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      Psychosocial mechanisms of change in symptoms of Persistent Complex Bereavement Disorder amongst refugees from Myanmar over the course of Integrative Adapt Therapy Translated title: Mecanismos psicosociales de cambio en los síntomas del trastorno de duelo complejo persistente entre los refugiados de myanmar en el transcurso de la terapia de adaptación integrativa Translated title: 综合适应疗法过程中缅甸难民持续性复杂丧痛障碍症状改变的社会心理机制


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          Background: The ability to adapt to the psychosocial disruptions associated with the refugee experience may influence the course of complicated grief reactions.

          Objective: We examine these relationships amongst Myanmar refugees relocated to Malaysia who participated in a six-week course of Integrative Adapt Therapy (IAT).

          Method: Participants (n = 170) included Rohingya, Chin, and Kachin refugees relocated to Malaysia. At baseline and six-week post-treatment, we applied culturally adapted measures to assess symptoms of Prolonged Complex Bereavement Disorder (PCBD) and adaptive capacity to psychosocial disruptions, based on the Adaptive Stress Index (ASI). The ASI comprises five sub-scales of safety/security (ASI-1); bonds and networks (ASI-2); injustice (ASI-3); roles and identity (ASI-4); and existential meaning (ASI-5).

          Results: Multilevel linear models indicated that the relationship between baseline and posttreatment PCBD symptoms was mediated by the ASI scale scores. Further, ASI scale scores assessed posttreatment mediated the relationship between baseline and posttreatment PCBD symptoms. Mediation of PCBD change was greatest for the ASI II scale representing disrupted bonds and networks.

          Conclusion: Our findings are consistent with the informing model of IAT in demonstrating that changes in adaptive capacity, and especially in dealing with disrupted bonds and networks, may mediate the process of symptom improvement over the course of therapy.


          • Our finding supports the core premise of IAT in improving adaptive stress (reflected in the ASI scales) as a potential mechanism through which mental health symptoms can be mitigated with ASI-2 (bonds and networks) exerting the largest effect on PCBD symptoms at follow-up.

          Antecedentes: La capacidad de adaptarse a las alteraciones psicosociales asociadas con la experiencia de los refugiados puede influir en el curso de las reacciones de duelo complicadas.

          Objetivo: Examinamos estas relaciones entre los refugiados de Myanmar reubicados en Malasia que participaron en un proceso de seis semanas de Terapia de Adaptación Integrativa (IAT por sus siglas en ingles).

          Método: Los participantes (n = 170) incluyeron refugiados rohingya, chin y kachin reubicados en Malasia. Al inicio y seis semanas después del tratamiento, aplicamos instrumentos adaptados culturalmente para evaluar los síntomas del trastorno de duelo complejo prolongado (PCBD por sus siglas en ingles) y la capacidad de adaptación a las alteraciones psicosociales, según el índice de estrés adaptativo (ASI). El ASI comprende cinco subescalas de seguridad/protección (ASI-1); lazos y redes (ASI-2); injusticia (ASI-3); roles e identidad (ASI-4); y significado existencial (ASI-5).

          Resultados: Los modelos lineales multinivel indicaron que la relación entre los síntomas de PCBD basales y posteriores al tratamiento estuvo mediada por las puntuaciones de la escala ASI. Además, los puntajes de la escala ASI evaluados después del tratamiento median la relación entre los síntomas de PCBD basales y posteriores al tratamiento. La mediación del cambio de PCBD fue mayor para la escala ASI II que representa los lazos y redes interrumpidos.

          Conclusión: Nuestros hallazgos son consistentes con el modelo informativo de IAT al demostrar que los cambios en la capacidad de adaptación, y especialmente al tratar con los lazos y las redes interrumpidas, pueden mediar el proceso de mejora de los síntomas durante el curso de la terapia.

          背景: 适应难民经历相关的社会心理瓦解的能力可能会影响复杂哀伤反应的进程。

          目的: 我们在移居了并参与了为期六周的综合适应疗法 (IAT) 马来西亚的缅甸难民中考察了这些关系。

          方法: 170名参与者 (包括罗兴亚族, 钦族和克钦族难民) 移居马来西亚。在基线和治疗后六周, 我们采用了文化适应的测量来评估持续性复杂丧痛障 (PCBD) 的症状, 和适应应激指数 (ASI) 评估对心理社会干扰因素的适应能力。 ASI包括五个子量表:安全感/安全 (ASI-1) ;联结和网络 (ASI-2) ;不公正 (ASI-3) ;角色和身份 (ASI-4) ;存在意义 (ASI-5) 。

          结果: 多水平线性模型表明, 基线和治疗后PCBD症状之间的关系受ASI量表得分中介。此外, 治疗后评估的ASI量表得分中介了基线与治疗后PCBD症状之间的关系。PCBD变化对于表示联结和网络瓦解的ASI II量表的中介作用最大。

          结论: 我们的发现与IAT的信息模型相吻合, 证明了适应能力的变化, 尤其是在处理瓦解的联结和网络方面, 可能中介了治疗过程中症状改善的过程。

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            A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries.

            This paper describes the Common Elements Treatment Approach (CETA) for adults presenting with mood or anxiety problems developed specifically for use with lay counselors in low- and middle-income countries (LMIC). Details of the intervention development, training, supervision, and decision-making process are presented. Case vignettes are used as examples throughout. Preliminary findings are presented on counselor/supervisor performance and client outcomes from practice cases completed prior to randomized controlled trials (RCT) conducted at two sites for adult survivors of torture and/or systematic violence in (a) southern Iraq and (b) Thailand-Burma border. Data suggest that local supervisors and lay counselors with little prior mental health training or experience maintained fidelity to the model. The majority of pilot clients were retained in treatment, suggesting acceptability. Using the Reliable Change Index (RCI) for each individual we examined the number of clients above a minimal threshold (z > 1.96) for each outcome. In Iraq 100% of clients had RCIs above the threshold for depression and posttraumatic stress, and 81.8% for impaired function. In Thailand, 81.3% of clients had RCIs above minimum threshold for depression, 68.8% for posttraumatic stress, and 37.5% for impaired function. Implementation of CETA is discussed in relation to cultural issues within LMIC. These findings, combined with US-based evidence, suggest that a common elements approach warrants further development and testing as a means for addressing the treatment gap for mental health problems in LMIC.
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              Culturally centered psychosocial interventions


                Author and article information

                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                16 September 2020
                : 11
                : 1
                : 1807170
                [a ]School of Psychiatry, Faculty of Medicine, University of New South Wales; , Sydney, Australia
                [b ]Perdana University-Centre for Global Health and Social Change (PU-GHSC); , Kuala Lumpur, Malaysia
                [c ]United Nations High Commissioner for Refugees; , Kuala Lumpur, Malaysia
                [d ]Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine; , Kuala Lumpur, Malaysia
                [e ]Psychiatry Research and Teaching Unit, Liverpool Hospital, NSW Health; , Sydney, Australia
                Author notes
                CONTACT Alvin Kuowei Tay alvin.tay@ 123456unsw.edu.au School of Psychiatry, University of New South Wales; , Sydney, NSW2052, Australia
                Author information
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 3, References: 27, Pages: 1
                Research Article
                Clinical Research Article

                Clinical Psychology & Psychiatry
                persistent complex bereavement disorder,prolonged grief,refugee mental health,integrative adapt therapy,adaptive stress index,trastorno de duelo complejo persistente,trastorno de duelo prolongado,salud mental de los refugiados,terapia de adaptación integrativa,índice de estrés adaptativo,持续性复杂丧痛障碍,延长哀伤,难民心理健康,综合适应疗法,适应应激指数


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