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This study has been supported by
Psychotherapy for traumatised refugees – a randomised clinical trial
Jessica Carlsson, M.D., PhD Charlotte Sonne, M.D.,PhD-student
Competence Center for Transcultural Psychiatry (CTP), Psychiatric Center Ballerup
Objectives
•To study the effect of Cognitive Behavioural Therapy (CBT) with a focus on either Stress Management or Cognitive Restructuring in a clinical sample of traumatised refugees with PTSD
•To identify predictors for the treatment effect
Take home message
•The present study will help to provide knowledge regarding the effect of CBT in severly traumatised refugees
•The study will compare the effect of CBT with a focus on either thoughts (Restructuring) or Stress Manangement
•143 patients have been included and results will be published ultimo 2013
Pre-treatment examination (project
information and inclusion)
Pre-treatment examination (project
information and inclusion)
At pre-treatment examination:
1st self-rating 1st HAM D + A observer ratings
At pre-treatment examination:
1st self-rating 1st HAM D + A observer ratings
Weekly consultations with medical doctor: manualised psycho-education and when needed pharmacological treatment
Weekly consultations with medical doctor: manualised psycho-education and when needed pharmacological treatment
Weekly consultations with medical doctor: manualised psycho-education and when needed pharmacological treatment
Weekly consultations with medical doctor: manualised psycho-education and when needed pharmacological treatment
Weekly psychotherapy sessions with psychologist
CBT: Stress Management
Monthly consultations with medical doctor
Weekly psychotherapy sessions with psychologist
CBT: Stress Management
Monthly consultations with medical doctor
Weekly psychotherapy sessions with psychologist
CBT: Cognitive Restructuring
Monthly consultations with medical doctor
Weekly psychotherapy sessions with psychologist
CBT: Cognitive Restructuring
Monthly consultations with medical doctor
After 6-7 months of treatment: End of treatment and evaluation
After 6-7 months of treatment: End of treatment and evaluation
Week 1-6of treatment
Week 6-24 of treatment
After 6 weeks of treatment:
2nd self-rating
After 6 weeks of treatment:
2nd self-rating
At end of treatment:
3rd self-rating 2nd HAM D + A observer ratings
At end of treatment:
3rd self-rating 2nd HAM D + A observer ratings
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Background
There is a lack of evidence regarding which kind of psychotherapy that is the most effective when treating traumatised refugees. Studies on the effect of psychotherapy among other patient groups with PTSD suggest a good effect using CBT 1,2.
The Competence Center for Transcultural Psychiatry (CTP) has specialised in the treatment of traumatised refugees.
The clinical experience at CTP suggests that Cognitive Restructuring is not always a useful tool and that stress reducing techniques could be more useful. This hypothesis is tested in the present study.
Methods
All patients referred to CTP from June 2011 – March 2012 and fulfilling the inclusion criteria were offered to participate in the study.
Participants were offered combined treatment with a psychiatrist (psycho-education and psychopharmacological treatment when needed) and a psychologist (CBT). The duration of the treatment was 6-7 months.
The participants were randomised to either:CBT with a focus on Stress Management orCBT with focus on Cognitive Restructuring
Referencer1) Bisson J., Andrews M., Psychological treatment of post-traumatic stress
disorder (PTSD). The Cochrane Library, 2009.2) Crumlish N., O’Rourke K., A systematic Review of Treatments for Post-
Traumatic Stress Disorder among Refugees and Asylum seekers, J Nerv Ment Dis 2010;198:237-51.
Author for correspondence:
Jessica Carlsson, M.D., PhD,Competence Center for Transcultural PsychiatryPsychiatric Center BallerupThe Mental Health Services of the Capital Region of Denmark
E-mail: [email protected]
Outcome measuresPrimary outcome:Harvard Trauma Questionnaire (HTQ): PTSD Secondary outcomes: Hopkins Symptom Checklist-25 (HSCL-25): anxiety and depression Sheehan Disability Scale (SDS): functioning, WHO-5: quality of lifeVAS: pain
Hamilton Depression and Anxiety Rating Scales (HAM D+A ): anxiety and depression
