在乌干达难民营中采用团体认知行为疗法成功治疗难民创伤后应激症状。

Successfully treating refugees' post-traumatic stress symptoms in a Ugandan settlement with group cognitive behaviour therapy.

机构信息

School of Social Sciences, University of the Sunshine Coast, Queensland, Australia.

Sunshine Coast Mind & Neuroscience - Thompson Institute, School of Social Sciences, University of the Sunshine Coast, Queensland, Australia.

出版信息

Behav Cogn Psychother. 2021 Jan;49(1):35-49. doi: 10.1017/S1352465820000478. Epub 2020 Sep 1.

DOI:10.1017/S1352465820000478

PMID:32867883

Abstract

BACKGROUND

High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations.

AIMS

To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees' post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes.

METHOD AND RESULTS

Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes.

DISCUSSION

A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees' PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.

摘要

背景

在难民群体中，创伤后应激障碍（PTSD）的发生率很高。尽管研究支持在西方人群中使用以创伤为中心的认知行为疗法（TF-CBT）的有效性，但在发展中国家的难民营和定居点中，针对难民的这种疗法的疗效研究却很少。

目的

调查在乌干达难民营中实施的一种文化敏感的、基于小组的 TF-CBT 方案（EMPOWER）是否能有效降低难民的创伤后应激症状（PTSS），以及社会人口因素、创伤特征或 PTSS 严重程度是否与方案完成或治疗结果相关。

方法和结果

对居住在乌干达难民营的 174 名刚果难民提供的信息进行了数据链接（平均年龄=33.4 岁，标准差=11.7；49%为男性）。使用准实验设计，最初完成干预的 43 名参与者接受了九次 90 分钟的干预，报告了自我报告的 PTSS 显著减少，具有较大的效应量。延迟治疗组（n=55）在接受干预后也报告了显著的治疗效果。完成方案的参与者报告的初始 PTSS 严重程度显著高于退出者，而没有任何社会人口因素、创伤特征或 PTSS 与更好的治疗结果相关。

讨论

在难民营中实施的一种文化敏感的、基于小组的 TF-CBT 方案显著降低了难民的 PTSS 严重程度，对所有参与者都同样有效，而最需要治疗的参与者的保留率最高。这种方案具有同时治疗数百人的能力，对于在发展中国家的人道主义环境中生活的难民的 PTSD 是一种高度具有成本效益、可及性、可传播性和有效的治疗方法。