Skip to main content
SpringerLink
Log in

Low Intensity Interventions for Psychological Symptoms Following Mass Trauma

  • Chapter
  • First Online:
Mental Health of Refugee and Conflict-Affected Populations

Abstract

With the increased recognition of mental health as part of global health agendas, the substantial gap between mental health needs and access to evidence-based treatment services in low- and middle-income countries (LMICs) has been exposed. More than 80% of the world’s population reside in these lower resource settings where exposure to adverse living conditions and mass trauma is widespread. However, less than 20% of mental health resources are managed by LMICs. Evidence-informed psychological and psychosocial interventions that have been adapted for trauma-affected LMICs and can be delivered by non-specialist providers offer one solution to filling this treatment gap. While the evidence for these low-intensity interventions is mounting, many challenges remain that impinge on the effective implementation of such interventions in these settings. These include the selection of delivery agents, the duration and methods of training and supervision, and challenges related to implementation and local government ownership. This chapter examines the current literature on low-intensity interventions in LMICs and provides a brief commentary on the existing challenges to implementation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Bass, J., Neugebauer, R., Clougherty, K. F., Verdeli, H., Wickramaratne, P., Ndogoni, L., … Bolton, P. (2006). Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes. British Journal of Psychiatry, 188(6), 567–573. https://doi.org/10.1192/bjp.188.6.567

    Article  Google Scholar 

  • Baxter, A. J., Patton, G., Scott, K. M., Degenhardt, L., & Whiteford, H. A. (2013). Global epidemiology of mental disorders: What are we missing? PLoS One, 8(6), e65514. https://doi.org/10.1371/journal.pone.0065514

    Article  PubMed  PubMed Central  Google Scholar 

  • Bennet-Levy, J., Richards, D., Farrand, P., Christensen, H., Griffiths, K., Kavanagh, D., … Williams, C. (2010). The Oxford guide to low intensity CBT interventions. Oxford, UK: Oxford University Press.

    Google Scholar 

  • Betancourt, T. S., McBain, R., Newnham, E. A., Akinsulure-Smith, A. M., Brennan, R. T., Weisz, J. R., & Hansen, N. B. (2014). A behavioral intervention for war-affected youth in Sierra Leone: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1288–1297. https://doi.org/10.1016/j.jaac.2014.09.011

    Article  Google Scholar 

  • Bolton, P., Lee, C., Haroz, E. E., Murray, L., Dorsey, S., Robinson, C., … Bass, J. (2014). A transdiagnostic community-based mental health treatment for comorbid disorders: Development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS One, 11(11), e1001757. https://doi.org/10.1371/journal.pmed.1001757

    Article  Google Scholar 

  • Bryant, R. A., Schafer, A., Dawson, K. S., Anjuri, D., Mulili, C., Ndogoni, L., … van Ommeren, M. (2017). Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial. PLoS Medicine, 14(8), e1002371.

    Google Scholar 

  • Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9(1), 22. https://doi.org/10.1186/1471-244X-9-22

    Article  PubMed  PubMed Central  Google Scholar 

  • Chisholm, D. (2006). Dollars, DALYs and decisions: Economic aspects of the mental health system. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., & Daar, A. S. (2011). Grand challenges in global mental health: A consortium of researchers, advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment. Nature, 475(7354), 27–30. https://doi.org/10.1038/475027a

    Article  PubMed  PubMed Central  Google Scholar 

  • Dawson, K. S., Bryant, R. A., Harper, M., Tay, A. K., Rahman, A., Schafer, A., & van Ommeren, M. (2015). Problem Management Plus (PM+): A WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry, 14(3), 354–357. https://doi.org/10.1002/wps.20255

    Article  PubMed  PubMed Central  Google Scholar 

  • Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P., … Consortium, W. W. M. H. S. (2004). Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surverys. JAMA, 29(21), 2581–2590. https://doi.org/10.1001/jama.291.21.2581

    Article  Google Scholar 

  • Dybdahl, R. (2001). Children and mothers in war: An outcome study of a psychological intervention program. Child Development, 72(4), 1214–1230. https://doi.org/10.1111/1467-8624.00343

    Article  PubMed  Google Scholar 

  • Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in Northern Uganda: A randomized controlled trial. JAMA, 306(5), 503–512. https://doi.org/10.1001/jama.2011.1060

    Article  PubMed  Google Scholar 

  • Gillies, D., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2012). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Cochrane Database of Systematic Reviews, 2014(12), 1–64. https://doi.org/10.1002/14651858.CD006726.pub2

    Article  Google Scholar 

  • Inter-Agency Standing Committee (IASC). (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva, Switzerland: IASC.

    Google Scholar 

  • James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 6, CD004690. https://doi.org/10.1002/14651858.cd004690

    Article  Google Scholar 

  • Jordans, M. J., & Tol, W. A. (2013). Mental health in humanitarian settings: Shifting focus to care systems. International Health, 5(1), 9–10. https://doi.org/10.1093/inthealth/ihs005

    Article  PubMed  Google Scholar 

  • Jordans, M. J. D., Komproe, I. H., Tol, W. A., Kohrt, B. A., Luitel, N. P., Macy, R. D., & de Jong, J. T. V. M. (2010). Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized controlled trial. Journal of Child Psychology and Psychiatry, 51(7), 818–826. https://doi.org/10.1111/j.1469-7610.2010.02209.x

    Article  PubMed  Google Scholar 

  • Jordans, M. J. D., Pigott, H., & Tol, W. A. (2016). Interventions for children affected by armed conflict: A systematic review of mental health and psychosocial support in low- and middle-income countries. Current Psychiatry Reports, 18(1), 9–24. https://doi.org/10.1007/s11920-015-0648-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Jordans, M. J. D., Tol, W. A., Susanty, D., Ntamatumba, P., Luitel, N. P., Komproe, I. H., & de Jong, J. T. V. M. (2013). Implementation of a mental health care package for children in areas of armed conflict: A case study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan. PLoS Medicine, 10(1), e1001371. https://doi.org/10.1371/journal.pmed.1001371

    Article  PubMed  PubMed Central  Google Scholar 

  • McEnvoy, P. M., Nathan, P., & Norton, P. J. (2009). Efficacy of transdiagnostic treatments: A review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy, 23(1), 20–33. https://doi.org/10.1891/0889-8391.23.1.20

    Article  Google Scholar 

  • McLean, K. E., Kaiser, B. N., Hagaman, A. K., Wagenaar, B. H., Therosme, T. P., & Kohrt, B. A. (2015). Task sharing in Haiti: Qualitative assessment of a brief, structured training with and without apprenticeship supervision for community health workers. Intervention, 13(2), 135–155. https://doi.org/10.1097/wtf.0000000000000074

    Article  PubMed  Google Scholar 

  • Murray, L. K., Dorsey, S., Bolton, P., Jordans, M. J. D., Rahman, A., Bass, J., & Verdeli, H. (2011). Building capacity in mental health interventions in low resource countries: An apprenticeship model for training local providers. International Journal of Mental Health Systems, 5(1), 30–42. https://doi.org/10.1186/1752-4458-5-30

    Article  PubMed  PubMed Central  Google Scholar 

  • Murray, L. K., Dorsey, S., Haroz, E., Lee, C., Alsiary, M. M., Haydary, … Bolton, P. (2013). A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cognitive and Bheavioral Practice, 21(2), 111–123. https://doi.org/10.1016/j.cbpra.2013.06.005

    Article  Google Scholar 

  • Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., … Bolton, P. A. (2015). Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial. JAMA Pediatrics, 169(8), 761–769. https://doi.org/10.1001/jamapediatrics.2015.0580

    Article  PubMed  Google Scholar 

  • Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., … van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370(9591), 991–1005. https://doi.org/10.1016/s0140-6736(07)61240-9

    Article  PubMed  Google Scholar 

  • Patel, V., Chowdhary, N., Rahman, A., & Verdeli, H. (2011). Improving access to psychological treatments: Lessons from developing countries. Behaviour Research and Therapy, 49(9), 523–528. https://doi.org/10.1016/j.brat.2011.06.012

    Article  PubMed  PubMed Central  Google Scholar 

  • Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: A global public-health challenge. Lancet, 369(9569), 1302–1313. https://doi.org/10.1016/s0140-6736(07)60368-7

    Article  PubMed  Google Scholar 

  • Patel, V., & Prince, M. J. (2010). Global mental health: A new global health field comes of age. JAMA, 303(19), 1976–1977. https://doi.org/10.1001/jama.2010.616

    Article  PubMed  PubMed Central  Google Scholar 

  • Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and infants in rural Pakistan: A cluster-randomised controlled trial. Lancet, 372(9642), 902–909. https://doi.org/10.1016/s0140-6736(08)61400-2

    Article  PubMed  PubMed Central  Google Scholar 

  • Rahman, A., Riaz, N., Dawson, K. S., Hamdani, S. U., Chiumento, A., Sijbrandij, M., … Farooq, S. (2016). Problem Management Plus (PM+): Pilot trial of a WHO transdiagnostic psychological intervention in conflict-affected Pakistan. World Psychiatry, 15(2), 182–183. https://doi.org/10.1002/wps.20312

    Article  PubMed  PubMed Central  Google Scholar 

  • Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373(9682), 2223–2233. https://doi.org/10.1016/s0140-6736(09)60746-7

    Article  PubMed  Google Scholar 

  • Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., … Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet, 370(9593), 1164–1174. https://doi.org/10.1016/s0140-6736(07)61263-x

    Article  PubMed  Google Scholar 

  • Sharan, P., Levav, I., Olifson, S., de Francisco, A., & Saxena, S. (2007). Research capacity for mental health in low- and middle-income countries: Results of a mapping project. Geneva, Switzerland: World Health Organization and Global Forum for Health Research.

    Google Scholar 

  • Thornicroft, G., Alem, A., Anturies Dos Santos, R., Barley, E., Drake, R. E., Gregorio, G., … Wondimagegn, D. (2010). WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry, 9(2), 67–77. https://doi.org/10.1002/j.2051-5545.2010.tb00276.x

    Article  PubMed  PubMed Central  Google Scholar 

  • Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, A., Sipsma, H., Sivayokan, S., … de Jong, J. T. V. M. (2012). Outcomes and moderators of a preventive school-based mental health intervention for children affected by war in Sri Lanka: A cluster randomized trial. World Psychiatry, 11(2), 114–122. https://doi.org/10.1016/j.wpsyc.2012.05.008

    Article  PubMed  PubMed Central  Google Scholar 

  • Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & de Jong, J. T. V. M. (2008). School-based mental health intervention for children affected by political violence in Indonesia: A cluster randomized trial. JAMA, 300(6), 655–662. https://doi.org/10.1001/jama.300.6.655

    Article  PubMed  Google Scholar 

  • van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S. M., Pian, J., … Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews, 11, CD009149. https://doi.org/10.1002/14651858.cd009149.pub2

    Article  Google Scholar 

  • Weiss, W. M., Murray, L. K., Zangana, G. A. S., Mahmooth, Z., Kaysen, D., Dorsey, S., … Bolton, P. (2015). Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: A randomized control trial. BMC Psychiatry, 15(1), 249–265. https://doi.org/10.1186/s12888-015-0622-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., … Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/s0140-6736(13)61611-6

    Article  PubMed  Google Scholar 

  • WHO. (2013). Mental health action plan 2013–2020. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • WHO. (2015). Mental health atlas 2014. Geneva, Switzerland: Department of Mental Health and Substance Abuse, WHO.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychology, University of New South Wales, Sydney, NSW, Australia

    Katie S. Dawson

  2. Institute of Psychology, Health and Society, University of Liverpool, Liverpool, Merseyside, UK

    Atif Rahman

Authors
  1. Katie S. Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atif Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katie S. Dawson .

Editor information

Editors and Affiliations

  1. Department of Clinical Psychology and Psychotherapy, University of MĂĽnster, MĂĽnster, Germany

    Nexhmedin Morina

  2. School of Psychology, University of New South Wales, Sydney, NSW, Australia

    Angela Nickerson

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dawson, K.S., Rahman, A. (2018). Low Intensity Interventions for Psychological Symptoms Following Mass Trauma. In: Morina, N., Nickerson, A. (eds) Mental Health of Refugee and Conflict-Affected Populations. Springer, Cham. https://doi.org/10.1007/978-3-319-97046-2_17

Download citation

Publish with us

Policies and ethics

Search

Navigation