Can Group Therapy Help Refugees and Asylum Seekers with PTSD?

What you need to know

• A group-based stabilization program for refugees and asylum seekers with PTSD showed promising results in reducing symptoms of depression, anxiety, and PTSD.
• The program, called Moving On After Trauma (MOAT), was delivered in a group setting and focused on building coping skills and understanding trauma reactions.
• While the study had limitations, it suggests that group therapy could be a helpful first step in treating PTSD for refugees and asylum seekers.

Understanding PTSD in Refugees and Asylum Seekers

Post-traumatic stress disorder (PTSD) is a common mental health condition among refugees and asylum seekers. These individuals have often experienced severe trauma, including persecution, torture, and violence in their home countries. The journey to safety and the challenges of adapting to a new country can also be traumatic experiences.

PTSD symptoms can include:

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

For refugees and asylum seekers, these symptoms can be particularly challenging as they try to navigate a new culture and build a new life.

The Moving On After Trauma (MOAT) Program

Researchers in the UK developed and tested a group therapy program called Moving On After Trauma (MOAT) specifically for refugees and asylum seekers with PTSD. The program aimed to help participants:

1. Understand their trauma reactions
2. Learn coping skills for managing symptoms
3. Connect with others who have had similar experiences

The MOAT program consisted of eight weekly two-hour sessions. Topics covered included:

• Understanding how the brain responds to trauma
• Managing overwhelming emotions or feeling emotionally numb
• Improving sleep
• Building connections with others

A key feature of the program was its use of visual aids, metaphors, and hands-on activities to make the concepts accessible across different cultures and education levels.

The Study: Testing MOAT’s Effectiveness

The researchers conducted a study to see if the MOAT program could help reduce PTSD symptoms in refugees and asylum seekers. They also wanted to know if it was feasible to use standard mental health questionnaires with this diverse group.

Participants

The study included 82 refugees and asylum seekers from 22 different countries. They spoke 14 different languages, and many needed interpreters to participate. The average age was 30 years old, and about two-thirds were men.

Measuring Change

Participants completed questionnaires before and after the MOAT program to measure:

• Depression symptoms (using the PHQ-9)
• Anxiety symptoms (using the GAD-7)
• PTSD symptoms (using the IES-R)

The researchers also created a custom questionnaire to measure:

• Feelings of connection to others
• Sense of social integration
• Understanding of PTSD symptoms

Results

The good news is that participants who completed the MOAT program showed improvements in all areas measured:

• Depression symptoms decreased
• Anxiety symptoms decreased
• PTSD symptoms decreased
• Participants reported feeling more connected to others
• Participants felt more socially integrated
• Participants had a better understanding of their PTSD symptoms

These improvements were statistically significant, meaning they were likely due to the program rather than chance.

Challenges and Limitations

While the results are promising, the study had some important limitations:

1. No control group: Without a group of similar people who didn’t receive the treatment to compare to, we can’t be certain that the improvements were due to the MOAT program alone.

2. Difficulty with questionnaires: Many participants struggled to complete the standard mental health questionnaires. This was due to language barriers, lack of literacy, and the cognitive challenges that often come with PTSD (like difficulty concentrating).

3. Attendance challenges: While most participants attended at least five of the eight sessions, some had difficulty attending regularly due to other appointments or health issues.

4. PTSD symptoms remained high: Even though PTSD symptoms improved, they were still at a level indicating that participants likely needed additional treatment.

The Potential of Group Therapy for Refugees and Asylum Seekers

Despite these challenges, the study suggests that group therapy could be a valuable tool for helping refugees and asylum seekers with PTSD. Some potential benefits of this approach include:

1. Efficiency: Group therapy allows mental health professionals to help multiple people at once, which is important given the high demand for services.

2. Social connection: The group format allows participants to meet others with similar experiences, potentially reducing feelings of isolation.

3. Cultural adaptation: The MOAT program was designed to be culturally sensitive and accessible to people from diverse backgrounds.

4. Preparation for further treatment: The group program could help participants feel more comfortable with therapy and prepare them for more intensive individual treatment if needed.

Looking Forward: Improving Mental Health Care for Refugees and Asylum Seekers

This study highlights some important considerations for improving mental health care for refugees and asylum seekers:

1. Need for specialized training: Mental health professionals working with this population need specific training in trauma, cultural sensitivity, and working with interpreters.

2. Importance of practical support: Participants appreciated when clinicians helped with practical issues, like housing concerns. This support can be crucial for building trust and addressing the many challenges refugees and asylum seekers face.

3. Adapting assessment tools: Standard mental health questionnaires may need to be adapted or translated to be more accessible to this diverse population.

4. Flexible policies: Mental health services may need to adapt their policies (e.g., for missed appointments) to account for the unique challenges faced by refugees and asylum seekers.

Conclusions

• Group-based stabilization therapy shows promise as an initial treatment for refugees and asylum seekers with PTSD.
• The MOAT program led to improvements in depression, anxiety, PTSD symptoms, and feelings of connection and integration.
• More research is needed to confirm these findings and determine the best ways to support the mental health of refugees and asylum seekers.