Increasing transcultural competence in clinical psychologists through a web-based training: study protocol for a randomized controlled trial.

BACKGROUND: In mental health care, the number of patients with diverse cultural backgrounds is growing. Nevertheless, evaluated training programs for transcultural competence are missing. Barriers for engaging in transcultural therapy can be identified in patients as well as in therapists. Besides language barriers, clinical psychologists report insecurities, for example, fear of additional expenses when involving a language mediator, ethical concerns such as power imbalances, or fear of lack of knowledge or incorrect handling when working with patients from other cultures. Divergent values and concepts of disease, prejudices, and stereotyping are also among the issues discussed as barriers to optimal psychotherapy care. The planned study aims to empower clinical psychologists to handle both their own as well as patients' barriers through a web-based training on transcultural competence. METHODS: The training includes 6 modules, which are unlocked weekly. A total of N = 174 clinical psychologists are randomly assigned to two groups: the training group (TG) works through the complete training over 6 weeks, which includes a variety of practical exercises and self-reflections. In addition, participants receive weekly written feedback from a trained psychologist. The waitlist control group (WL) completes the training after the end of the waiting period (2 months after the end of the TG's training). The primary outcome is transcultural competence. Secondary outcomes consist of experiences in treating people from other cultures (number of patients, satisfaction and experience of competence in treatment, etc.). Data will be collected before and after the training as well as 2 and 6 months after the end of the training. DISCUSSION: This randomized controlled trial tests the efficacy of and satisfaction with a web-based training on transcultural competence for German-speaking clinical psychologists. If validated successfully, the training can represent a time- and place-flexible training opportunity that could be integrated into the continuing education of clinical psychologists in the long term. TRIAL REGISTRATION: DRKS00031105. Registered on 21 February 2023.

[Apps for tinnitus? A systematic review on quality, intervention components, and behavior change techniques]. / Mit Apps gegen den Tinnitus? Ein systematisches Review zu Qualität, Interventionselementen und Techniken der Verhaltensänderung.

BACKGROUND: Various smartphone applications (apps) for people with tinnitus are available and promise tinnitus relief. Yet, it is difficult for people suffering from tinnitus and healthcare professionals to estimate their quality, potential, or risks. The current study aims to generate an overview of available tinnitus apps in the German language and to offer orientation for research and healthcare providers. METHOD: The most prominent stores were searched systematically (November 2020-April 2021; Google Play Store and Apple App Store). Apps specifically developed for tinnitus were evaluated by two independent raters using multiple approaches: a) a quality screening was performed using the German version of the Mobile App Rating Scale (MARS-G), b) intervention components were assessed using a newly developed list of categories, and c) implemented strategies for active tinnitus management were analyzed using behavior change techniques (BCTs). RESULTS: The search yielded 1073 apps, of which 21 apps were analyzed. The apps' overall quality as assessed by MARS­G was average (M = 3.37, SD = 039). A lot of apps offered sounds (n = 18) and information (n = 9) or assessed tinnitus characteristics (n = 13). Out of 93 BCTs, 24 were identified at least once. Only one app was evaluated in non-randomized trials. CONCLUSION: Although a variety of apps are available, most of them focus on a few intervention components (e.g., sounds or information). Therefore, apps do not exploit their potential to impart important evidence-based content for tinnitus management. The app evaluation using multiple approaches points out potential for improvement.

Association between expectations and clinical outcomes in online v. face-to-face therapy - an individual participant data meta-analysis.

BACKGROUND: Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions. METHODS: MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model. RESULTS: Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (ß = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face). CONCLUSIONS: Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms.

Previous studies showed that alpha/delta ratio neurofeedback was effective in reducing unpleasant psychological, emotional and perceptual consequences of tinnitus. The main goal of the present study was to investigate, whether the specific combination of enhancing alpha frequency band activity and reducing delta frequency band activity was necessary, or merely sufficient, to obtain a positive treatment outcome regarding tinnitus distress and intensity. A second research aim was to assess the relative contribution of neurofeedback-related non-specific and general non-specific effects in neurofeedback treatment. In a three-arm, randomized controlled trial, 94 chronic tinnitus patients were randomly assigned to one of three conditions: alpha/delta ratio neurofeedback (n = 31), beta/theta ratio neurofeedback (n = 28) and non-neurofeedback minimal treatment intervention (n = 35). Neurofeedback participants underwent 10 treatment sessions over a 4-week period. Outcome measures were collected pre-, mid- and post-interventions and at 3-months follow-up. The Tinnitus Handicap Inventory and the Tinnitus Magnitude Index were used as primary outcome measures for tinnitus distress and tinnitus intensity. EEG data recorded during training supplemented primary outcomes. Since data were repeated measures, the analyses used a two-level mixed effects model approach including by-subject random effects (random intercept). For the Tinnitus Handicap Inventory, the results showed no interaction effect. For the Tinnitus Magnitude Index, the analysis showed a significant time × group interaction, indicating that both alpha/delta ratio neurofeedback and beta/theta ratio neurofeedback reported reduced tinnitus intensity. Analysis of EEG data showed a consistent pattern for the alpha/delta ratio over the course of training. Compared to beta/theta ratio neurofeedback, alpha/delta ratio neurofeedback showed an elevated response. Conversely, for the beta ratio to theta ratio, the pattern was more inconsistent, with no clear indication of superiority for beta/theta ratio neurofeedback over alpha/delta ratio neurofeedback. The main question of this piece of research was whether alpha/delta ratio neurofeedback demonstrated frequency band specificity in the alleviation of tinnitus distress and perceived intensity. Results showed that alpha/delta ratio neurofeedback was sufficient but importantly 'not' necessary to achieve a positive outcome on both the Tinnitus Handicap Inventory and Tinnitus Magnitude Index, when compared to beta/theta ratio neurofeedback. Still, the data suggest a trend towards specificity for alpha/delta ratio neurofeedback. Because of this, it may be too premature to discard alpha/delta ratio neurofeedback in the treatment of tinnitus. Recommendations for future studies are outlined.

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective.

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.

Selected Trends in Psychotherapy Research: An Index Analysis of RCTs.

Background: We wanted to analyze trends in psychotherapy research during the last decade. We used published randomized clinical trials (RCTs) that are cited in Web of Science (WoS) as an index for these activities. Method: We searched for RCTs published between the years 2010 and 2019. Search criteria included cognitive-behavioral treatments (CBT), e-mental health, Acceptance and Commitment Therapy (ACT), psychodynamic treatments, interpersonal therapy (IPT), schema therapy, systemic therapy, mindfulness treatments, and emotion-focused therapy (EFT). The numbers of publications for each treatment approach were accumulated for 5-year blocks (2010 to 2014; 2015 to 2019). Results: The search revealed 4,523 hits for the selected treatment options, of which 1,605 were finally included in the analysis. There was a continuous increase in published RCTs, with 68% more trials during the second five-year block. CBT (68%) and eHealth interventions (18%) show an increase in the number of studies, but there were no significant changes in its percentage in relation to all published RCTs. The next frequent treatments were ACT (4%), psychodynamic treatments (2%), IPT (2%), and mindfulness interventions (2%). We found a significant increase of the percentage of mindfulness (p = .008) and a significant decrease of the percentage of psychodynamic treatments (p = .02). Systemic (1.1%), emotion-focused (0.7%) and schema therapy (0.6%) represented smaller parts of published RCTs. Conclusion: A continuous increase of published RCTs underlines an active field of research on psychological interventions. Third wave treatments such as mindfulness increased their representation in research, while the part of psychodynamic treatments decreased.

Culturally adapted cognitive behavioural group therapy for mental disorders in refugees plus problem solving training (ReTreat): study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Since a high proportion of refugees in Germany suffer from mental disorders, culturally adapted treatments are needed that target a broad range of symptoms. There is much evidence for the efficacy of culturally adapted cognitive behavioural therapy (CA-CBT). Given the promising results of CA-CBT, the combination with problem solving training (CA-CBT+) represents a novel approach that potentially improves the refugees' ability to cope actively with psychosocial problems. This randomised controlled trial evaluates the efficacy of 12-session outpatient CA-CBT+ compared with to treatment as usual (TAU) in a sample of refugees suffering from at least one DSM-5 disorder. METHODS AND ANALYSIS: The present study will be carried out as two-group randomised trial with 1:1 individual allocation to either (1) culturally adapted cognitive behavioural therapy in a group setting (CA-CBT+) or (2) TAU. The study takes place at four sites in Germany, randomising in total 138 adult refugees with at least one primary DSM-5 diagnosis to the treatment conditions. In CA-CBT+ the patients receive 12 sessions of 120 min duration over the course of 12 weeks providing psychoeducation, meditation and other techniques of emotional regulation, stretching and problem solving training. The primary outcome is treatment response operationalised by a clinically significant change in General Health Questionnaire (GHQ-28) score. Follow-up visits will take place 3 and 9 months after the end of the intervention. Secondary outcomes include changes in psychopathological symptoms, somatic symptoms and quality of life. Intention-to-treat analysis will be performed. Adverse and serious adverse events will be analysed. Further, healthcare usage and economic outcomes will be assessed and analysed. Primary and secondary outcomes will be analysed using appropriate statistical methods. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Commission of the German Psychological Society (ref: StangierUlrich2019-1018VA). Results will be disseminated via presentations, publication in international journals, and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER: DRKS00021536.

Relations between criteria for somatic symptom disorder and quality of life in asylum seekers living in Germany.

OBJECTIVE: Asylum seekers often suffer from medically unexplained symptoms that affect their quality of life (QoL). The present study is the first to investigate the extent to which somatic symptoms and the B criteria for the DSM-5 somatic symptom disorder (SSD) are associated with the QoL of asylum seekers living in Germany. METHODS: In 144 asylum seekers, somatic symptoms (PHQ-15), B criteria for SSD, symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), post-migration living difficulties (PMLD), and QoL (EUROHIS) were assessed cross-sectionally. Multiple regressions in the total sample and in groups of somatic symptom severity (mild/moderate and severe) were conducted to examine the associations between somatic symptoms and B criteria with QoL. RESULTS: Sleep problems and pain were the most frequently reported somatic symptoms. Sixteen (11%) participants met one B criterion, 24 (17%) met two, and 84 (58%) met all three criteria. QoL correlated negatively with somatic symptoms (r = -0.56, p < .001) and with the existence of at least one B criterion (r = -0.24, p < .001). In the total sample, stronger depressive and somatic symptoms were related to lower QoL (adjusted R2 = 0.53) while the B criteria were not. In persons with severe somatic symptom severity, the B criterion behavior was associated with lower QoL. CONCLUSION: In addition to stronger somatic and depressive symptoms, the psychological B criterion behavior seems to play an important role in the lower QoL of asylum seekers with severe somatic symptoms.

Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial.

BACKGROUND: The trial investigates the efficacy of internet-based cognitive behavioral therapy (iCBT) in improving health-related QoL in patients with endometriosis, which is a chronic gynecological condition affecting up to 15% of people with female-assigned reproductive organs. Endometriosis is stress-related and comes with various physical symptoms such as pelvic pain and infertility. It has a substantial impact on health-related quality of life (QoL), and mind-body interventions seem promising in reducing the psychological burden. METHODS: This is a monocentric randomized-controlled trial recruiting 120 patients with endometriosis. The intervention consists of eight iCBT modules focusing on psychoeducation, cognitive restructuring, pacing, and emotion regulation. Participants will receive written feedback from a trained therapist weekly. The comparator is a waitlist control group. All participants will be followed up 3 months after the intervention, and the intervention group will additionally be followed up 12 months after the intervention. Trial participants will not be blinded to the allocated trial arm. Primary outcome measures are endometriosis-related QoL, pain, and pain-related disability. Secondary outcomes include coping, illness representations, and psychological flexibility. Statistical analyses will be performed following intention-to-treat principles. DISCUSSION: This randomized-controlled trial is the first trial to test the efficacy of iCBT for improving endometriosis-related QoL. Potential predictor variables and key mechanisms in treatment will be investigated to enable further progression in medical and psychological care for patients with endometriosis. TRIAL REGISTRATION: ClinicalTrials.gov , NCT05098444 Registered on October 28, 2021.

Improving the assessment of functional impairment in tinnitus sufferers: validation of the German version of the Tinnitus Functional Index using a confirmatory factor analysis.

OBJECTIVES: Chronic tinnitus negatively impacts daily functioning. To specifically assess this impairment, the Tinnitus Functional Index (TFI) was developed. The current study investigated the hierarchical, eight-factorial structure for the German TFI and examined its psychometric properties. DESIGN: In an online assessment, the TFI and other validated health-related measurements were completed. Confirmatory factor analysis (CFA) was conducted to investigate the factorial structure by testing two competing models: (1) a general factor model, and (2) a hierarchical second-order factor model. STUDY SAMPLE: 316 research volunteers (59.8% female) with low to moderate tinnitus distress were included. RESULTS: CFA revealed an insufficient fit of the data to the general factor model. For the hierarchical second-order factor model, an acceptable model fit was shown (χ2/df ratio = 2.74, RMSEA = 0.07, SRMR = 0.05, CFI = 0.95, TLI = 0.95). Correlational analyses between the TFI and measures assessing tinnitus distress, depression, sleeping difficulties, subjective well-being, and personality dimensions indicated high convergent and moderate discriminant validity. Internal consistency reliability was excellent. CONCLUSIONS: The results confirm the hierarchical, eight-factorial structure of the German TFI. The TFI is a promising inventory that should be used on a regular basis.HighlightsThe results of our study confirm the hierarchical eight-factorial structure of the German TFI.Confirmatory factor analysis revealed an acceptable model fit of the data.Convergent validity of the German TFI was high.Discriminant validity of the German TFI was moderate.The German TFI is a reliable questionnaire to assess tinnitus functional impairment.

Efficacy of a Low-threshold, Culturally-Sensitive Group Psychoeducation Programme for Asylum Seekers (LoPe): study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Despite high levels of mental distress, accessing psychological treatment is difficult for asylum seekers in Western host countries due to a lack of knowledge about mental disorders, and the health system, as well as due to cultural and language barriers. This study aims to investigate whether brief culturally sensitive and transdiagnostic psychoeducation is effective in increasing mental health literacy. METHODS AND ANALYSIS: The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either culturally sensitive, low-threshold psychoeducation ('Tea Garden' (TG)) or a waitlist (WL) control group. It takes place at four study sites in Germany. A total of 166 adult asylum seekers who report at least mild mental distress will be randomly assigned. The TG consists of two 90 min group sessions and provides information about mental distress, resources and mental health services in a culturally sensitive manner. The primary outcome is the percentage of participants in the TG, as compared with the WL, achieving an increase in knowledge concerning symptoms of mental disorders, individual resources and mental healthcare from preintervention to postintervention. The further trajectory will be assessed 2 and 6 months after the end of the intervention. Secondary outcomes include changes in mental distress, openness towards psychotherapy and resilience. Furthermore, healthcare utilisation and economics will be assessed at all assessment points. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Commission of the German Psychological Society (ref: WeiseCornelia2019-10-18VA). Results will be disseminated via presentations, publication in international journals and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER: DRKS00020564; Pre-results. PROTOCOL VERSION: 2020-10-06, version number: VO2F.

On the impairment of executive control of attention in chronic tinnitus: Evidence from the attention network test.

Subjective, chronic tinnitus is a condition that is common in most populations. Whereas many individuals tend to habituate to tinnitus over time, for some their attention seems pathologically drawn towards the sensation. For this subgroup of individuals with severe tinnitus, dysfunctional executive attention has been suggested to be implicated in the failure to habituate. However, since most previous studies have used attention tests with low validity and specificity in this assessment, there is a need for further corroborating studies. In the present study, the Attention Network Test was used to compare mainly the efficiency of executive attention between a group of individuals with chronic tinnitus (TG; n = 33) and a healthy control group (CG; n = 37). The results showed that individuals with chronic tinnitus, compared to the CG, did not present with a specific impairment in executive control of attention, nor in any of the other two attention domains. These findings are discussed in relation to the sampling characteristics in this study, which might have led to the sample being more homogenous and high functioning than samples in tinnitus studies generally. Overall, this study suggests that tinnitus and executive control of attention impairment might not be directly related, and that the latter might not necessarily be associated with the maintenance of the condition.

Emerging Topics in the Behavioral Neuroscience of Tinnitus.

This volume has highlighted the many recent advances in tinnitus theory, models, diagnostics, therapies, and therapeutics. But tinnitus knowledge is far from complete. In this chapter, contributors to the Behavioral Neuroscience of Tinnitus consider emerging topics and areas of research needed in light of recent findings. New research avenues and methods to explore are discussed. Issues pertaining to current assessment, treatment, and research methods are outlined, along with recommendations on new avenues to explore with research.

Psychosocial Variables That Predict Chronic and Disabling Tinnitus: A Systematic Review.

To improve tinnitus management we have to gain more knowledge of factors that explain how a persistent distressing tinnitus develops. The central aim of this systematic review was to identify longitudinal studies that investigated psychosocial variables predicting the transition from an acute to a chronic, disabling tinnitus (i.e. tinnitus decompensation) or tinnitus outcomes in chronic tinnitus sufferers. We conducted a systematic literature search of electronic databases and searched manually reference lists. We identified 16 eligible studies: Four longitudinal studies targeted predictors of the transition from acute to chronic tinnitus and 12 longitudinal studies investigated predictors of tinnitus distress (k = 9 observational, longitudinal studies; k = 3 ecological momentary assessment [EMA] and diary studies). The results of this systematic review showed that tinnitus distress, general psychological distress, tendencies to somatize, tinnitus-related delay of sleep onset, certain health behaviors, general illness coping, and certain personality traits (e.g. neuroticism) predicted the transition from acute to chronic, disabling tinnitus. General psychological, mental disorders, tinnitus distress, tinnitus disability (e.g. in different domains of physical, emotional, and social functioning; sleep disturbances), certain health behaviors (e.g. physical exercise), the level of physical and social functioning, and the report of other somatic problems such as pain were predictors of tinnitus outcomes in chronic tinnitus patients at a later follow-up. Studies that examined psychosocial variables as predictors of tinnitus distress are rare and had substantial methodological shortcomings. Future research should focus on core outcome domains and use standardized outcome measures to improve the comparability of results from different studies. Numerous psychosocial variables that have already been investigated as correlates of tinnitus sufferers' functioning in cross-sectional studies are worth investigating with longitudinal designs in future research. Identified predictors of the transition from acute to chronic, disabling tinnitus have to be addressed by health care practitioners who commonly function as the first contact person of individuals with acute tinnitus in the healthcare system.

Brief imagery rescripting vs. usual care and treatment advice in refugees with posttraumatic stress disorder: study protocol for a multi-center randomized-controlled trial.

Background: Many refugees have experienced multiple traumatic events in their country of origin and/or during flight. Trauma-related disorders such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD) are prevalent in this population, which highlights the need for accessible and effective treatment. Imagery Rescripting (ImRs), an imagery-based treatment that does not use formal exposure and that has received growing interest as an innovative treatment for PTSD, appears to be a promising approach. Objective: This randomized-controlled trial aims to investigate the efficacy of ImRs for refugees compared to Usual Care and Treatment Advice (UC+TA) on (C)PTSD remission and reduction in other related symptoms. Method: Subjects are 90 refugees to Germany with a diagnosis of PTSD according to DSM-5. They will be randomly allocated to receive either UC+TA (n = 45) or 10 sessions of ImRs (n = 45). Assessments will be conducted at baseline, post-intervention, three-month follow-up, and 12-month follow-up. Primary outcome is the (C)PTSD remission rate. Secondary outcomes are severity of PTSD and CPTSD symptoms, psychiatric symptoms, dissociative symptoms, quality of sleep, and treatment satisfaction. Economic analyses will investigate health-related quality of life and costs. Additional measures will assess migration and stress-related factors, predictors of dropout, therapeutic alliance and session-by-session changes in trauma-related symptoms. Results and Conclusions: Emerging evidence suggests the suitability of ImRs in the treatment of refugees with PTSD. After positive evaluation, this short and culturally adaptable treatment can contribute to close the treatment gap for refugees in high-income countries such as Germany. Trial registration: German Clinical Trials Register under trial number DRKS00019876, registered prospectively on 28 April 2020.

Antecedentes: Muchos refugiados han experimentado múltiples eventos traumáticos en su país de origen y/o durante la huida. Los trastornos relacionados con el trauma, como el trastorno de estrés postraumático (TEPT) o el trastorno de estrés postraumático complejo (TEPTC), son frecuentes en esta población, lo que pone de relieve la necesidad de un tratamiento accesible y eficaz. La reescritura de imágenes (ImRs, en sus siglas en inglés), un tratamiento basado en imágenes que no utiliza la exposición formal y que ha recibido un creciente interés como tratamiento innovador para el TEPT, parece ser un enfoque prometedor.Objetivo: Este ensayo controlado aleatorizado tiene como objetivo investigar la eficacia de la ImRs para los refugiados en comparación con cuidado habitual y consejería de tratamiento (UC+TA) en la remisión del TEPT(C) y la reducción de otros síntomas relacionados.Método: Los sujetos son 90 refugiados en Alemania con un diagnóstico de TEPT según el DSM-5. Serán asignados aleatoriamente para recibir UC+TA (n = 45) o diez sesiones de ImRs (n = 45). Las evaluaciones se llevarán a cabo al inicio, post-intervención, con un seguimiento de tres meses y un seguimiento de 12 meses. El resultado primario es la tasa de remisión del TEPT(C). Los resultados secundarios son la gravedad de los síntomas del TEPT y del TEPTC, los síntomas psiquiátricos, los síntomas disociativos, la calidad del sueño y la satisfacción del tratamiento. Los análisis económicos investigarán la calidad de vida y los costos relacionados con la salud. Medidas adicionales evaluarán los factores relacionados con la migración y el estrés, los predictores de la deserción, la alianza terapéutica y los cambios sesión por sesión en los síntomas relacionados con el trauma.Resultados y conclusiones: Las evidencias emergentes sugieren la idoneidad de la ImRs en el tratamiento de los refugiados con TEPT. Después de una evaluación positiva, este tratamiento corto y culturalmente adaptable puede contribuir a reducir la brecha de tratamiento para los refugiados en países de altos ingresos como Alemania.

Description of a Culture-Sensitive, Low-Threshold Psychoeducation Intervention for Asylum Seekers (Tea Garden).

Background: Asylum seekers often suffer from high levels of mental distress. However, as a result of a lack of knowledge about mental health and health care, as well as cultural and language barriers, the utilization of mental health care in Western host countries is often difficult for these individuals. Reducing these barriers may thus be a crucial first step towards appropriate mental health care. Previous research showed that psychoeducation may be helpful in this regard. Method: The current manuscript describes a short, low-threshold and transdiagnostic intervention named 'Tea Garden (TG)'. The TG aims to increase specific knowledge about mental health problems and available treatments, and may improve psychological resilience and self-care. In this manuscript, we specifically focus on culturally sensitive facets, following the framework proposed by Heim and colleagues (2021, https://doi.org/10.32872/cpe.6351), and lessons learned from three independent pilot evaluations (Ns = 31; 61; 20). Results: The TG was found to be feasible and quantitative results showed that it was helpful for male and female asylum seekers from different countries of origin (e.g., Afghanistan, Syria, Pakistan, Iraq) and with different educational levels. Interestingly, even asylum seekers who had already been in Germany or Austria for three or more years benefited from the TG. Conclusion: The TG specifically aims to be culture-sensitive rather than culture-specific, to be transdiagnostic rather than focused on specific mental disorders, and to be suitable for asylum seekers who are still in the insecure process of applying for asylum. It may also be helpful for distressed asylum seekers who do not fulfill the criteria for a mental disorder, and for healthy asylum seekers who could use the knowledge gained in the TG to help others.