Can Group Therapy Help Refugees and Asylum Seekers with PTSD?

What you need to know

• Many refugees and asylum seekers experience post-traumatic stress disorder (PTSD) due to traumatic experiences
• This study tested a group therapy program aimed at helping refugees and asylum seekers manage PTSD symptoms
• Participants reported improvements in depression, anxiety, and PTSD symptoms after the 8-week program
• Group therapy may be a useful first step in PTSD treatment for refugees, but more research is needed

Understanding PTSD in Refugees and Asylum Seekers

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing traumatic events. For refugees and asylum seekers, who have often fled dangerous situations in their home countries, rates of PTSD are much higher than in the general population. Studies estimate that anywhere from 3% to 88% of adult refugees and asylum seekers experience PTSD.

The symptoms of PTSD can include:

• Reliving or re-experiencing the traumatic event through flashbacks or nightmares
• Avoiding reminders of the trauma
• Feeling on edge or easily startled
• Negative changes in thoughts and mood

For refugees and asylum seekers, these symptoms are often compounded by the stress and uncertainty of adjusting to life in a new country. Many face challenges like social isolation, poverty, and anxiety about their immigration status.

Challenges in Treating PTSD in Refugees

While effective treatments for PTSD exist, refugees and asylum seekers often face barriers to accessing mental health care. Some of these challenges include:

• Language barriers
• Lack of culturally appropriate services
• Distrust of authority figures or institutions
• Practical issues like transportation or childcare
• Stigma around mental health in some cultures

Additionally, the complex trauma experienced by many refugees may require specialized treatment approaches. Some experts argue that a period of “stabilization” - focused on coping skills and building trust - should come before trauma-focused therapy.

Testing a Group Therapy Approach

To address some of these challenges, researchers in the UK developed and tested a group therapy program specifically for refugees and asylum seekers with PTSD. The program, called “Moving On After Trauma” (MOAT), aimed to:

1. Provide education about PTSD symptoms
2. Teach coping skills for managing symptoms
3. Build trust and comfort with mental health treatment
4. Connect participants with others who have had similar experiences

The 8-week program was delivered in a group format, with 8-10 participants per group. Sessions were led by a clinical psychologist with experience working with refugees. Interpreters were available for those who needed language assistance.

How the Study Worked

To test whether this group therapy approach could help reduce PTSD symptoms, the researchers conducted a study with 82 refugees and asylum seekers. Participants came from 22 different countries and spoke 14 different languages.

Before starting the program, participants completed questionnaires measuring their levels of:

• Depression
• Anxiety
• PTSD symptoms
• Feelings of social connection and integration

They completed the same questionnaires again after finishing the 8-week program. The researchers then compared the before and after scores to see if there were any improvements.

What the Study Found

Overall, the results suggested that the group therapy program was helpful for many participants:

• 71% of participants (58 people) attended at least 5 out of the 8 sessions
• Participants reported significantly lower levels of depression after the program
• Anxiety scores also decreased significantly
• PTSD symptom scores improved, though still remained high for many
• Participants reported feeling more socially connected and integrated after the program

It’s important to note that this study did not include a control group (people who didn’t receive the treatment), so we can’t say for sure that the improvements were caused by the therapy program. However, the results are promising and suggest this approach is worth studying further.

Benefits of the Group Format

The researchers noted several potential benefits to delivering this treatment in a group format:

1. Efficiency - Multiple people can receive treatment at once, which is valuable given limited mental health resources

2. Social connection - Participants can meet others with similar experiences, reducing isolation

3. Normalization - Hearing others’ stories can help people realize their reactions are normal responses to trauma

4. Cultural exchange - With participants from many backgrounds, the group can explore different cultural understandings of mental health

5. Skill practice - The group provides a safe space to practice new coping skills

Challenges in Measuring Outcomes

One major challenge the researchers encountered was in measuring the effects of treatment. Standard questionnaires used to assess mental health symptoms were difficult to use with this population for several reasons:

• Many participants did not speak English or read in their native language, requiring use of interpreters
• Questionnaires developed for Western populations don’t always translate well to other cultures
• Cognitive difficulties related to PTSD made it hard for some to complete long questionnaires

The researchers had to develop creative solutions, like using simpler scales and visual aids. This highlights the need for better assessment tools for diverse populations.

Is Group Therapy Enough?

While participants showed improvements after the 8-week program, most still had significant PTSD symptoms. The researchers suggest that this type of group therapy could be a helpful first step, but many refugees may need additional individual therapy afterwards.

The group program seemed to help in several ways:

• Building trust with mental health providers
• Increasing understanding of PTSD symptoms
• Teaching basic coping skills
• Connecting participants to other supportive services

These benefits may help refugees feel more comfortable and prepared to engage in more intensive, trauma-focused therapy if needed.

Supporting Refugee Mental Health

This study highlights both the great need for mental health support among refugees and asylum seekers, and the challenges in providing it effectively. Some key takeaways for improving mental health care for this population include:

• Develop treatments that are culturally sensitive and trauma-informed
• Provide interpreters and language support
• Address practical barriers like transportation and childcare
• Combine mental health care with other social services
• Create opportunities for social connection
• Train mental health providers in working with refugee populations

While more research is needed, group-based approaches like the one in this study may be a promising way to reach more refugees in need of mental health support.

Conclusions

• Group therapy focused on managing PTSD symptoms shows promise for helping refugees and asylum seekers
• Participants reported improvements in mental health after an 8-week program, though many still had significant symptoms
• Group formats offer benefits like efficiency, social connection, and cultural exchange
• Significant challenges remain in assessing outcomes and providing accessible, appropriate mental health care for refugee populations