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      Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War

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          Abstract

          Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors ( N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD ( g = 1.91), depression ( g = 2.00), somatic symptoms ( g = 2.73), and well-being ( g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs.

          ClinicalTrials.gov Identifier: NCT03761732.

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          Most cited references31

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          Diagnostic and Statistical Manual of Mental Disorders

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              The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change

              Background Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. Discussion We examine the development of concepts of sustainability, and respond to two frequent assumptions —'voltage drop,’ whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,’ whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase’ that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. Summary A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                02 June 2021
                2021
                : 12
                : 599293
                Affiliations
                [1] 1Department of Psychology, University of Washington , Seattle, WA, United States
                [2] 2Department of Clinical Psychology, Seattle Pacific University , Seattle, WA, United States
                [3] 3Department of Psychological Sciences, Case Western Reserve University , Cleveland, OH, United States
                [4] 4Ma'alin Haruon Masjid , Hargeisa, Somalia
                [5] 5Abu-Bakar Al-Siddique Islamic Center , Borama, Somalia
                Author notes

                Edited by: Veena Kumari, Brunel University London, United Kingdom

                Reviewed by: Rahmi Saylik, Mus Alparslan University, Turkey; Sheila A. M. Rauch, Emory University, United States

                *Correspondence: Lori A. Zoellner zoellner@ 123456uw.edu
                Norah C. Feeny ncf2@ 123456case.edu

                This article was submitted to Psychological Therapies, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2021.599293
                8208506
                34149468
                fcd93490-cbaa-4d41-8be3-45215095ba1e
                Copyright © 2021 Zoellner, Bentley, Feeny, Klein, Dolezal, Angula and Egeh.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 August 2020
                : 26 April 2021
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 34, Pages: 8, Words: 6146
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                war,trauma,ptsd,islam,depression,mosque,community,psychotherapy
                Clinical Psychology & Psychiatry
                war, trauma, ptsd, islam, depression, mosque, community, psychotherapy

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