmark)

Applications of EMDR and EEG in treatment of clients suffering from PTSD

Eye Movement Desensitisation and Reprocessing (EMDR) technique has been successfully implemented with a number of clients that were referred to the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) Sydney.

This presentation demonstrates the utilisation of the EMDR technique in a female 22 year old Tibetan client, who suffered a severe form of PTSD that was inflicted by multiple events of grievous and violent torture. As a part of the treatment EMDR technique was applied with the aim to assist processing of PTSD symptoms. In particular, emphasis was placed on the elimination and analysis of intrusive memories, continuous anxiety, vivid night flashbacks and disturbing nightmares with the aim to monitor changes in neurophysiology by implementing Electroencephalography (EEG) biofeedback.

Over the course of the treatment, provided on a weekly/bi weekly basis, EEG was used to precisely monitor neuronal activation during the EMDR sessions. It was noted that processing of the trauma occurred when the beta brain waves appeared in the frontal and orbito frontal lobes. The manifestation of the beta brain waves signalled the activation of the executive brain functions including intellectual responses associated with the logical thinking, capacity to memorise, analyse and make decisions that require a good focus and concentration. The presence of the beta brain waves indicated that client was actively processing trauma, which was “”locked”” or “frozen” in the nervous system. This further highlights clients’ capacity to engage with traumatic memories and their readiness for trauma processing.

In the future, detailed studies with the wider group of clients with similar symptomatology may need to be conducted with the aim to identify the timing of trauma-processing initiation. This would also assist in providing more focused and timely treatments to PTSD sufferers.

Gordana Hol-Radicic (STARTTS)

Moral Injury Appraisals in Traumatised Refugees

Refugees are often exposed to a number of traumatic experiences, that can lead to elevated rates of posttraumatic stress disorder (PTSD). While PTSD has largely been conceptualised as a fear based disorder, refugees often report emotions such as anger, guilt or shame. These may be a result of moral injury, which refer to appraisals that violate deeply held moral beliefs and frameworks. This study investigated the factor structure of the Moral Injury Scale (MIS), to see if moral injury appraisals differentiated, depending on whether the appraisal was made externally (violation from others) or internally (violation from oneself). Additionally, we were interested in how these factors would be related to key predictor (age, gender, trauma exposure) and outcome (PTSD symptoms, anger, depression) variables. A diverse group of 222 refugees was used in this study. Confirmatory factor analyses revealed a two factor structure (external and internal) in line with our hypothesis. Structural equation modelling indicated that both factors were predicted by higher trauma exposure. Additionally, higher moral injury in both factors was associated with higher levels of anger and depression. Unexpectedly, if moral injury was appraised externally this was also associated with higher PTSD symptom clusters, but internal appraisals did not find this association, and in fact, predicted lower levels or re-experiencing symptoms. Therefore, the underlying mechanisms of each factor may be distinct, which will have important implications in designing treatments that are effective for moral injury.

Joel Colbourne-Hoffman (Refugee Trauma Recovery Program- UNSW Australia)

Presenation currently unavailable