Complex PTSD and Phased Treatment in Refugees: a Debate Piece

Overview

Journal Eur J Psychotraumatol

Date 2016 Feb 18

PMID 26886486

Citations 15

Authors

F Jackie June Ter Heide

Trudy M Mooren

Rolf J Kleber

Affiliations

Soon will be listed here.

Abstract

Background: Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD.

Objective: The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD.

Methods: The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees.

Results: Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high.

Conclusions: Complex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers.

Citing Articles

"Same Same or Adapted?" Therapists' Feedback on the Implementation of Trauma-Focused Cognitive Behavioral Therapy With Unaccompanied Young Refugees.

Unterhitzenberger J, Haberstumpf S, Rosner R, Pfeiffer E Clin Psychol Eur. 2022; 3(Spec Issue):e5431.

PMID: 36405672 PMC: 9670829. DOI: 10.32872/cpe.5431.

Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review.

de Silva U, Glover N, Katona C BJPsych Open. 2021; 7(6):e194.

PMID: 34649634 PMC: 8570104. DOI: 10.1192/bjo.2021.1013.

Interleukin-6 secretion upon acute psychosocial stress as a potential predictor of psychotherapy outcome in posttraumatic stress disorder.

Rhein C, Hepp T, Kraus O, von Majewski K, Lieb M, Rohleder N J Neural Transm (Vienna). 2021; 128(9):1301-1310.

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Readiness of Allied Professionals to Join the Mental Health Workforce: A Qualitative Evaluation of Trained Lay Trauma Counsellors' Experiences When Refugee Youth Disclose Suicidal Ideation.

Lofving Gupta S, Wijk K, Warner G, Sarkadi A Int J Environ Res Public Health. 2021; 18(4).

PMID: 33557361 PMC: 7914504. DOI: 10.3390/ijerph18041486.

Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis.

Lewis C, Roberts N, Gibson S, Bisson J Eur J Psychotraumatol. 2020; 11(1):1709709.

PMID: 32284816 PMC: 7144189. DOI: 10.1080/20008198.2019.1709709.

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