Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries.

In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.

"I Have No Words": A Qualitative Study About the Traumatic Experience of Violent Death.

Individuals bereaved by violent death have a higher risk of developing psychopathology. Consistent data concerning the subjective experience during the traumatic event of the death are still scarce. This study aimed to explore the traumatic experience of the violent death of a loved one. Nine reports of patients bereaved by violence were selected and transcribed. Reports were analyzed using Bardin's Content Analysis. Two final categories were generated. It was observed that most participants remembered details about the traumatic event or the time they were told about the violent death. There were two factors described as important when coping with the loss, social support during the traumatic event, and receiving detailed information from the authorities and others present in that moment. This study provides relevant data for future interventions during violent situations by health and security professionals.

Hair cortisol levels and mental health problems in children and adolescents exposed to victimization.

Youths who experience multiple forms of victimization are at a heightened risk for psychopathology across the lifespan. The hypothalamic-pituitary-adrenal (HPA) axis is a key target for the investigation of neurobiological changes induced by chronic stress and violence exposure. The measurement of hair cortisol concentration allows the investigation of long-term HPA activity and its association with victimization. The present study investigated the impact of exposure to polyvictimization in Latin-American children and adolescents on hair cortisol levels. We investigated association among cortisol, mental health problems and victimization. The study included 83 youths (mean age 10.84 years-old) from southern Brazil. We assessed self-reported victimization scores (Juvenile Victimization Questionnaire - JVQ-R2), mental health problems (Child Behavior Checklist - CBCL/6-18), and hair cortisol concentrations for the previous 30 days. The results showed an association between exposure to multiple forms of victimization and higher concentrations of hair cortisol; the results also showed that cortisol levels and mental health problems were associated with the severity of polyvictimization. These findings suggest that preadolescent victimization is associated with hyperactivation of HPA axis and with increased risk of mental health issues.

Post-traumatic stress symptoms and exacerbations in COPD patients.

BACKGROUND: Post-Traumatic Stress Disorder (PTSD) is a common psychological consequence of exposure to traumatic stressful life events. During COPD exacerbations dyspnea can be considered a near-death experience that may induce post-traumatic stress symptoms. The aim of this study was to evaluate the relationship between COPD exacerbations and PTSD- related symptoms. METHOD: Thirty-three in-patients with COPD exacerbations were screened for the following: PTSS (Screen for Posttraumatic Stress Symptoms), anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory). Patients had a median age of 72 years and 72.7% were female. RESULTS: Mean FEV1 and FVC were 0.8 ± 0.3 (37.7 ± 14.9% of predicted) and 1.7 ± 0.6 (60 ± 18.8% of predicted), respectively with a mean exacerbation of 2.9 episodes over the past year. Post-traumatic stress symptoms related to PTSD were found in 11 (33.3%) patients (SPTSS mean score 4.13 ± 2.54); moderate to severe depression in 16 (48.5%) (BDI mean score 21.2 ± 12.1) and moderate to severe anxiety in 23 (69.7%) (BAI mean score 23.5 ± 12.4). In a linear regression model, exacerbations significantly predicted post-traumatic stress symptoms scores: SPTSS scores increased 0.9 points with each exacerbation (p = 0.001). Significant correlations were detected between PTSD-related symptoms and anxiety (rs = 0.57; p = 0.001) and PTSD symptoms and depression (rs = 0.62; p = 0.0001). In a multivariable analysis model, two or more exacerbation episodes led to a near twofold increase in the prevalence ratio of post-traumatic stress symptoms related to PTSD(PR1.71; p = 0.015) specially those requiring hospitalization (PR 1.13; p = 0.030) CONCLUSION: PTSD symptoms increase as the patient's exacerbations increase. Two or more exacerbation episodes lead to a near twofold increase in the prevalence ratio of post-traumatic symptomatology. Overall, these findings suggest that psychological domains should be addressed along with respiratory function and exacerbations in COPD patients.

Childhood maltreatment and executive functions in adolescents.

BACKGROUND: The aim of this study was to investigate differences in executive functions between adolescents exposed to different forms of single- and multitype childhood maltreatment. METHOD: The sample was composed of 83 adolescents, divided into three groups: single-type maltreatment (n = 24), multitype maltreatment (n = 19), and no history of maltreatment (n = 40), matched for education and sex. RESULTS: The results showed that teenagers who suffered a single type of childhood maltreatment performed worse than the other two groups on tasks of cognitive flexibility and visual processing speed. Individuals who suffered multitype maltreatment had worse initiation and lower verbal processing speed than the other two groups. CONCLUSIONS: Childhood maltreatment may have a significant impact on executive functioning in adolescence.

The effect of age on decision making according to the Iowa gambling task.

Aging has been associated with several brain changes that often affect the cognitive functioning of adults, but changes in executive functions, particularly in the field of decision making, have not been fully investigated. The Iowa Gambling Task (IGT) is a widely used tool to evaluate decision making, but little is known about the effect of age on its results. This study used the IGT and compared healthy young (n = 40) and elderly (n = 40) adults to evaluate their decision making processes. There were significant differences in the learning curve of the two age groups, but no difference in overall IGT performance. The results for the first IGT block were different from those of the rest of the task, and the group of elderly adults had a better performance in this block. Elderly adults also showed a preference for deck A, the one that resulted in greater losses. Findings confirmed the results of other studies, which reported that the IGT block score is the variable with the greatest sensitivity to age in this instrument.

Habituating to pandemic anxiety: Temporal trends of COVID-19 anxiety over sixteen months of COVID-19.

The impact of COVID-19 anxiety on mental health and its association with preventive measures is well-established. We aimed to study how COVID-19 anxiety and its dimensions vary over time (16 months) in a sample of individuals (N = 2717) suffering from mental distress in the pandemic context that participated in a randomized clinical trial testing psychosocial interventions in Brazil. Results showed that pandemic anxiety reduced over time. COVID-19 influences fear of others being infected and concerns about mental health being affected by COVID-19 were more significant than the fear of being infected or the physical health influenced by COVID-19. A similar temporal effect was not found for burnout, and this effect was not correlated with the number of COVID-related deaths. Habituation to pandemic anxiety or higher intolerance of uncertainty at the beginning of the pandemic is putative mechanisms for the patterns observed in the data. They might have implications for mental health interventions in the pandemic scenario and motivational strategies for prevention. TRIAL REGISTRATION NUMBER: Plataforma Basil (CAAE: 30608420.5.0000.5327), ClinicalTrials.gov (NCT04632082; November 17, 2020).

Migration experience and mental health: A qualitative study in France and Brazil.

BACKGROUND: The relationship between migration and mental health is complex and involves factors at different levels, as the individual history of the migrant, the collective history of their home country, the host society's and their mutual past history. Even though the migratory scenario of France and Brazil has changed over the years, both countries currently host an important number of immigrants. AIM: The main objective of the present study was to describe and analyze the impacts of the migratory experience on mental health of migrants with different migration experiences and living in two countries: France and Brazil. METHOD: Semi-structured interviews were conducted with 13 participants, six in France and seven in Brazil. A thematic qualitative analysis of the data was performed using the ATLAS.TI software. Three themes were created based on the different times of the migration experience: before migration, during migration and after migration. All codes of these three bigger themes were organized in sub-themes for the samples in France and Brazil. RESULTS: Participants in France described an important exposure to traumatic events before and during migration. In Brazil, the migration experiences were multiple, in some cases presenting a traumatic history, but in most cases migration was seen as an opportunity to have access to better life conditions. In both countries, participants reported a great level of psychological distress associated to post-migratory difficulties (e.g. unemployment, learning a new language, or facing a new cultural environment). CONCLUSIONS: Our results suggest that multidisciplinary interventions, with focus on skills development, such as language and work-related skills, and on access to basic needs may be essential for both voluntary and involuntary migrants. In addition to these interventions, some individuals may need specialized mental health intervention, focusing in past traumatic exposure and in the current acculturation process.

A systematic review and meta-analysis of epigenetic clocks in schizophrenia.

INTRODUCTION: Evidence suggests that schizophrenia (SZ) is associated with accelerated biological aging. DNA methylation can be used as an indicator of biological aging by means of epigenetic clock estimates. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate the association between SZ and different epigenetic clocks. METHODS: Search terms were applied in different databases: Embase, MEDLINE (EBSCO), Cochrane Central Register of Controlled Trials, PubMed, PsychINFO and Web of Science. To assess for risk of bias we utilized an adapted version of the Newcastle-Ottawa Scale. Meta-analyses were conducted using the random effects model and meta-regressions were used to assess factors associated with heterogeneity. RESULTS: Eight studies were included (Controls, n = 3394; SZ subjects, n = 3096), which analyzed five different epigenetic clocks. Overall meta-analysis revealed no significant differences between SZ and controls on epigenetic aging (Standardized Mean Difference - SMD = -0.21; p = 0.13). However, epigenetic clock method was a significant moderator of heterogeneity (p = 0.004). Using Horvath's clock as reference, higher SMD's were found for PhenoAge and Intrinsic epigenetic age acceleration (IEAA) clocks. In a stratified meta-analysis restricted to the two clocks mentioned above, a significant accelerating effect was found in patients with SZ when compared to controls (SMD = 0.29; p = 0.003). CONCLUSION: Our findings suggest that the method of epigenetic clocks is a critical factor associated with estimates of aging acceleration in SZ. However, more studies are needed to confirm these findings and in order to evaluate a possible minor effect in overall analysis.

Topiramate diminishes fear memory consolidation and extinguishes conditioned fear in rats.

BACKGROUND: Topiramate has been recognized as a drug that can induce memory and cognitive impairment. Using the one-trial inhibitory avoidance task, we sought to verify the effect of topiramate on consolidation and extinction of aversive memory. Our hypothesis was that topiramate inhibits the consolidation and enhances the extinction of this fear memory. METHODS: In experiment 1, which occured immediately or 3 hours after training, topiramate was administered to rats, and consolidation of memory was verified 18 days after the conditioning session. In experiment 2, which occured 18-22 days after the training session, rats were submitted to the extinction protocol. Rats received topiramate 14 days before or during the extinction protocol. RESULTS: Topiramate blocked fear memory retention (p < 0.01) and enhanced fear memory extinction (p < 0.001) only when administered during the extinction protocol. LIMITATIONS: This experimental design did not allow us to determine whether topiramate also blocked the reconsolidation of fear memory. CONCLUSION: Topira mate diminishes fear memory consolidation and promotes extinction of inhibitory avoidance memory.

A behavioral economic risk aversion experiment in the context of the COVID-19 pandemic.

We investigated what degree of risk of infection with COVID-19 is necessary so that people intend to stay home, even when doing so means losing their salary. We conducted an online survey across Brazil during the initial outbreak, in which 8,345 participants answered a questionnaire designed to identify the maximum tolerated risk (k') necessary for them to disregard social distancing recommendations and guarantee their salaries. Generalized linear mixed models, path analysis structural equation, and conditional interference classification tree were performed to further understand how sociodemographic factors impact k' and to establish a predictive model for the risk behavior of leaving home during the pandemic. We found that, on average, people tolerate 38% risk of infection to leave home and earn a full salary, but this number decreased to 13% when the individual risk perception of becoming ill from severe acute respiratory syndrome coronavirus-2 is considered. Furthermore, participants who have a medium-to-high household income and who are older than 35 years are more likely to be part of the risk-taking group who leave home regardless of the potential COVID-19 infection level; while participants over 45 years old and with good financial health are more likely to be part of the risk-averse group, who stay home at the expense of any salary offered. Our findings add to the political and public debate concerning lockdown strategies by showing that, contrary to supposition, people with low socioeconomic status are not more likely to ignore social distancing recommendations due to personal economic matters.

Executive functions and clinical symptoms in children exposed to maltreatment.

There is evidence of an association between childhood maltreatment and lifelong cognitive impairment. Few studies investigate cognitive functioning in maltreated children. The objective of this study was to investigate whether there are differences in executive processing between maltreated and nonmaltreated children. Additionally, clinical symptoms were compared between groups and possible associations between clinical symptoms, and deficits in executive functions were investigated. The sample consisted of 55 children (8-12 years), 30 with a history of maltreatment and 25 with no history of maltreatment. An interview was conducted with the child's legal guardian and instruments were administered: Juvenile Victimization Questionnaire (JVQ), Child Behavior Checklist (CBCL), and Spence Children's Anxiety Scale (SCAS). The following clinical instruments were administered to the children: JVQ, Trauma Symptom Checklist for Children (TSCC), and Children's Depression Inventory (CDI). Children underwent neuropsychological assessment. Data were analyzed by comparing the groups for clinical and cognitive variables. Differences were found between the groups in all executive functions. Most clinical symptomatology scales showed differences between the groups. Few associations were found between clinical and executive impairment profiles. Cognitive stimulation interventions, focused on inhibitory control, should be proposed in combination with psychotherapy.

Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese.

BACKGROUND: The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE: The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING: The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS: The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS: Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION: ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.

Validation of the Core Beliefs Inventory (CBI) in Brazilian Portuguese.

INTRODUCTION: Experiencing trauma may entail psychopathological consequences, but also changes considered to be positive (i.e., posttraumatic growth). For positive change to occur, an impact on the beliefs of individuals is required, which may be measured through the Core Beliefs Inventory (CBI). The objective of this study was to validate the Brazilian Portuguese version of the CBI. METHODS: A total of 248 university students (65.7% female) answered the following assessment instruments: sociodemographic data sheet, Posttraumatic Growth Inventory (PTGI), Posttraumatic Symptoms Checklist - Clinician Version (PCL-5) and the CBI. Psychometric properties of the CBI were assessed by conducting an exploratory factor analysis through a principal component analysis with varimax rotation. Internal consistency (Cronbach's α) and convergent validity (Pearson correlation between instruments) were also investigated. RESULTS: The total scale showed adequate internal consistency (α = 0.83). A single factor solution explained 42.63% of the variance of the CBI. Significant correlations were found between CBI and PTGI, and between CBI and PCL-5. CONCLUSION: The psychometric properties indicated adequate internal consistency and construct validity of the Brazilian Portuguese version of the CBI.

Psychometric properties of the Posttraumatic Growth Inventory in a sample of Brazilian university students.

OBJECTIVE: To examine psychometric properties of the Brazilian version of the Posttraumatic Growth Inventory (PTGI). METHOD: A total of 300 university students were evaluated though instruments that investigated trauma history, depression and posttraumatic symptoms, and personality traits through the Big Five model. Pearson's correlation was used to assess internal consistency, inter-item reliability and construct validity. Principal component analysis and confirmatory factor analysis were performed to investigate the factor structure of the PTGI. RESULTS: Results confirmed the original five-factor structure. The results showed good internal consistency for the total scale (α = 0.91) and its subscales, ranging from α = 0.85 to α = 0.70. Also, evidence of construct and convergent validity was observed through correlations with posttraumatic and depression symptoms and personality measures. CONCLUSIONS: These preliminary results suggest that the Brazilian PTGI is reliable and showed adequate evidence of validity.

Psychometric properties of the Brazilian version of the Cognitive Emotion Regulation Questionnaire.

INTRODUCTION: The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine cognitive strategies referring to what someone thinks after the experience of threatening or stressful events. The main purpose of this study was to evaluate the validity of the Brazilian version of the CERQ. METHODS: The adaptation process included translation, backtranslation, expert committee evaluation, and test on 30 participants from the target population. A sample of 445 university students completed the Portuguese version of the CERQ, a sociodemographic questionnaire, the Life Events Checklist (LEC-5), and the Positive and Negative Affect Schedule (PANAS) on an on-line research platform. Validity was assessed through confirmatory factor analysis of two models - a nine-factor model and a second-order model. Internal consistency was assessed through Cronbach's alpha analysis and correlations with affective variables measured by the PANAS. RESULTS: The analyses showed that the nine-factor model of the CERQ has good factorial validity and high reliability, with Cronbach's alpha values ranging between 0.71 and 0.88. The second-order model did not have a good fit to the data. CONCLUSION: The results obtained in this study are similar to the ones found previously, indicating that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, but that grouping them according to their adaptability is not recommended.

Quando homens vão à psicoterapia: uma revisão de contextos e demandas / When men go to psychotherapy: a review of contexts and demands

INTRODUÇÃO: Homens, como grupo, buscam menos ajuda em uma gama de contextos (e.g., acadêmico, médico, profissional), incluindo em saúde mental. A população masculina menos acessa os serviços de saúde mental disponíveis, apresentando também menor busca e engajamento em psicoterapia. O menor engajamento da população masculina também foi observado em diferentes faixas etárias, nacionalidades e contextos socieconômicos. OBJETIVO: Revisar quais são os contextos e demandas apontados na literatura científica internacional que influenciam a busca masculina por ajuda em saúde mental, e acrescentar à literatura científica nacional que é limitada nessa temática. MÉTODO: O presente artigo faz uso do método de revisão narrativa da literatura, realizando uma busca ampla na literatura sobre a temática do engajamento masculino em saúde mental. RESULTADOS E DISCUSSÃO: A população masculina, estatisticamente, apresenta um perfil diferente de prevalência de transtornos mentais, com menor prevalência de transtornos de humor porém prevalência significativamente maior em transtornos de abuso por substâncias. Homens também desproporcionalmente compõe as estatísticas de vítimas de suicídio. O menor engajamento masculino em saúde mental comparado a outras populações é influenciado por fatores culturais (e.g.: papéis de gênero, estigma associado aos transtornos mentais) e contextuais (e.g.: pessoas próximas, etapa de vida, modalidade de terapia). Considerações finais: há a necessidade de ampliar o engajamento masculino em serviços de saúde mental. Mudanças culturais de médio e longo prazo, melhor treinamento dos profissionais de saúde mental e realização campanhas públicas podem ser ferramentas para melhor engajar essa população.(AU)

INTRODUCTION: Men, as a group, seek less help in a variety of contexts (e.g.: academic, medical, professional), including in mental health. The male population makes less use of available mental health services, also seeking and engaging less in psychotherapy. The lesser male engagement also has been observed in different age groups, nationalities and socioeconomic contexts. OBJECTIVE: Review which are the contexts and demands shown in the international scientific literature that influence male mental health help-seeking, and adding to national scientific literature which is limited in this field. METHOD: The current paper makes use of the narrative literature review method, making a wide search in the literature about male engagement in mental health. RESULTS AND DISCUSSION: Statistically, the male population has a different profile of mental disorder prevalence, with less prevalence of mood disorders but significantly higher prevalence of substance abuse disorders. Males also disproportionally constitute suicide victim statistics. The lesser male engagement in mental health compared to other groups is influenced by both cultural (e.g.: gender roles, mental disorder stigmas) and contextual (e.g.: close acquaintances, life stage, therapy modality) factors. Final considerations: there is a need to increase male engagement in mental health services. Medium- and long-term cultural changes, better training for mental health professionals and public awareness campaigns may be tools to help engage this population.

INTRODUCCIÓN: Los hombres, como grupo, buscan menos ayuda en una variedad de contextos (p. ej., académico, médico, profesional), incluso la salud mental. La población masculina accede menos servicios de salud mental disponibles, también presenta menor búsqueda y participación en psicoterapia. La menor participación de la población masculina también se observó en diferentes grupos de edad, nacionalidades y contextos socioeconómicos. OBJETIVO: Revisar cuáles son los contextos y demandas señalados en la literatura científica internacional que influyen en la búsqueda de ayuda en salud mental por parte de los hombres, y sumar a la literatura científica nacional que es limitada sobre este tema. MÉTODO: este artículo utiliza el método de revisión narrativa de la literatura, realizando una búsqueda amplia en la literatura sobre el tema de la participación masculina en la salud mental. RESULTADOS Y DISCUSIÓN: La población masculina, estadísticamente, tiene un perfil diferente de prevalencia de trastornos mentales, con una menor prevalencia de trastornos del estado de ánimo pero una prevalencia significativamente mayor de trastornos por abuso de sustancias. Los hombres también constituyen desproporcionadamente las estadísticas de víctimas de suicidio. La menor participación masculina en salud mental en comparación con otras poblaciones está influenciada por factores culturales (p. ej., roles de género, estigma asociado con los trastornos mentales) y factores contextuales (p. ej., personas cercanas, etapa de la vida, modalidad de terapia). Consideraciones finales: existe la necesidad de ampliar la participación masculina en los servicios de salud mental. Los cambios culturales a mediano y largo plazo, una mejor capacitación de los profesionales de la salud mental y las campañas públicas pueden ser herramientas para involucrar mejor a esta población.

Brazilian norms and effects of age and education on the Hayling and Trail Making Tests.

OBJECTIVES: To describe normative data for the Hayling Test and the Trail Making Test (TMT) in a sample of Brazilian adults, and to investigate the effects of age and education on test performance. METHOD: A total of 313 (TMT) and 364 (Hayling) individuals with age ranges of 19-39, 40-59, and 60-75 years, and with at least 5 years of formal education, participated in this study. The tests were administered as part of a large battery of a normative project. Individuals were evaluated individually in silent, ventilated rooms at a university clinic. Instrument protocols were scored by trained research assistants and double-checked to ensure data reliability. RESULTS: There were major effects of age on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Errors B/15, B/45), and major effects of education on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Time A, Errors B/15, B/45). Interaction effects were found in Time B and B-A for the Hayling Test and in Time A for the TMT. CONCLUSIONS: Age and education were critical for performance on both verbal and non-verbal executive functions.

The role of memory in posttraumatic stress disorder: implications for clinical practice.

INTRODUCTION: Posttraumatic stress disorder (PTSD) is a highly prevalent disorder with important social consequences. Several models have been developed with the aim of understanding the mechanisms underlying its symptoms. Intrusions are idiosyncratic symptoms that commonly take the form of involuntary recollection of images or flashbacks about the traumatic event. OBJECTIVE: To review how memory is conceptualized in each of these models and the implications for clinical practice. METHODS: A narrative review of the literature was conducted through analysis of the perspectives of memory in theoretical models of PTSD. RESULTS: Two main perspectives were identified: 1) models in which specific mechanisms of memory for processing traumatic events are proposed, especially those based on clinical studies, and 2) models in which common mnemonic mechanisms are utilized to explain the phenomenon, primarily based on basic experimental research studies investigating memory. The different theories based on these approaches have led to distinct psychotherapy interventions. CONCLUSION: In order to clarify these discrepancies, future research should aim for the methodological rigor of experimental studies, while maintaining the ecological applicability of findings. Cognitive experimental psychopathology is therefore an area on which research funding should be focused. Such studies could elucidate the role of mnemonic aspects in PTSD and how they impact psychological treatments.

Protocolos de terapia cognitivo-comportamental culturalmente adaptados para tratamento de tept: uma revisão sistemática da literatura / Cognitive-behavioral therapy protocols culturally adapted for PTSD treatment: a systematic review of the literature

Imigrantes e refugiados são uma população de risco para transtornos mentais, como o Transtorno de Estresse Pós-Traumático (Tept), e a psicoterapia com indivíduos provenientes de diferentes contextos culturais pode ser desafiadora, porém, a Terapia Cognitivo-Comportamental (TCC) vem se mostrando uma abordagem eficaz com essa população. O presente estudo de revisão sistemática tem como objetivo descrever os protocolos culturalmente adaptados de TCC para imigrantes e refugiados com diagnóstico ou sintomas de Tept, seguindo as recomendações do método PRISMA. Foram realizadas buscas nas bases de dados PubMed/Medline e PsycInfo, nos últimos 15 anos, sendo incluídos 11 artigos. As principais adaptações realizadas pelos estudos foram: o uso da língua mãe dos participantes, uso de imagens relativas ao país de origem ou à religião e modificações na exposição usual. As informações descritas neste estudo podem auxiliar no desenvolvimento de futuros estudos ou na prática clínica com essa população.

Immigrants and refugees are a population at risk for mental disorders, such as Posttraumatic Stress Disorder (PTSD), and psychotherapy with individuals from different cultural contexts can be challenging, however, Cognitive-Behavioral Therapy (CBT) has shown to be an effective approach with this population. This systematic review study aims to describe the culturally adapted protocols of CBT for immigrants and refugees with diagnosis or symptoms of PTSD, following the recommendations of the PRISMA method. Searches were conducted in the PubMed/Medline and PsycInfo databases, in the last 15 years, and 11 articles were included. The main adjustments made by the studies were: the use of the participant's mother tongue, use of images related to the country of origin or religion and modifications in the usual exposure. The information described in this study may help in the development of future studies or in clinical practice with this population.