Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study.

BACKGROUND: Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees' emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. OBJECTIVE: This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. METHODS: From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. RESULTS: At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique "The Inner Safe Place" was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. CONCLUSIONS: The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, "The Inner Safe Place" technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.

Stabilizing Techniques and Guided Imagery for Traumatized Male Refugees in a German State Registration and Reception Center: A Qualitative Study on a Psychotherapeutic Group Intervention.

Refugees have an increased risk of developing mental health problems. Due to the unstable setting in refugee state registration and reception centers, recommended trauma-focused treatment approaches are often not applicable. For this purpose, we devised a suitable therapeutic approach to treat traumatized refugees in a German state registration and reception center: Group therapy, focusing on stabilizing techniques and guided imagery according to Reddemann (2017). From May 2017 to April 2018, we conducted semi-structured interviews with n = 30 traumatized refugees to assess their experiences with the stabilizing techniques and guided imagery in group sessions and self-practice. Participants mainly reported that they had more pleasant feelings, felt increasingly relaxed, and could better handle recurrent thoughts. Additionally, the participants noticed that their psychosocial functioning had improved. The main difficulties that participants encountered were feeling stressed, having difficulties staying focused, or concentrating on the techniques. During self-practice, the participants found it most challenging that they did not have any verbal guidance, were often distracted by the surroundings in the accommodation, and had recurrent thoughts about post-migratory stressors, such as insecurity concerning the future or the application for asylum. Our results show that stabilizing techniques and guided imagery according to Reddemann (2017) are a suitable approach to treat traumatized refugees living in volatile conditions.

Measuring Self-Soothing Ability in Patients with Childhood Trauma - Psychometric Evaluation of the Self-Soothing Scale in a Clinical Sample.

OBJECTIVES: The regulation of strong emotions is an essential skill for traumatized patients. The present instrument was developed for the measurement of the self-soothing ability in traumatized patients. METHODS: The psychometric properties of the SBS were investigated in a clinical sample of patients with childhood trauma (N = 143). In addition, the study explored the factorial structure, internal consistency, retest reliability, convergent validity, and responsiveness of the instrument. RESULTS: Results of an exploratory factor analysis indicated a two-factor structure: 'self-soothing' and 'impulse control', explaining 55% of the variance. The total score showed a good internal consistency (α = .83) and re-test reliability (rtt = .87) as well as good validity and responsiveness. CONCLUSIONS: The 7-item SBS is a suitable instrument for the measurement of self-soothing ability in traumatized patients.

Long-term course in female survivors of childhood abuse after psychodynamically oriented, trauma-specific inpatient treatment: a naturalistic two-year follow-up.

OBJECTIVES: This study examined the long-term course of 43 female survivors of childhood abuse after receiving inpatient treatment based on psychodynamic-orientated trauma therapy. METHODS: Data on symptom load was assessed at admission, discharge and two-year follow-up. Further information on post-discharge treatment and life events in the follow-up period was collected. RESULTS: At two-year follow-up global symptom load (GSI), PTSD, depression (d = 0.43-0.57) and self-soothing ability (d = 0.72) were significantly improved compared to the admission status with no change in dissociative symptoms. 40% of the sample showed good long-term outcome (clinical significant change, GSI) with a significant reduction in depressive, dissociative and by trend in PTSD symptoms. There were no group differences in the amount of stressful life-events and treatment in the follow-up period. Patients with good outcome showed more previous inpatient treatment. CONCLUSIONS: Inpatient treatment leads to a significant symptom reduction in women with severe childhood abuse. The treatment effects remain stable for two years under further outpatient psychotherapy.

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified.

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.

[Treatment outcome of psychodynamic trauma therapy in an inpatient setting]. / Therapieevaluation der Psychodynamisch Imaginativen Traumatherapie (PITT) im stationären Setting.

OBJECTIVE: Chronic traumatization with the beginning in childhood may result in a number of additional problems not included in the diagnosis of Posttraumatic Stress Disorder (PTSD). The efficacy of a three-stage psychodynamically oriented inpatient treatment program (PITT) and the role of chronic childhood threat on treatment outcome was investigated. METHODS: A six-week treatment group of 84 inpatients were compared with 43 wait-list controls with "treatment as usual" (outpatient psychotherapy or psychiatric treatment in the meanwhile). Using measures on PTSD, dissociation, depression, selfsoothing, anxiety and somatization, assessments were made at admission, at discharge and 6 months postdischarge. Assessments for the outpatient control group were made at comparable time spans. RESULTS: In the treatment group significant improvements emerged on all investigated parameters (depression, intrusion, avoidance, anxiety, somatization, and self-soothing) from baseline to discharge, many of which could be maintained over a period for 6 months. PITT especially supports the stabilization of patients with experiences of childhood chronic threat and insecure attachment. Gains in depression, anxiety, somatization, and self-soothing were also significant in comparison to the control group. CONCLUSIONS: Our results suggest that PITT offered on an inpatient basis is an effective treatment for severely traumatized patients that gives impetus to change which should be supplemented with further trauma-specific outpatient therapy to stabilize gains.

Functional MRI correlates of the recall of unresolved life events in borderline personality disorder.

BACKGROUND: Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls. METHOD: Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories. RESULTS: When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2 x 2 factorial analysis (DeltaBPD - Deltacontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition. CONCLUSIONS: The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.

Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder.

BACKGROUND: Early traumatization and additional posttraumatic stress disorder are frequent in patients with borderline personality disorder (BPD). The purpose of this study was to investigate neural correlates of traumatic memory in BPD with and without posttraumatic stress disorder (PTSD) using functional magnetic resonance imaging (fMRI). METHODS: We studied 12 traumatized female patients BPD, 6 of them with and 6 without PTSD. According to an autobiographical interview key words (cues) were defined for traumatic and for negative but nontraumatic episodes. In a block-designed fMRI task patients recalled these episodes. Contrasts between trauma condition and nontrauma condition were analyzed. RESULTS: Analyses for all subjects revealed activation of orbitofrontal cortex areas in both hemispheres, anterior temporal lobes, and occipital areas. In the subgroup without PTSD, activation of orbitofrontal cortex on both sides and Broca's area predominated. In the subgroup with additional PTSD, we observed right more than left activation of anterior temporal lobes, mesiotemporal areas, amygdala, posterior cingulate gyrus, occipital areas, and cerebellum. CONCLUSIONS: Dependent on absence or presence of additional PTSD different neural networks seem to be involved in the traumatic memory of patients with BPD.