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A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction?
Abstract
This is the first controlled study of an expressive arts group intervention with unaccompanied minor asylum seeking children. The aim of the study was to examine whether such an intervention may alleviate symptoms of trauma and enhance life satisfaction and hope. One hundred forty five unaccompanied minor refugee boys with their stated age between 15 and 18 were allocated into a 10 session 5 weeks manualized expressive arts intervention (EXIT) or a life as usual (LAU) control group. The participants were assessed at onset and 4 times over a period of 25 months with a battery of instruments measuring post-traumatic stress symptoms (PTSS), general psychological distress (HSCL-25A), current life satisfaction (CLS) and expected life satisfaction (ELS). The instruments were presented in the participants’ native languages, using touch-screen laptops and the computer program Multilingual Computer Assisted Interview (MultiCASI). There were significant time by group interactions in favor of the EXIT group for PTSS and CLS. At the end of the follow up the EXIT group had higher life satisfaction and hope for the future than the LAU group. A manualized EXIT group intervention can have a beneficial effect on helping minor refugee boys to cope with symptoms of trauma, strengthen their life satisfaction and develop hope for the future. Our findings support previous studies showing that the arts may help people in reconstructing meaning and connection with others by focusing on resources and creativity.
... and 25 months (p = .003) (DeMott et al., 2017). Writing for recovery presented remarkable outcomes in moderating traumatic grief symptoms (Cohen's d = 0.67, p < .005) ...
... All the four therapeutic interventions (EXIT, BATP, HEAL, & Writing for Recovery; Table 3) were conducted in a group format, adopting creative arts interventions/programmes for therapeutic purposes. Three were based on weekly sessions offering different art styles (DeMott et al., 2017;Quinlan et al., 2016;Rowe et al., 2017) with two facilitated access to individual sessions (Quinlan et al., 2016;Rowe et al., 2017) and two integrated others in parallel activities like play and breathing exercises (DeMott et al., 2017;Quinlan et al., 2016). Regarding the providers, Kalantari et al. (2012) did not report on who led writing for recovery. ...
... All the four therapeutic interventions (EXIT, BATP, HEAL, & Writing for Recovery; Table 3) were conducted in a group format, adopting creative arts interventions/programmes for therapeutic purposes. Three were based on weekly sessions offering different art styles (DeMott et al., 2017;Quinlan et al., 2016;Rowe et al., 2017) with two facilitated access to individual sessions (Quinlan et al., 2016;Rowe et al., 2017) and two integrated others in parallel activities like play and breathing exercises (DeMott et al., 2017;Quinlan et al., 2016). Regarding the providers, Kalantari et al. (2012) did not report on who led writing for recovery. ...
... To date, there have been relatively few publications on this issue. The available research primarily focuses on art therapy, including dance/movement therapy, movement and play therapy, BBAT, trauma-focused art therapy [20,[31][32][33][34][35][36][37], arts activism, and expressive arts intervention [34,[38][39][40][41]. ...
... To date, there have been relatively few publications on this issue. The available research primarily focuses on art therapy, including dance/movement therapy, movement and play therapy, BBAT, trauma-focused art therapy [20,[31][32][33][34][35][36][37], arts activism, and expressive arts intervention [34,[38][39][40][41]. ...
... Various studies have been conducted on both children and adults, including Syrian refugee children in Turkey [37], war-affected children from the developing world [32], youth detained at the Tornillo Influx Center in the USA [39], unaccompanied asylumseeking children in Norway [34], and adolescent refugees from Burma in the USA [35]. Similarly, adult groups such as Chilean exiles in Europe, Canada, the United States, Latin America, and North Africa [38]; refugees residing at a nonprofit humanitarian organization in the USA [31]; traumatized refugees at the REFUGIO treatment centre in Germany [20]; traumatized refugees with PTSD in Denmark [33]; female refugees from Albania, Ghana, Iraqi Kurdistan, Iraq, Iran, Malawi, and Turkey in the UK [40]; refugees and asylum seekers with a PTSD diagnosis in Denmark [36]; and Syrian refugees resettled in Belgium [41] have been studied. ...
This study aimed to address the mental health challenges faced by refugee artists who are grantees of ICORN—the International Cities of Refuge Network—from the perspective of the extended conceptual ADAPT model. The study employed exploratory qualitative research, and data were collected through semi-structured interviews with ICORN artists in Poland, Norway, and Sweden. For data analysis, Interpretive Phenomenological Analysis (IPA) was used, whereas for the presentation of the results, the framework of the ADAPT model was applied. The results showed that the super-ordinate themes that emerged from the IPA analysis related directly to the ADAPT model and could mostly be assigned to its basic pillars: (1) Security; (2) Bonds and Networks; (3) Justice; (4) Roles and Identities; and (5) Existential Meaning. However, the model was insufficient for capturing the full diversity of experiences described by the respondents. Therefore, an extension of the model in the form of two additional pillars, Art and Body and Mind, was proposed. The findings confirm that the ADAPT model is adequate for systematizing and depicting in detail the experiences of migrants/refugees. However, further modifications of the model are necessary, particularly the additional pillar Body and Mind, which has the potential to become a separate category in other migrants’/refugees’ assessment frameworks. Moreover, Art itself could be seen as a universal bridging factor between the refugee and the host population, contributing to the refugees’ adaptation to the host society.
... Of the 46 papers that concern psychotherapy, 23 report CBT interventions , 6 transcultural interventions [60][61][62][63][64][65], 5 psychodynamic interventions [66][67][68][69][70], 2 NET interventions [71,72], 2 narrative interventions [73,74], 2 art interventions [75,76], 1 systemic intervention [77] and 5 examine various other approaches [78][79][80][81][82]. Furthermore, 12 ...
... Of the 46 papers that concern psychotherapy, 23 report CBT interventions , 6 transcultural interventions [60][61][62][63][64][65], 5 psychodynamic interventions [66][67][68][69][70], 2 NET interventions [71,72], 2 narrative interventions [73,74], 2 art interventions [75,76], 1 systemic intervention [77] and 5 examine various other approaches [78][79][80][81][82]. Furthermore, 12 studies followed a multimodal approach [45,46,51,58,59,[67][68][69][70]78,81,82], yet we categorized them based on the therapeutic approach that seemed more prevalent, as they were very heterogeneous. Five of the papers concern further analysis [40,61,72], extra aspects [50] or systematization [75] of previously published studies [39,44,60,71,76]; thus, we do not regard them as distinct. ...
... Of the 46 papers that concern psychotherapy, 23 report CBT interventions , 6 transcultural interventions [60][61][62][63][64][65], 5 psychodynamic interventions [66][67][68][69][70], 2 NET interventions [71,72], 2 narrative interventions [73,74], 2 art interventions [75,76], 1 systemic intervention [77] and 5 examine various other approaches [78][79][80][81][82]. Furthermore, 12 studies followed a multimodal approach [45,46,51,58,59,[67][68][69][70]78,81,82], yet we categorized them based on the therapeutic approach that seemed more prevalent, as they were very heterogeneous. Five of the papers concern further analysis [40,61,72], extra aspects [50] or systematization [75] of previously published studies [39,44,60,71,76]; thus, we do not regard them as distinct. ...
Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs' trauma, mental health and wellbeing, as well as professionals' skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs' empowerment, wellbeing, support and integration, as well as at improving caregivers' skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.
... Considering that severe exposure to trauma can adversely affect the verbal memory [26], which may impair daily functioning, it is worth, investigating whether art therapy could be used as an alternative treatment approach rather than merely a palliative intervention with refugees [25]. Furthermore, previous research posits that group art therapy interventions could be more cost-effective [30] and thus cover a greater number of refugees arriving in a new host country [31]. Hence, this review aims to integrate and to summarize the previous research that examined the effect of art therapy interventions on the psychological issues of refugees and to delineate the methodologies used in these studies. ...
... Rowe et al. [44] reported a non-significant increase in the symptoms of depression. Meyer DeMott et al. [31] did not report changes in depression. Only Ugurlu et al. [17] reported significant reduction in depression by comparing the mean depression scores before and after art therapy. ...
... Quinlan et al. [41] concluded that art therapy interventions did not significantly change the anxiety symptoms of the participants in the treatment group. Meyer DeMott et al. [31] measured psychological distress in their study through using an extended version of HSCL-25, which measures depression and anxiety. They reported a close to significant time by group interaction effect on psychological distress but reported no significant group differences at any point of time. ...
... Similarly, all reviewed studies met the criteria related to providing sufficient information on participants' demographics. It is also critical to note that none of the studies that involved more than one group used random participant assignment to study groups (DroŽdek et al., 2014;Meyer DeMott et al., 2017;Feen-Calligan et al., 2020). The sample size across studies varied from 12 to 145 participants, and the age of participants ranged from seven to 80 years. ...
... In addition, the study that was conducted by Van Wyk et al. (2012) did not describe materials or provide accessible sources. Five out of eight studies did not meet this criterion as no implementation fidelity data were collected (Van Wyk et al., 2012;DroŽdek et al., 2014;Ugurlu et al., 2016;Meyer DeMott et al., 2017;Moosa et al., 2017). In article Rowe et al.'s article, the authors described how the therapists were able to follow the planned protocol for administering assessment tools and dose delivered but it did not clearly state the measures used such as observation checklists or self-reports of the implementation by unit analysis. ...
... As mentioned earlier, according to CEC standards, a study can be considered for evidence-based classification only when they employ a group comparison design (e.g., randomized or quasi-experiment) or a single subject design (Cook et al., 2014). The only two studies that were eligible for classification were the ones that employed quasi-experimental designs (Meyer DeMott et al., 2017;Feen-Calligan et al., 2020). Both studies met more than 50% of quality indicators (see Table 1). ...
The current global refugee crisis revealed that refugee children, youth, and adults are uniquely vulnerable to traumatic events. Yet, there are only a few studies available that report robust systematic data on art therapy interventions with mental health in recent refugee populations. The purpose of the study is to synthesize and evaluate (a) the available research evidence on the use of art therapy in reducing post-traumatic stress disorder (PTSD) levels in refugees, and (b) the quality of empirical evidence for each of the reviewed studies. The authors adopted the Council for Exceptional Children (CEC) evidence-based practice (EBP) standards and quality indicators to evaluate the methodological soundness of the reviewed studies and the evidence-based classification of art therapy as a treatment intervention. We systematically searched electronic databases of pertinent review articles for the period from 2010 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic searches identified 70 research articles but yielded eight eligible journals as per the inclusion criteria. Results indicated that, though considered a promising treatment approach, art therapy is presently classified as an intervention that falls under the category of practice with insufficient evidence. The findings suggest the need for further methodologically sound experimental studies to strengthen the evidence behind art therapy as an intervention to reduce PTSD symptoms in refugees around the world.
... However, the authors noted that engagement with the immediate social environment and taking part in daily activities was associated with improved wellbeing (Garoff et al., 2019). A Norwegian group-based intervention, aimed at improving participants' feelings of safety and stabilization, anxiety and stress management, emotion regulation skills and trauma education, reported significantly improved long-term life satisfaction and hope for the future (Meyer DeMott et al., 2017). A 12-week psychosocial support program in Germany, that offered a combination of individual, family, and group sessions on trauma-and grief focusing therapy; verbalizing techniques; relaxation techniques; painting; playing and acting; and fantasy journeys, discussions, and psychoeducation about trauma and trauma reactions, showed significant improvement in psychosocial functioning, reduction in posttraumatic, anxiety and depressive symptoms, and reduction in PTSD diagnoses. ...
... Quantitative studies. The assessment of quantitative research studies (n = 19) with the EPHPP tool resulted in three studies scoring "strong" (Ellis et al., 2013;Kalantari et al., 2012;Rousseau et al., 2007), seven "moderate" (Baker & Jones, 2006;Barrett et al., 2000;Meyer DeMott et al., 2017;Möhlen et al., 2005;Panter-Brick et al., 2018;Quinlan et al., 2016;Stark et al., 2018), and nine scoring "weak" (Barrett et al., 2001(Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Fazel et al., 2009;Onyut et al., 2005;Oras et al., 2004;Schauer et al., 2004;Yankey & Biswas, 2012). The scores were evaluated according to the EPPHP global rating scale of "strong" = no weak ratings, "moderate" = one weak rating, and "weak" = two or more weak ratings. ...
... Amongst the studies that achieved a moderate overall score, the areas where they performed well included: a description of whether confounders were being controlled in the design or analysis of the study; the reliability and validity of the data collection tools; and the strength of the study design in terms of bias, for example, the existence of a control group and the allocation of participants to both groups. The areas that rated lowly in almost half of the papers in this category (n = 9) were: (a) whether assessors were described as blinded to which participants were allocated to the treatment and control group, and study participants were not aware of the research question (Barrett et al., 2003;Beehler et al., 2012;Fazel et al., 2009;Meyer DeMott et al., 2017;Möhlen et al., 2005;Onyut et al., 2005;Oras et al., 2004;Quinlan et al., 2016;Stark et al., 2018); and (b) whether there was discussion of the numbers and reasons for dropouts and withdrawals (Baker & Jones, 2006;Barrett et al., 2000Barrett et al., , 2001Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Panter-Brick et al., 2018;Yankey & Biswas, 2012;Supplemental Appendix A). ...
Migration can affect the physical, mental, emotional, and social wellbeing of individuals and families. This study provides an overview of interventions aimed at improving the wellbeing of young migrants. It identifies knowledge gaps and provides direction for future research. The review process comprises a systematic search of six academic databases, and websites for relevant peer-reviewed and gray literature on the topic. A total of 2,911 records were identified, of which 28 studies met our eligibility criteria for inclusion. Thematic analysis comprised of the description of study characteristics and outcome themes. EPHPP and CASP tools were utilized to assess the methodological quality of studies. The review findings indicate a number of approaches with varying effectivity, however, arts, music, and sports programs showed good results for youth across all migrant groups. Our findings call for further and more high-quality evaluation research, with longitudinal designs that ideally include stakeholder collaboration.
... With respect to study design, all but three studies were nonrandomized. Specifically, 11 studies were singlecondition pre-post studies (Allison & Ferreira, 2017;El-Khani et al., 2018;Gormez et al., 2017;Grasser et al., 2019;Mancini, 2019;Perilli et al., 2019;Pfeiffer & Goldbeck, 2017;Sarkadi et al., 2018;Ugurlu et al., 2016;Van der Gucht et al., 2019), three used nonrandomized comparison conditions (Ehntholt et al., 2005;Meyer DeMott et al., 2017;Thabet et al., 2005), and three used a randomized controlled design (Kataoka et al., 2003;Ooi et al., 2016;Pfeiffer et al., 2018). All studies used valid and reliable measures to assess the intervention effect on the outcomes. ...
... In general, the most problematic domains were bias due to confounding variables and bias in measurement of the outcomes. Three studies had better ratings but still had serious overall risk of bias (Gormez et al., 2017;Meyer DeMott et al., 2017;Pfeiffer & Goldbeck, 2017). ...
... PTSS. One study (Meyer DeMott et al., 2017) did not provide the required data for a meta-analysis and thus 15 studies were included in the meta-analysis of PTSS. The combined pre-post effect size for PTSS was statistically significant in the random effects model, d ¼ �0.66, 95% CI [�0.86, �0.46], p < .001 ...
Purpose: A meta-analysis of group interventions to reduce post-traumatic stress symptoms (PTSS) and/or depression among
refugee and immigrant children and adolescents.
Methods: A systematic search was followed by independent reviews of each study for risk of bias. The meta-analysis pooled between- and within-condition effect sizes on PTSS and depression across studies
using a random effects model.
Results: The search yielded 16 studies utilizing eight interventions involving 976 participants. For all studies, within conditions, there were good effects on PTSS (d¼�0.66, 95% CI [�0.86, �0.46]) and depression (d¼�0.51, 95% CI [�0.79, �0.23]) with substantial heterogeneity. For studies with control groups, the between-group effect sizes yielded a small effect on PTSS (d¼�0.31, 95% CI [�0.65, 0.03]) with no significant effect on depression.
Conclusions: The interventions helped to reduce PTSS and depression. Most studies lacked rigorous designs and provided little information on group variables needed for replication.
... However, the authors noted that engagement with the immediate social environment and taking part in daily activities was associated with improved wellbeing (Garoff et al., 2019). A Norwegian group-based intervention, aimed at improving participants' feelings of safety and stabilization, anxiety and stress management, emotion regulation skills and trauma education, reported significantly improved long-term life satisfaction and hope for the future (Meyer DeMott et al., 2017). A 12-week psychosocial support program in Germany, that offered a combination of individual, family, and group sessions on trauma-and grief focusing therapy; verbalizing techniques; relaxation techniques; painting; playing and acting; and fantasy journeys, discussions, and psychoeducation about trauma and trauma reactions, showed significant improvement in psychosocial functioning, reduction in posttraumatic, anxiety and depressive symptoms, and reduction in PTSD diagnoses. ...
... Quantitative studies. The assessment of quantitative research studies (n = 19) with the EPHPP tool resulted in three studies scoring "strong" (Ellis et al., 2013;Kalantari et al., 2012;Rousseau et al., 2007), seven "moderate" (Baker & Jones, 2006;Barrett et al., 2000;Meyer DeMott et al., 2017;Möhlen et al., 2005;Panter-Brick et al., 2018;Quinlan et al., 2016;Stark et al., 2018), and nine scoring "weak" (Barrett et al., 2001(Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Fazel et al., 2009;Onyut et al., 2005;Oras et al., 2004;Schauer et al., 2004;Yankey & Biswas, 2012). The scores were evaluated according to the EPPHP global rating scale of "strong" = no weak ratings, "moderate" = one weak rating, and "weak" = two or more weak ratings. ...
... Amongst the studies that achieved a moderate overall score, the areas where they performed well included: a description of whether confounders were being controlled in the design or analysis of the study; the reliability and validity of the data collection tools; and the strength of the study design in terms of bias, for example, the existence of a control group and the allocation of participants to both groups. The areas that rated lowly in almost half of the papers in this category (n = 9) were: (a) whether assessors were described as blinded to which participants were allocated to the treatment and control group, and study participants were not aware of the research question (Barrett et al., 2003;Beehler et al., 2012;Fazel et al., 2009;Meyer DeMott et al., 2017;Möhlen et al., 2005;Onyut et al., 2005;Oras et al., 2004;Quinlan et al., 2016;Stark et al., 2018); and (b) whether there was discussion of the numbers and reasons for dropouts and withdrawals (Baker & Jones, 2006;Barrett et al., 2000Barrett et al., , 2001Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Panter-Brick et al., 2018;Yankey & Biswas, 2012;Supplemental Appendix A). ...
A systematic review of interventions targeting the wellbeing of young people of migrant and refugee backgrounds.
... The EXIT intervention revealed that this art and expression program is suitable for early support and it showed modest long-term positive effects during a 25-month follow-up for the treatment group in mental health complaints. Moreover, life satisfaction and expectations increased more evidently over time (DeMott et al. 2017). ...
... The included studies described self-efficacy, connectedness, and safety as important components of interventions with newly arrived refugee youth. Although these aspects were already identified in the context of interventions shortly after mass trauma and during the first stage of trauma therapy (Herman 2015;Hobfoll et al. 2007), only one of the included studies referred to those theoretical approaches (DeMott et al. 2017). Nevertheless, this theoretical background explains the importance of the elements counteracting the consequences of trauma. ...
... Another aspect to consider is the element of collective efficacy, although this was not addressed by the reviewed studies (Hobfoll et al. 2007). This might partly be due to the impossibility of involving family and community members also affected by the trauma, as four of the included studies examined unaccompanied adolescent refugees only (Bemak and Timm 1994;DeMott et al. 2017;Katsounari 2014;Lustig et al. 2004). Nevertheless, the reviewed studies also focused on connectedness as a trauma-related element. ...
Adolescent refugees are confronted with multiple developmental, psychological, and social challenges after flight. Psychosocial interventions are therefore necessary to support adolescents during the first period after arrival in a receiving country and to avoid negative long-term consequences. Unfortunately, little is known about the types and the effects of such interventions provided during this time. This systematic review aimed to synthesize research about psychosocial interventions for refugee youth during the first year after arrival. Seven studies were identified and showed positive effects on the psychological symptoms of anxiety, post-traumatic stress disorder, and depression, as well as on the personal development of adolescents regarding their life satisfaction, behavioral problems, hope for the future, and their social and cultural integration. Effective elements of the interventions were categorized into trauma-related elements (self-efficacy, safety, and connectedness) and elements associated with forced migration (culture, post-migration environment, and professional network). Nonetheless, the methodological quality of the included studies was heterogenous and the review showed a lack of comprehensive, long-term, and high-quality research in this field. Recommendations for future research include a greater utilization of strong research designs and translated and cross-culturally validated instruments, as well as a focus on elements specifically related to the phase of adolescence.
... The EXIT intervention revealed that this art and expression program is suitable for early support and it showed modest long-term positive effects during a 25-month follow-up for the treatment group in mental health complaints. Moreover, life satisfaction and expectations increased more evidently over time (DeMott et al. 2017). ...
... The included studies described self-efficacy, connectedness, and safety as important components of interventions with newly arrived refugee youth. Although these aspects were already identified in the context of interventions shortly after mass trauma and during the first stage of trauma therapy (Herman 2015;Hobfoll et al. 2007), only one of the included studies referred to those theoretical approaches (DeMott et al. 2017). Nevertheless, this theoretical background explains the importance of the elements counteracting the consequences of trauma. ...
... Another aspect to consider is the element of collective efficacy, although this was not addressed by the reviewed studies (Hobfoll et al. 2007). This might partly be due to the impossibility of involving family and community members also affected by the trauma, as four of the included studies examined unaccompanied adolescent refugees only (Bemak and Timm 1994;DeMott et al. 2017;Katsounari 2014;Lustig et al. 2004). Nevertheless, the reviewed studies also focused on connectedness as a trauma-related element. ...
... The positive change in life satisfaction following participation in a low-threshold intervention is in line with one of the few studies investigating life satisfaction among URMs. Participants and non-participants in an expressive art therapy intervention showed different trajectories of life satisfaction, symptoms of PTSD, and mental distress [46]. This was most evident for the life satisfaction trajectory, showing that psychological interventions can lead to different trajectories of mental distress, symptoms of PTSD, and life satisfaction, and signals why it is important to study both illbeing and wellbeing, both for clinical and theoretical purposes [46]. ...
... Participants and non-participants in an expressive art therapy intervention showed different trajectories of life satisfaction, symptoms of PTSD, and mental distress [46]. This was most evident for the life satisfaction trajectory, showing that psychological interventions can lead to different trajectories of mental distress, symptoms of PTSD, and life satisfaction, and signals why it is important to study both illbeing and wellbeing, both for clinical and theoretical purposes [46]. ...
Background
Unaccompanied asylum-seeking and refugee minors report low life satisfaction and high levels of mental health problems, nevertheless they often do not seek or receive help for their problems. Teaching Recovery Techniques (TRT) is a low-threshold, five sessions intervention developed to reduce distressing war- and disaster-related trauma reactions among children and youth. In this study, we investigate if TRT can contribute to increased life satisfaction among unaccompanied asylum-seeking and refugee minors.
Methods
Asylum-seeking and resettled unaccompanied minors participated in TRT carried out in 15 locations throughout Norway, n = 147, mean age = 16.61 (SD = 1.80), 88% boys, and 67% from Afghanistan. Life satisfaction was measured by the Cantril Ladder before the intervention, and two- and eight weeks post-intervention. We also included indices of intervention compliance and contextual variables, such as asylum status. We applied a pre- and post-intervention design with linear mixed model analyses to investigate change in life satisfaction.
Results
Life satisfaction significantly increased from pre- to post- intervention, but not for youth whose asylum application had been rejected or who were still awaiting a decision. Indices of intervention compliance were associated with an increase in life satisfaction.
Conclusions
TRT is a potential useful intervention to enhance life satisfaction among unaccompanied asylum-seeking and refugee minors and can be a measure to support positive development among youth at risk for mental health problems. However, TRT initiatives should consider the participant’s stage of asylum process, because harsh immigration policies may overburden the coping capacity. Without further adaptation, TRT seems most useful for youth granted residence. The manual has been revised to include asylum-related stressors.
Trial Registration
ClinicalTrials.gov (16/54,571, registered 30.01.2019).
... Eight [40][41][42][43][44][45][46][47] included studies were RCTs; 15 48-62 were non-randomised single-group pre-post studies. Studies were diverse in intervention setting, population age group, intervention type, intervention form and intensity. ...
... 48 The same studies also reported on externalising problems. Behavioral problems of childhood Six out of the 10 reported effect size estimates showed statistically significant improvements in this category, however, meta-analysis was not appropriate due to the use Meyer DeMott et al., 42 Metzler et al., 41 Betancourt et al., 43 Lange-Nielsen et al., 44 Sirin et al., 45 Yankey et al. 46 and Scheiber et al. 47 *Risk of bias classification was based on ROB-2 and ROBINS-I instruments. 31 'Low' risk of bias is considered comparable to an RCT; 'moderate' risk of bias is considered inferior to an RCT but sound for observational studies; 'serious' risk of bias or 'some concerns' indicates at least one domain where bias likely affects results; high risk of bias indicates substantial risk of bias in one domain or concerns across multiple domains; 'critical' indicates risk of bias to a degree that renders the evidence likely not useful. ...
Background
Children represent nearly 40% of forcibly displaced populations and are subject to stressors that affect well-being. Little is known about the effects of interventions to enhance psychological resilience in these children, outside clinical settings.
Methods
We conducted a systematic review, following Cochrane methods. Eligible studies tested resilience-enhancing interventions outside clinical settings in forcibly displaced children/adolescents. We included longitudinal quantitative studies with comparator conditions irrespective of geographical scope or language. We searched articles published between January 2010 and April 2020 in PubMed, Embase, Cochrane Library, Web of Science, PsycINFO and the WHO’s Global Index Medicus. To standardise effect sizes across the different reported outcomes, we transformed reported mean differences to standardised mean differences using Hedge’s g statistic with associated 95% CI. We pooled data for meta-analysis where appropriate. We used Cochrane tools to assess study risk of bias and used Grading of Recommendations Assessment, Development and Evaluation to determine evidence quality for meta-analysed outcomes.
Results
Searches yielded 4829 results. Twenty-three studies met inclusion criteria. Studies reported 18 outcomes measured by 48 different scales; only 1 study explicitly measured resilience. Eight studies were randomised controlled trials; the rest were non-randomised pre–post studies. Interventions were diverse and typically implemented in group settings. Studies reported significant improvement in outcomes pertinent to behavioural problems, coping mechanisms and general well-being but not to caregiver support or psychiatric symptoms. In meta-analysis, resilience was improved (g av =0.194, 95% CI 0.018 to 0.369), but anxiety symptoms and quality of life were not (g av =−0.326, 95% CI −0.782 to 0.131 and g av =0.325, 95% CI −0.027 to 0.678, respectively). Risk of bias varied. Quality of evidence for most graded outcomes was very low.
Conclusions
The multiplicity of study designs, intervention types, outcomes and measures incumbered quantifying intervention effectiveness. Future resilience research in this population should use rigorous methods and follow reporting guidelines.
PROSPERO registration number
CRD42020177069.
... In one small RCT, participating in a creative dance programme improved life satisfaction for older women (35). In another RCT, an expressive arts intervention increased the life satisfaction of adolescent refugees (36). Other evidence for the role of arts engagement in life satisfaction comes from observational studies. ...
... Participating in the arts may also enhance resilience, another form of subjective wellbeing that describes one's ability to recover from or adjust easily to change, through processes such as supporting coping, buffering stress, reducing catastrophising and suicidal ideation, and managing grief. Scoping reviews have outlined evidence for using the arts to support coping, including theatre arts and dramatic play for children to learn how to cope with adversities (35); use of musical activities, particularly listening to music, to cope with stress during adolescence (36); music interventions to reduce coping anxiety in people with cancer (37); and expressive arts such as music, movement, art making, and drama to cope with loss (38). However, several of these reviews have concluded that further evidence is needed, including from high-quality trials and longitudinal studies including more representative samples. ...
... As Arteterapias criativas e expressivas têm mostrado que podem auxiliar as pessoas a reconstruir o significado e a conexão com os outros, concentra-se nos recursos e na criatividade, o que pode favorecer aliviar os sintomas de trauma e aumentar a satisfação da vida e a esperança para o futuro (2) . ...
... As artes terapias criativas e expressivas têm mostrado que podem auxiliar as pessoas a reconstruir o significado e a conexão com os outros, concentra-se nos recursos e na criatividade, o que pode favorecer aliviar os sintomas de trauma e aumentar a satisfação da vida e a esperança para o futuro (2). ...
RESUMO Objetivo: identificar a percepção de um grupo de pessoas adultas com transtornos induzidos por substâncias sobre as intervenções de Arteterapia. Métodos: pesquisa qualiquantitativa, descritiva e exploratória por meio de instrumentos aplicados aos toxicômanos, como feedback individual ao final de três intervenções de Arteterapia (relaxamento, visualização criativa e atividade de arte). Resultados: os resultados das avaliações da análise de conteúdo e termômetro das emoções foram a diminuição da tensão e ansiedade, proporcionaram o relaxamento ou distração, seguida da melhora de humor, diminuição da tristeza e aumento da alegria, além de facilitarem a integração e o acolhimento grupal. Conclusão: Arteterapia é uma intervenção benéfica, que contribui significativamente para um cuidado mais humanizado no campo da saúde mental, em especial da dependência de drogas. As intervenções criativas e dinâmicas favorecem o relaxamento e, concomitantemente, diminuem a tensão e a ansiedade, bem como melhoram o humor de seus participantes. Palavras-chave: Terapia pela arte, Saúde mental, Transtornos relacionados ao uso de substâncias, Enfermagem psiquiátrica, Serviços de saúde mental. ABSTRACT Objective: to identify the perception of a group of adult people with substance-induced disorders about Art therapy interventions. Methods: qualitative, quantitative, descriptive and exploratory research using instruments applied to drug addicts, such as individual feedback at the end of three Art therapy interventions (relaxation, creative visualization and art activity). Results: the results of the content analysis and thermometer evaluations of emotions were the reduction of tension and anxiety, provided relaxation or distraction, followed by improved mood, decreased sadness and increased joy, in addition to facilitating integration and welcoming group. Conclusion: Art therapy is a beneficial intervention, which
... Other well-known psychological assessment tools were used in approximately 38% of the reviewed articles to measure anxiety and depression (Jakobsen, 2018;Jakobsen et al., 2017;Jensen et al., 2014;Vervliet, Meyer Demott, et al., 2014;Smid, Lensvelt-Mulders, Knipscheer, Gersons, & Kleber, 2011;Seglem et al., 2011). Additionally, 23.8% of selected articles focused on stress and adjustment (Huemer et al., 2011;Jakobsen, 2018;DeMott et al., 2017;Smid et al., 2011;Vervliet, Meyer Demott, et al., 2014). ...
... Of the reviewed articles, there are three papers focused on psychotherapy and group intervention for separated refugee youth to reduce trauma symptoms. Demott et al., (2017) found that using a ...
... Syv av åtte kvantitative studier omhandlet enslige mindreårige asylsøkere (9)(10)(11)(12)(13)(14)(15). I flere studier så man på prevalens av psykiske lidelser og symptomer i denne gruppen (10-14), i all hovedsak posttraumatisk stress, depresjon og angst. ...
... I flere studier så man på prevalens av psykiske lidelser og symptomer i denne gruppen (10-14), i all hovedsak posttraumatisk stress, depresjon og angst. Meyer DeMott og kolleger gjennomførte en intervensjonsstudie der de undersøkte hvorvidt tidlig gruppeintervensjon kunne redusere symptomer på traumer og øke livskvaliteten (15). I en annen studie undersøkte man nivåer av psykologisk stress hos enslige mindreårige asylsøkere gjennom spesifikke steg i asylsøkerprosessen (9). ...
Background:
Many asylum seekers arrived in Norway during autumn 2015, and there has been a call for more knowledge regarding the health of this group. The aim of this exploratory literature review was to investigate the state of knowledge about asylum seekers' health and use of healthcare services in Norway.
Material and method:
We conducted two literature searches for the periods 2007-2017 and 2017-2019 in 12 databases using the keywords 'refugees' and related terms, with a filter for research undertaken in or about Norway and published in Norwegian or English. The title and summary were read first, after which relevant articles were read in full text. Publications concerning asylum seekers in Norway and related to health and/or use of health services were included.
Results:
A total of 28 publications met the criteria for inclusion: 22 peer-reviewed articles and six reports. The most common topics were mental health and infectious diseases. Other topics that the studies dealt with were nutrition, functional impairment and healthcare services.
Interpretation:
Little research has been undertaken on asylum seekers' health and use of healthcare services. Research on asylum seekers' health in Norway primarily concerns mental health and infectious diseases, and there is little research on other somatic disorders.
... Other well-known psychological assessment tools were used in approximately 38% of the reviewed articles to measure anxiety and depression (Jakobsen, 2018;Jakobsen et al., 2017;Jensen et al., 2014;Vervliet, Meyer Demott, et al., 2014;Smid, Lensvelt-Mulders, Knipscheer, Gersons, & Kleber, 2011;Seglem et al., 2011). Additionally, 23.8% of selected articles focused on stress and adjustment (Huemer et al., 2011;Jakobsen, 2018;DeMott et al., 2017;Smid et al., 2011;Vervliet, Meyer Demott, et al., 2014). ...
... Of the reviewed articles, there are three papers focused on psychotherapy and group intervention for separated refugee youth to reduce trauma symptoms. Demott et al., (2017) found that using a manualized group intervention of expressive arts had positive effects, reducing trauma symptoms among separated refugee minor boys. Manualized trauma-focused cognitive-behavioural therapy (CBT) was examined by Unterhitzenberger & Rosner (2016), and the results showed significant decrease in clinical PTSD symptoms. ...
Separated refugee youth research is multidimensional and require review to conclude evidence, determine gaps and set future directions. The current 25 articles scoping review provided insight about mental health: prevalence, predictors, prognoses and psychotherapy among separated refugee youth. Besides, highlighted separated refugee perspectives about the foster care program and refugee journey.
... Studies by Uğurlu et al. (2016) andMeyer DeMott et al. (2017) also show that art therapy has positive effects especially on children and contributes to the reduction of post-traumatic stress symptoms in refugee children. In trauma-exposed groups such as refugee children and asylum seekers, art therapy accelerates the healing process by supporting emotional expressions. ...
Purpose: This study will explore the role of creative art therapies in the treatment of PTSD, with the view of judging their efficacy in reducing symptoms of an emotional and psychological nature associated with trauma. Creative art therapies provide a complementary approach to other traditional treatments by facilitating emotional expression and working through traumatic experiences. Methodology: A systematic review was conducted, and 11 randomized controlled trials and experimental studies published between 2014 and 2024 were included in the review. The databases used for searching include PubMed, PsycINFO, and Scopus. Study selection was performed based on specific inclusion criteria. The techniques of art therapy applied in the studies included visual arts, music, and drama. Findings: The studies hint at how art therapies may contribute to symptom reduction, particularly in managing anxiety and depression among people with PTSD. Art therapy seemed to be effective in improving emotional regulation and processing trauma in more than one population, including refugee children and war veterans. However, its effectiveness varied based on the type of therapy, its duration, the person's characteristics, and cultural factors. Unique Contribution to Theory, Practice, and Policy: This research provides evidence of the potential of art therapy as an adjunct treatment for PTSD. It also serves to accentuate the need for tailor-made therapy programs in view of individual and cultural differences. The results stress the integration of creative therapies with traditional psychotherapies to enhance outcomes. More large-scale studies will be needed to develop standardized protocols and further expand the use of art therapy across mental health disorders.
... This is essential for young people battling drug addiction, who need to manage complex emotions for their recovery and future. Studies show that art expands therapeutic possibilities and contributes to life satisfaction and happiness (Carlson, 1997;Meyer DeMott et al., 2017;Michalos & Kahlke, 2010). Motivational interviewing is adopted as the third approach in our integrative model to encourage rehabilitated youth to refrain from drug use and create life plans. ...
Background:
The effectiveness of an integrative life design model in preventing drug relapses among rehabilitated youth was evaluated. This model combined Savickas’ narrative life design in vocational counseling, expressive arts groups, and motivational interviewing. Its objective was to enhance life satisfaction and foster long-term resilience against relapse among young individuals recovering from drug abuse.
Methods:
The study involved 70 rehabilitated drug abusers, equally divided into intervention and control groups. After four waves of data collection, 62 participants completed various assessments to monitor drug use behaviors and psychosocial changes.
Results:
The intervention group showed continuous improvement in their self-efficacy to refuse drug use, whereas the control group’s self-efficacy to refuse drugs decreased by T4. The intervention group also had a lower relapse rate than the control group. Participants in both groups demonstrated improvements on various psychometric scales. However, those in the intervention group exhibited more substantial progress over time.
Conclusions:
The study demonstrates the effectiveness of the integrative vocational life design model in preventing relapse among rehabilitated drug abusers. It emphasizes the importance of establishing future expectations and promoting life satisfaction for rehabilitated drug abusers. The study concludes with recommendations for future research and practice.
... The four main contributing factors to life satisfaction are life chances, course of events, flow of experience, and evaluation of life (Veenhoven, 1996). Art has been known to aid in the facilitation of a positive effect and life satisfaction (Meyer DeMott et al., 2017), however, no previous literature has been found in regards to satisfaction with life being included in an adult colouring study. ...
Adult colouring has become one of the newest trends over the last decade with an increase in well-being attached to its effects, yet it is unclear how a colouring book can provide such benefits. Colouring is an activity that promotes concentration and engagement but does not require excessive skills or focus. With that being said, adult colouring provides enough structure so that users are not overwhelmed by too many decisions but is intricate enough to promote engagement and possibly a state of mindfulness. The current study explores the potential effects adult colouring can have on psychological measures including anxiety, burnout, satisfaction with life, desire for control, and mindfulness. Using a mixed-method approach, 105 participants who identified themselves as "adult colourers" completed an online survey that assessed their colouring experience and how colouring has influenced their lives in regard to psychological measures. Additionally, 4 participants completed colouring sessions which altered the degree of structure throughout the colourings while mindful breathing techniques were also implemented. Semi-structured interviews were conducted after the colouring sessions to gain insight into the benefits the "adult colourers" experienced. Results showed several significant correlations
between the psychological measures with the strongest correlation existing negatively between mindfulness and anxiety. Additionally, all participants who completed the colouring sessions reported a decrease in anxiety and an increase in mindfulness. These results demonstrate that individuals who practice mindfulness or partake in mindful activities are likely to have low levels of anxiety. Qualitative results showed that participants colouring structure preferences aligned with their everyday life control preferences. For instance, the participant who considered themselves to be a leader preferred the unstructured colourings while the participants who considered themselves to be followers preferred the structured colouring designs. There were no significant differences found between participants experience or frequency with colouring. While most adult colourers do not colour to improve on the skill, but merely for enjoyment purposes, the benefits of colouring could become effective immediately and not increase over time which could be why there were no differences found, however, further research is needed to support this claim. Furthermore, additional research is needed to determine the appropriate amount of mindful techniques to include while colouring as one participant mentioned they found the breathing bubble used in the current study to be distracting at times and stated that it took away from their colouring mindset. The results from the current study are consistent with previous literature supporting evidence that adult colouring has the potential to decrease anxiety, increase mindfulness, and essentially benefit one's well-being.
... A meta-analysis of group interventions for trauma and depression yielded 16 studies using eight interventions with 976 immigrant and refugee children and found little effect on post-traumatic stress symptoms with no significant effect on depression (Rafieifar & Macgowan, 2022). Of 16 studies, two art therapy studies showed effects leading to helpful thinking and the rebuilding of healthy social connections (Ugurlu et al., 2016) and the effectiveness of expressive arts groups with intervention relating to unaccompanied minor asylumseeking adolescents in Norway (Meyer DeMott et al., 2017). Another meta-analysis by Morison et al. (2022) found the significant effectiveness of creative arts-based interventions on children experiencing traumatic events; in addition, significant reductions were found with negative moods. ...
Abstract
This bibliometric study analyzed characteristics of publications related to art therapy for children from 1990 to 2020, based on the datasets taken from Web of Science (WoS) core collections. The results indicate that the U.S.A., Israel, Germany, UK, Australia, and Canada were six leading countries in this field of research interest. The Top 5 most influential journals were identified by the number of publications, TLCS, TGCS and by their impact factor. Five leading journals in the art therapy studies include Arts in Psychotherapy, American Journal of Art Therapy, Child & Family Social Work, Frontiers in Psychology, and Monatsschrift Kinderheilkunde. Core themes from the 87 articles focus on surrounding socialization and attachment relationship, art therapy for the well-being of children with learning disabilities, alternative intervention for art therapy, and parent-child art therapy. This bibliometric study portrayed the development of art therapy for children by means of visualization techniques. The potential issues emerging from the data will contribute to future studies in this field. Multiple methods of art therapy are applied for all children’s well-being; as such, children’s art therapy in schools can be seen as the potential trend for researchers and teachers.
... Improvement was noted in a greater sense of safety, calming, connectedness, self-and community efficacy, and hope. At the end of the follow-up, the EXIT group had a beneficial effect on helping minor refugee boys cope with symptoms of trauma, increase life satisfaction, and develop hope for the future compared to the control group [66]. ...
In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17–85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belonging to a social network, religion, having an adult mentor, and having a family (even if far away). Immigrant youth can thrive most easily in multiculturally affirming countries. Five interventions demonstrated effectiveness, comprising trauma-focused cognitive behavioral therapy (TF-CBT); “Mein Weg”, a TF-CBT combined with a group-processing mixed therapy approach; teaching recovery techniques (TRT), narrative exposure therapy for children (KIDNET), and expressive arts intervention (EXIT). The significant mental health conditions include depression, anxiety, internalizing and externalizing behaviors, and frequently PTSD. It is fair to conclude that the high levels of mental health problems experienced in URM are due to exposure to traumatic experiences, separation from parents, and lack of social support.
... A meta-analysis of group interventions for trauma and depression yielded 16 studies using eight interventions with 976 immigrant and refugee children and found little effect on post-traumatic stress symptoms with no significant effect on depression (Rafieifar & Macgowan, 2022). Of 16 studies, two art therapy studies showed effects leading to helpful thinking and the rebuilding of healthy social connections (Ugurlu et al., 2016) and the effectiveness of expressive arts groups with intervention relating to unaccompanied minor asylumseeking adolescents in Norway (Meyer DeMott et al., 2017). Another meta-analysis by Morison et al. (2022) found the significant effectiveness of creative arts-based interventions on children experiencing traumatic events; in addition, significant reductions were found with negative moods. ...
Taken from publications on art therapy from 1989 to 2019, bibliometric characteristics were analysed based on datasets located in the Social Science Citation Index (SSCI) and Science Citation Index Expanded (SCIE). Terms relating to “art therapy”, “art therapies”, “art* therapy”, “art* therapies” were used as keywords to search journal articles as of May 24th, 2020. A total of 935 articles, representing 2,650 authors across 363 journals were scanned. The USA, UK, Germany, Israel, Canada, South Korea, Netherlands, and Italy were eight of the top 14 countries in this field. The top 10 most influential countries and journals were identified by the number of publications, Total Local Citation Score (TLCS), and Total Citations / Total Publications (TC/TP). The top three journals are Arts in Psychotherapy, American Journal of Art Therapy, and Frontiers in Psychology. Three emerging core themes determined from highly-cited articles and keyword co-occurrence are art therapy with cancer patients, art therapy with prison inmates, and art therapy for mental disorders. The “effects of art therapy on trauma” is likely a potential trend of art therapy. The topics on “parental mentalization” (or “mother-child relationship”) and “art-making experiences” (“art-materials”) in the process of art therapy are promising.
... The benefits of exercise and creative expression for addressing stress and extended crises are well documented (S. Ahn & Fedewa, 2011;Beauregard, 2014;Jansen & LeBlanc, 2010;Meyer DeMott et al., 2017), and we applaud states for this emphasis. It is perhaps noteworthy that many school systems, when operating under a typical full-day schedule, do not allot daily time for physical activity and the arts. ...
We analyze the state education agency policy guidance concerning remote learning published by all 50 U.S. states by the end of March 2020. We find several areas of consensus, including cancellation of testing, recommendations to continue some form of remote learning, attention to digital and non-digital options, and a concerns for providing a fair and appropriate education for students with disabilities. The primary area of policy divergence that we found regarded the purpose of continuous learning during a pandemic: whether to pursue forward progress in standards-aligned new material or whether to pursue skills review and enrichment learning. We recommend that states continue to emphasize equity, consider the particular challenges of home-based learning, and produce concise communications for multiple target audiences.
... Fourteen studies had been excluded due to missing data or other reasons outlined in the Methods section, some of which may be possibly recovered for future analyses. They investigated learning disabilities (Alotaibi et al., 2017), children with attention deficit/hyperactivity disorder (Alrazain et al., 2018), fornix integrity (Burzynska et al., 2017), depression (Cross et al., 2012), falls (Duim et al., 2015), oncological patients (Ho et al., 2016b), schizophrenia Savill et al., 2017), Parkinson's disease (Lewis et al., 2014), autism (Mateos-Moreno and Atencia-Doña, 2013), trauma in unaccompanied minors (Meyer DeMott et al., 2017), development of kindergarteners (Stück and Villegas, 2017), personal development and increase of emotional intelligence in students (Vancea, 2013), and traumatized children (Van Westrhenen et al., 2019). ...
Background: Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy¹(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996–2012 to 6.8 detected studies/year in 2012–2018.
Method: We synthesized 41 controlled intervention studies (N = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies.
Results: Analyses yielded a medium overall effect (d² = 0.60), with high heterogeneity of results (I² = 72.62%). Sorted by outcome clusters, the effects were medium to large (d = 0.53 to d = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that type of intervention (DMT or dance) was a significant moderator of results. In the DMT cluster, the overall medium effect was small, significant, and homogeneous/consistent (d = 0.30, p < 0.001, I² = 3.47). In the dance intervention cluster, the overall medium effect was large, significant, yet heterogeneous/non-consistent (d = 0.81, p < 0.001, I² = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased.
Discussion: Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.
... En evalueringsstudie av et uttrykksterapeutisk program, EXIT, som ble gitt til asylsøkende ungdom i transittmottak, viste at deltakerne i programmet hadde bedre livskvalitet og mer positive håp for fremtiden på oppfølgingsundersøkelsene, enn en sammenligningsgruppe (271). Programmet er basert på uttrykksterapeutiske strategier som bevegelse, tegning, musikk, dans og drama for å forebygge psykiske problemer som angst og depresjon, og bedre fungering i hverdagen for målgruppen. ...
In today's world, the main problem affecting all humanity, especially children and adolescents, is the phenomenon of migration. In acculturation due to migration, the influence of dominant culture and ethnic identities on each other is discussed. Acculturation changes ethnic identities; acculturation stress experienced in this change affects adolescent mental health. In recent years, the effects of acculturation strategies preferred by majority and minority cultures on mental health and psychological well-being have been evaluated from a broad perspective. In this study, the relationships between acculturation, ethnic identity, and mental health are examined comprehensively, the literature on adolescent mental health findings is evaluated comparatively, and various suggestions are made for possible results. No systematic review study on this subject was found in the national and international literature. Early studies, in particular, found a positive relationship between adolescents' ability to identify with the dominant culture and mental health. However, today, the characteristics of the immigrant and the dominant culture are considered two-dimensionally, and it turns out that maintaining adaptation to both cultures positively affects mental health. In addition, the effectiveness of psychiatric interventions leads adoption of the society of immigrant/refugee adolescents is discussed in detail. More studies are needed to determine which acculturation processes positively affect adolescents' mental health.
Background:
This review aims to identify and analyse studies on art-based interventions and art therapy that are intended to promote better physical, mental and social health outcomes in culturally and linguistically diverse migrant populations.
Method:
A systematic literature review was used to address the following questions: 1) What published studies over the past five years examined health outcomes? 2) What are the identifying characteristics of the studies? 3) What kinds of effect did these studies describe? 4) What implications do the findings have for future research in this field?
Results:
Art-based interventions and art therapy can significantly reduce traumatic stress symptoms and anxiety, enhance well-being by giving people greater life satisfaction and hope, and improve the social behaviour of children and adolescents.
Conclusion:
In order to address humanitarian concerns in this field, researchers may apply innovative approaches to engage people from a refugee background in meaningful reflections on their lives.
Objective:
To systematically review existing research exploring the effectiveness of psychological interventions in reducing symptoms of distress amongst refugee and asylum-seeker children.
Method:
Six databases were searched to identify English studies presenting original empirical quantitative data (published before September 2022) testing the efficacy of psychological interventions for children from refugee and asylum-seeking backgrounds. Quality of studies were assessed through the Appraisal Tool for Cross-Sectional Studies as well as the Cochrane Risk of Bias Tool. Relevant data were extracted to facilitate a narrative synthesis.
Results:
Seventy-one eligible articles were identified (n > 10,000). A number of cognitive-behavioral, psychosocial, and trauma-focused interventions that catered specifically to children and their families were identified. A synthesis of these results suggest that interventions may assist in the reduction of various psychopathologies, although the effects were mixed across intervention types.
Conclusions:
While the review yielded promising findings, most findings were derived from small pilot and empirical studies, leading to difficulties with drawing conclusions. There remains a need for studies using more rigorous research methodologies to expand and ratify this valuable knowledge base.
Clinical significance:
Forced displacement is at an all-time high. Many children are being forced to seek asylum and refuge, and they become vulnerable to the development of poor mental health, with limited understanding surrounding how to appropriately intervene. This review aims to equip clinicians with increased knowledge and confidence in working therapeutically alongside clients from refugee or asylum-seeking background, with the goal of fostering positive mental health and wellbeing.
This research study aimed to address how engaging in nature base art therapy could support well-being with measurement tools that reflect the importance of both happiness and life satisfaction. The combination of art therapy and nature can be applied to help individuals improve wellness, even if an individual is unable to access nature. The purpose of this study was to evaluate if engaging in a nature-based art therapy session would increase one’s life satisfaction and positive affect. It was hypothesized that participants who engage in nature-based art therapy will report an increase in life satisfaction and positive affect as self-reported using the Satisfaction with Life Scale (SWLS; Diener et al., 1985) and the Positive Affect and Negative Affect Schedule (PANAS; Watson et al., 1988). The methods included two sets of data collection with 75 participants globally within two phases. The results showed that life satisfaction and positive affect improved more during phase II compared to the Phase I.Additionally, there appeared to be a significant difference in how each participant’s scores changed; this could indicate that the nature-based art therapy process allowed individuals to visually explore places in nature during restrictions to their autonomy.
Our book is the result of a unique international collaboration between sociodramatists and action methods practitioners from several different countries and organisations across Europe over a five-year period (PERFORMERS 1 from 2016-2017; PERFORMERS 2 from 2018-2021).
This Preface is by way of a brief journey map through the book to orientate you, our reader, to the delights to come. It is followed by an account of the conception, birth and development of the whole PERFORMERS project in a discussion between the initiators, Judith Teszáry (FEPTO) and Kata Horváth (Hungarian Psychodrama
Association), interviewed by Krisztina Galgóczi.
The overall aim of PERFORMERS has been to explore, to understand and to practice with each other and with external clients how sociodrama can be used in different fields, with a particular focus on working with vulnerable youth groups.
Part I: Our Stories, invites you in with brief accounts by the authors of moments of importance in their own experiences with sociodrama. These stories have stayed in the memory and may have been turning points in their appreciation of (and passion for disseminating) this creative action method in their own work.
Parts II, III and IV illustrate the reflections and practices of the authors in their own highly varied cultural, geographic and working contexts. Part II, Foundations of Sociodrama looks at some of the key principles and background theories.
Part III, Sociodrama in Social Settings includes also organisational and corporate work, and Part IV explores Sociodrama in Educational Settings. We have also included a Glossary of Terms.
Just as the whole world has had to adapt to the pandemic, so our entire project had to move online in March 2020. Our adaptations, to sustain our creative collaboration, have meant both gains and losses for the participants, the book, the group and the project as a whole.
We hope your curiosity about sociodrama is engaged – how, where and why to use it – and that you will wish to explore more widely in the future, perhaps even engaging in training in the method yourself! Who knows …
The Editorial Board
Background:
An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.
Objectives:
To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.
Search methods:
Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports. SELECTION CRITERIA: Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.
Data collection and analysis:
For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.
Main results:
We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results. Primary outcomes There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) -1.46, 95% confidence interval (CI) -6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI -2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD -10.5, 95% CI -47.94 to 26.94; 1 study; very low-certainty evidence). There were no data on adverse events. Secondary outcomes Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty). None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.
Authors' conclusions:
There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents.
Children and young people (CYPs) in low-income communities face significant health disparities that emerge in childhood due to dynamic processes of socioeconomic marginalization, preventing access to social power, resources and capacity to engage productively with society. The health consequences persist into adulthood regardless of subsequent social mobility. We review evidence-based resilience promotion interventions working with (i) family, (ii) school or community organizations and (iii) across multiple levels. Interventions use a range of theoretical frameworks, dominated by an ecological systems approach to resilience. A wide range of universal and contextual risk and protective mechanisms are addressed in these interventions, with strengths in developing life skills, coping, psychoeducation, relationship skills, maternal mental health, global mental health promotion and targeted support for highly vulnerable CYPs. In considering directions for concentrating therapeutic efforts and research agendas, we suggest that alongside initiatives to enhance social support, coping skills, resource promotion, life skills and resilience to contextually specific risk factors (e.g. sexual health), transformative approaches which trouble existing power structures, engage with culturally diverse theorizations and applications of resilience, create opportunities for supportive relationships and intervene across multiple levels may be especially useful to disrupt the manifestations of socioeconomic marginalization upon children and young people’s health.
Background
The effect of interventions based on the creative arts for children and adolescents exposed to traumatic events was estimated for measures of post-traumatic stress disorder (PTSD) and other psychological symptoms.
Method
Using a pre-registered protocol, relevant journal articles were identified through searches of: PsycInfo; Psychology and Behavioural Sciences Collection; CINAHL and PsycArticles. Data were pooled using a random effects model, and effect estimates were reported as Hedges’ g.
Results
Pooled effect estimates indicated that arts-based interventions significantly reduced PTSD symptom scores compared to pre-intervention (15 studies, g = −.67, p < .001) and a control group (7 studies, g = -.50, p < .001). Significant reductions were also found for measures of negative mood, but results were mixed for externalizing problems and anxiety.
Conclusions
Despite variations in study quality, intervention approaches and types of trauma experience, the results tentatively suggest that creative arts-based interventions may be effective in reducing symptoms of trauma and negative mood.
Background
Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited.
Aims
To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions.
Methods
Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population.
Results
Seventeen papers met eligibility criteria with a total of N = 1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM.
Conclusions
The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed.
The objective of this article is to understand the key mental health problems affecting unaccompanied refugee youth in Canada who experienced family loss and separation in their country of origin. This article is based on a research project that adopted a multi-phase sequential research design/strategy. This strategy entails that the first phase consisted of a scoping literature review to synthesize existing evidence and to identify knowledge gaps related to post-migration effects of loss and separation on the well-being of refugee youth and their families. The data collection phase included two focus groups with service providers and three focus group sessions with the refugee youth themselves. Refugee youth face several mental health problems resulting from pre-migration, peri-migration, and post-migration conditions. This study demonstrated that a significant number of unaccompanied refugee youth experience mental illness. The most commonly reported mental illnesses among the youth were post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the refugee youth developed coping strategies to help deal with their sadness about family loss or disappearance and the circumstances they were currently in surrounding their settlement. The article concludes that experiences of separation from or loss of one or more family members affect refugee youth’s mental health negatively. Nevertheless, most refugee youth approached for this study were not interested in talking about these, due to their perceived stigma and aversion to openly discussing mental health issues. The current support service and policies in Canada are serving refugee youth to meet their needs partially. There is an opportunity to build the capacity of the service providers with generated evidence, make the service navigation tools more user-friendly, and advocate amendment of the policies to address the real needs of the separated refugee youth.
Background:
College students are a high-risk subpopulation of psychological disorders. The problem of various adverse phenomena and consequences caused by excessive pressure on college students has gradually become the focus of social and psychological academic circles. However, studies related to individual self-concept and psychological pressure are rare.
Objective:
To explore the impact of sports dance exercises on college students' psychological pressure and improve the psychological effects of their self-satisfaction.
Methods:
College students were taken as research objects, randomly divided into a control group and an observation group. The observation group is intervened with sports dance exercises. The observation group was intervened with sports dance exercises. The stress response characteristic questionnaire and multidimensional self-satisfaction rating scale were utilized to measure college students' conditions before and after the intervention. Finally, the obtained data were statistically analyzed.
Results:
Generally, the psychological stress response of college students was mild, with self-satisfaction and various dimensions at a moderately higher level. No significant differences were discovered in the psychological stress response and self-satisfaction level between the control group and the observation group before intervention (P > 0.05), which were homogeneous. Compared with the data obtained before the intervention, after the intervention, the control group scores were slightly reduced in all dimensions of the psychological stress response and self-satisfaction. In contrast, the scores were significantly increased in the experimental group (P < 0.05). Psychological stress response could reliably explain 30.4%of the total self-satisfaction variance (P < 0.01). The negative self-evaluation was the most important variable affecting self-satisfaction, followed by poor interpersonal communication and poor sleeping quality.
Conclusions:
Sports dance exercises could alleviate the psychological stress of college students and improve their self-satisfaction. Colleges and universities should include sports dance in the content of optional public courses and encourage more college students to actively participate in sports dance exercises to improve their mental health.
This thesis aims to explore the use of the Expressive Therapies Continuum (ETC) in a social work context. The ETC is an assessment model sometimes applied in therapies utilizing different art expressions. The research on the ETC model has so far focused on visual art therapy, not on other art expressions. This study is an attempt to extend it´s use to expressive arts therapy, where music, guided imagery and movement are included besides visual art. The study has a qualitative approach. Observations have been made in video-recorded single case therapy. Seven therapy sessions led by an expressive arts therapist were observed. Theory-led thematic analysis has been used. Categories in the analysis have been the same as the components in the ETC model: sensory, kinesthetic, perceptual, affective, cognitive, symbolic and creative. In addition, predominant components and Media Dimensions Variables (MDV) have been observed. The results indicate that the ETC components can be distinguished and that predominant components can be identified. The ETC seem to have the potential to be a helpful tool in treatment and in creating a common language between different expressive therapies. It should, however, be combined with other measures, and the client´s subjective view to provide a more complete picture. Conclusions are that the ETC can be used successfully in expressive arts therapy. More studies, however, are needed to be able to transfer these results onto other populations and modalities.
Key words: Expressive Therapies Continuum (ETC), expressive arts therapy, systems theory, assessment, video observation, thematic analysis
Through the analysis of the Padua territory the study analysed the creation of the regulatory
indications for the reception of unaccompanied foreign minors and highlights the fragile
elements and the strategies activated from below to allow the achievement of the minimum
standard needed to scaffold the integration process.
Background
The Harvard Trauma Questionnaire (HTQ) is the predominant questionnaire for assessing PTSD in trauma-affected refugees. Although the scale is increasingly used for measuring treatment outcomes, it has never been specifically validated for such use. The current study does so by testing the HTQ with the Rasch model.
Methods
The analysis is based on 641 Arabic and Persian speaking refugees, diagnosed with PTSD and undergoing psychiatric treatment in Denmark. The responses were tested against the assumptions of the Rasch model, including unidimensionality, local independence and the absence of differential item function across subgroups.
Results
Results reveal two subscales that, when accounting for local dependence and differential item functioning, meet criteria for the Rasch model in the included samples: An arousal/intrusion subscale and an avoidance/numbing subscale.
Limitations
The included sample was highly chronic and suffered from major depressive disorder. Results may not be fully representative of less chronic populations, e.g. recently arrived refugees.
Conclusions
We recommend the use of the arousal/intrusion subscale and the avoidance/numbing subscale as an optimized way of summarizing responses to the HTQ, which remains simple to administer while effectively summarizing all the information available in the scores.
This article will provide counselors with creative skills and techniques to use when working with children who function as language brokers. Children who language broker are utilized by their family to interpret and translate information within a new culture. Narrative therapy could appropriately be used with individuals who have undergone such a life transition; however, children who language broker may find it difficult to express their feelings through words. Therefore, incorporating creative therapies into the counseling process can be valuable in aiding expression. Utilizing creative therapies in conjunction with narrative therapy helps children tell their stories more clearly, thus raising their awareness and ultimately encouraging improvements in familial relationships. This paper will outline the use of mixed media to create “altered art,” which involves taking an object and modifying it in an artistic way as a form of self-expression. This specific process used shoes as a symbolic medium, to facilitate the ability of children who language broker to tell their stories and to navigate their roles and transitions. This article is limited to a review of literature and a single group case study of refugee children who function as language brokers. Further research is needed with formal measurements and within other cultures and environments.
Objectives
To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications.
Design
This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival.
Setting
Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway.
Participants
Male UM from Afghanistan, Somalia, Algeria and Iran.
Main outcome measures
Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire.
Results
At the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress.
Conclusion
Mental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum.
Methods:
The authors conducted a systematic review of scholarly journals and manuscripts. The search was limited to articles published in English that focused on group treatment with torture survivors.
Findings:
The authors identified 36 articles and chapters for review describing a variety of group interventions for survivors of torture, including: • Supportive Group Therapy • Empowerment Workshops • Group Treatment for Sleep Disorders • Den Bosch model • Wraparound approach • Stage-oriented model The literature examined varied in approach and format: present-day and past-focused groups; structured, time-limited groups; and flexible, ongoing support groups. The studies took place in diverse locations, including Denmark, Germany, Guinea, Namibia, the Netherlands, Palestine, Serbia, the U.S., the UK, and Zimbabwe, and, in conflict, post-conflict and/or humanitarian settings. The interventions were facilitated by licensed mental health professionals, paraprofessionals, and bilingual/bicultural staff - or a combination of the latter two.
Interpretations:
Group treatment is an approach which can be administered to larger groups of survivors to address a range of treatment issues. The authors examined key clinical practice issues for group treatment including group composition and content, facilitation and measurement strategies. While the literature does provide a compelling conceptual rationale for using group treatment, the empirical literature is in fact very limited at this time, and needs to be strengthened in order to build confidence in outcomes across contexts and survivor communities.
Conclusions:
This paper points to a growing interest in the topic of group treatment for survivors of torture and severe violence, providing a comprehensive picture of group-based interventions and highlighting the need for additional research and knowledge-building.
Creative arts therapy programs delivered by qualified therapy professionals have been identified as effective for adolescents affected by adversity. The current study provided a controlled trial of creative arts therapy to address the psychosocial needs of students from refugee backgrounds. Forty-two students participated in a therapy trial, comprising an creative arts group and control group. Mental health and behavioural difficulties were assessed pre and post intervention. Hopkins Symptoms Checklist-25 (HSCL-25) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess well-being. Findings suggested an effect for a reduction in behavioural difficulties for the treatment group. A significant reduction in emotional symptoms was found for the treatment group. Findings provide empirical support for school-based creative arts therapy programs specific to refugee young people.
There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
Children's adjustment to resettlement countries is vitally important to future outcomes, yet little attention is given to the role of hope in this process. This research focused on expressions of hope in 10 refugee and immigrant children during early years of resettle-ment. Using case study methods that employed arts-based data collection, categories were constructed from participants' visual images and associated narratives. Hope in newcomer children was conceptualized as a dynamic enduring trait that is intimately linked to each child's life context. Further, three hope-engendering sources were identified that facilitated an emotional connection to others, to self, and to the environment.
Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries.
In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended.
A total of 65% of participants in the therapy group and 52% of participants in the individual-support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD.
In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.).
This paper illustrates how human ecological theory and hope theory were used to develop arts-based research tools and program
interventions with refugee children in a Canadian inner city context. Building on key ideas such as: the contextualized, reciprocal,
and dynamic nature of hope, the paper identifies a series of program activities. These include the use of photographs, a hope
quilt, the development of narratives, followed by opportunities for children to share their hope work with others and for
parents and other adults to undertake child-focused and hope-based discussions. Policy and program implications for refugee
children are then discussed.
This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects.
We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the child's psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identified as affecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the effective integration of internally displaced and refugee children.
There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.
Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret.
To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements.
MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database.
Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status.
Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature.
Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria.
The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally.
Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated.
The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up.
The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.
Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
Self-report screening is an important element of transcultural research. Problems concerning illiteracy, cultural sensitivity, and possible misunderstandings have been handled differently in different settings. The aim of this study was to evaluate the validity of two well-known instruments: the Hopkins Symptoms Check List (HSCL-25), and the Harvard Trauma Questionnaire (HTQ, Part IV), with a sample of 160 unaccompanied asylum-seeking adolescents from Afghanistan and Somalia. Assessments were performed 4 months after arrival in Norway, and the screening instruments were presented to the informants on computers with touch-screen function, using the program MultiCASI. Sound-files in the native languages of the informants appeared simultaneously with the written items and could be repeated by touch. We found that the screening procedures were well received and understood by the informants regardless of reading and writing abilities. Agreement between diagnoses (CIDI) and screening results were similar to other studies. Computer-based assessment in this setting was practical, cost effective, and can be recommended.
It is well known that infants as soon as they are born tend to use fist, fingers, thumbs in stimulation of the oral erotogenic zone, in satisfaction of the instincts at that zone, and also in quiet union. It is also well known that after a few months infants of either sex become fond of playing with dolls, and that most mothers allow their infants some special object and expect them to become, as it were, addicted to such objects. There is a relationship between these two sets of phenomena that are separated by a time interval, and a study of the development from the earlier into the later can be profitable, and can make use of important clinical material that has been somewhat neglected. Those who happen to be in close touch with mothers' interests and problems will be already aware of the very rich patterns ordinarily displayed by babies in their use of the first 'not-me' possession. These patterns, being displayed, can be subjected to direct observation. There is a wide variation to be found in a sequence of events that starts with the newborn infant's fist-in-mouth activities, and leads eventually on to an attachment to a teddy, a doll or soft toy, or to a hard toy. It is clear that something is important here other than oral excitement and satisfaction, although this may be the basis of everything else. Many other important things can be studied, and they include: 1. The nature of the object. 2. The infant's capacity to recognize the object as 'not-me'. 3. The place of the object – outside, inside, at the border. 4. The infant's capacity to create, think up, devise, originate, produce an object. 5. The initiation of an affectionate type of object-relationship.
Despite increasing numbers of unaccompanied refugee minors (UM) in Europe and heightened concerns for this group, research on their mental health has seldom included the factor “time since arrival.” As a result, our knowledge of the mental health statuses of UM at specific points in time and over periods in their resettlement trajectories in European host countries is limited. This study therefore examined the mental health of UM shortly after their arrival in Norway (n = 204) and Belgium (n = 103) through the use of self‐report questionnaires (HSCL‐37A, SLE, RATS, HTQ). High prevalence scores of anxiety, depression and posttraumatic stress disorder (PTSD) symptoms were found. In addition, particular associations were found with the number of traumatic events the UM reported. The results indicate that all UM have high support needs on arrival in the host country. Longitudinal studies following up patterns of continuity and change in their mental health during their trajectories in the host country are necessary.
Despite growing numbers of unaccompanied refugee minors (UMs) in Europe, and evidence that this group is at risk of developing mental health problems, there still remain important knowledge gaps regarding the development of UMs' mental health during their trajectories in the host country and, in particular, the possible influencing role of traumatic experiences and daily stressors therein. This study therefore followed 103 UMs from the moment they arrived in Belgium until 18 months later. Traumatic experiences (SLE), mental health symptoms (HSCL-37A, RATS) and daily stressors (DSSYR) were measured at arrival in Belgium, after 6 and 18 months. UMs reported generally high scores on anxiety, depression and post-traumatic stress disorder (PTSD). Linear mixed model analysis showed no significant differences in mental health scores over time, pointing towards the possible long-term persistence of mental health problems in this population. The number of traumatic experiences and the number of daily stressors leaded to a significant higher symptom level of depression (daily stressors), anxiety and PTSD (traumatic experiences and daily stressors). European migration policies need to reduce the impact of daily stressors on UMs' mental health by ameliorating the reception and care facilities for this group. Moreover, regular mental health screenings are needed, in combination with, if needed, adapted psychosocial and therapeutic care.
What happens in the psyche of the person who migrates? How is the balance between what is objectively perceived and what is subjectively conceived of restored? What factors impinge on this process? Can group analysis help with the transition or lack of it? Is the significance of the therapy group different from any other patient group? These are questions arising from my own personal experiences of being a foreigner in the UK, and from the experiences of running groups with immigrants. I would like to explore these issues, and perhaps speculate, on the basis of Winnicott's ideas of a transitional object and playing and reality. In the second part of the article I will relate these ideas to group analysis.
Previous research on political violence has shown an inverse relationship between overall exposure and psychological well-being. The aim of this study was to examine this relationship in more detail by exploring the impact of specific types of war-related events upon psychological well-being, as well as the role of social and political context in moderating these outcomes. The psychological well-being of 337 Bosnian adolescents living in two towns on opposite sides of the war was assessed using the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Based on the combined symptom scores, and in-depth interviews regarding life history, war experiences, and subjective experience of psychological well-being a gender-matched sub-sample of 40 adolescents was selected and completed a 45-item trauma event scale. Results from the quantitative and qualitative analyses showed that the relationship between exposure, displacement and well-being varied significantly depending on the community in which the adolescents lived. Specific meanings given to different types of war events were important in moderating their effect. Living in a neglected, isolated and depressed community, worry about school performance, missing friends and family breakdown could have as significant an effect on well-being as exposure to war-related events. The findings demonstrate the need to take social context and meaning of events into account when examining the impact of war exposure on psychological well-being.
Background
Researchers focused on mental health of conflict-affected children are increasingly interested in the concept of resilience. Knowledge on resilience may assist in developing interventions aimed at improving positive outcomes or reducing negative outcomes, termed promotive or protective interventions.Methods
We performed a systematic review of peer-reviewed qualitative and quantitative studies focused on resilience and mental health in children and adolescents affected by armed conflict in low- and middle-income countries.ResultsAltogether 53 studies were identified: 15 qualitative and mixed methods studies and 38 quantitative, mostly cross-sectional studies focused on school-aged children and adolescents. Qualitative studies identified variation across socio-cultural settings of relevant resilience outcomes, and report contextually unique processes contributing to such outcomes. Quantitative studies focused on promotive and protective factors at different socio-ecological levels (individual, family-, peer-, school-, and community-levels). Generally, promotive and protective factors showed gender-, symptom-, and phase of conflict-specific effects on mental health outcomes.Conclusions
Although limited by its predominantly cross-sectional nature and focus on protective outcomes, this body of knowledge supports a perspective of resilience as a complex dynamic process driven by time- and context-dependent variables, rather than the balance between risk- and protective factors with known impacts on mental health. Given the complexity of findings in this population, we conclude that resilience-focused interventions will need to be highly tailored to specific contexts, rather than the application of a universal model that may be expected to have similar effects on mental health across contexts.
Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the UK. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4 %) scored above cut-offs for emotional and behavioural problems, 34.6 % for anxiety and 23.4 % for depression. Ordinary least squares regression indicated a significant dose-response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.
There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
This evaluative study assessed the effect of a creative expression program designed to prevent emotional and behavioral problems and to enhance self-esteem in immigrant and refugee children attending multiethnic schools.
The 12-week program involved 138 children, aged 7 to 13, registered in both integration classes designed for immigrant children and regular classes at two elementary schools. Pretest and posttest data were collected from the children themselves and from their teacher. Teachers used Achenbach's Teacher's Report Form to assess the emotional and behavioral symptoms of their pupils whereas children self-reported their symptoms with the Dominic, a computerized questionnaire. Self-esteem was measured with the Piers-Harris Self-Concept Scale administered by interviewers to the children.
At the end of the program, the children in the experimental groups reported lower mean levels of internalizing and externalizing symptoms and higher mean levels of feelings of popularity and satisfaction than the children in the control groups, when controlling for baseline data. In integration classes, the effect on self-esteem was especially notable in boys. The intervention's effect on internalizing and externalizing symptoms was not modified by gender, age or fluency in the mainstream language.
The study provides some evidence that creative workshops in the classroom can have a beneficial effect on the self-esteem and symptomatology of immigrant and refugee children from various cultures and backgrounds. These quantitative results support previous qualitative analysis showing that the workshops participate in the reconstruction of a meaningful personal world while simultaneously strengthening the link of the child to the group. They also transform the teachers' perceptions of newcomers by placing an emphasis on their strength and their resilience, while not negating their vulnerabilities.
The objective of this study was to assess the preliminary psychometric properties of the Reaction of Adolescents to Traumatic Stress questionnaire (RATS) for refugee adolescents. Four independent heterogeneous adolescent population samples (N = 3,535) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmatory factor analyses, per language version, support the three-factor structure of intrusion, avoidance/numbing, and hyperarsoual. The total and subscales of the RATS show good internal consistency and good (content, construct, and criterion) validity. The RATS, in this study, was found to be a reliable and valid instrument for assessing posttraumatic stress reactions of culturally diverse adolescents.
The Hopkins Symptom Checklist depression scale (HSCL-D) and the Harvard Trauma Questionnaire (HTQ) have been used extensively in international studies, particularly among refugees and conflict-affected populations. Like many other screening measures, however, the HSCL-D and HTQ have not been subjected to extensive epidemiologic testing, particularly among communities not affected by war. The present study examined the psychometric properties of the HSCL-D and HTQ by comparing the measures with the Structured Clinical Interview for DSM-IV (SCID) among ethnic Cambodians living in Surin, Thailand, a community that was spared the long period of mass violence that affected Cambodia proper. The PTSD data of the HTQ were then contrasted with those obtained from a refugee clinic. The main finding was that in the Surin study, the screening measures showed greater agreement with the SCID in identifying noncases (negative prediction) than cases (positive prediction). In contrast, in the earlier clinic study, the HTQ showed high positive and moderately low negative prediction. The results support previous observations that clinical interviews such as the SCID may be more conservative in identifying cases. We raise the possibility, however, that structured interviews may perform differently across clinic and community populations. In particular, clinicians may be more accurate in identifying cases than noncases in highly symptomatic clinic populations, with the converse applying in low prevalence community populations. These issues warrant further investigation to specify more clearly the value of using the two approaches to case identification.
This study aims, firstly, to investigate the prevalence of emotional and behavioural problems in unaccompanied refugee children and adolescents living in Belgium. Secondly, this study compares the perspectives of the adolescents with those of social workers on the adolescents' emotional well-being.
A total of 166 unaccompanied refugee children and adolescents, living in different large- and small-scale centres, in foster care or alone, participated in the study. Of them, 142 completed self-report questionnaires on emotional and behavioural problems (HSCL-37A, SDQ-self and RATS) and traumatic experiences (SLE), and for 124 refugee youths, social workers filled in two questionnaires on emotional and behavioural problems (CBCL/6-18 and SDQ-parent).
Between 37 and 47% of the unaccompanied refugee youths have severe or very severe symptoms of anxiety, depression and post-traumatic stress. Girls and those having experienced many traumatic events are at even higher risk for the development of these emotional problems. Social workers also report a high prevalence of internalising problems in this population and they also report important externalising problems in unaccompanied refugee youths.
Being unaccompanied is an important risk factor for the emotional well-being of refugee children and adolescents. Therefore, appropriate measures on reception and care should be taken in order to support these youths.
Refugee and migrant adolescents may be at increased risk for the development of emotional and behavioural problems. Since studies on this topic are rather scarce and results inconsistent, this large-scale screening study aims at investigating the prevalence of emotional and behavioural problems in recently arrived migrant adolescents in Belgium, compared to Belgian peers. About 1,249 migrant adolescents and 602 Belgian adolescents filled in four self-report questionnaires on the prevalence of emotional and behavioural problems, traumatic experiences and symptoms of post-traumatic stress. Migrant adolescents experienced more traumatic events than their Belgian peers, and show higher levels of peer problems and avoidance symptoms. On the contrary, non-migrant adolescents reveal more symptoms of anxiety, externalizing problems and hyperactivity. Factors influencing the prevalence of emotional and behavioural problems are the number of traumatic events experienced, gender and the living situation. Although migrant and non-migrant adolescents don't differ much in the prevalence of emotional and behavioural symptoms, attention should be given to the screening and support of risk groups within the population of migrant adolescents, such as girls, those who experienced a lot of traumatic events and unaccompanied refugee children and adolescents.
To investigate the level of posttraumatic stress and depressive symptoms, and background risk and protective factors that might increase or ameliorate this distress amongst unaccompanied asylum-seeking children and adolescents (UASC).
Cross-sectional survey carried out in London. Participants were 78 UASC aged 13-18 years, predominantly from the Balkans and Africa, compared with 35 accompanied refugee children. Measures included self-report questionnaires of war trauma, posttraumatic stress and depressive symptoms.
UASC had experienced high levels of losses and war trauma, and posttraumatic stress symptoms. Predictors of high posttraumatic symptoms included low-support living arrangements, female gender and trauma events, and increasing age only amongst the UASC. High depressive scores were associated with female gender, and region of origin amongst the UASC.
UASC might have less psychological distress if offered high-support living arrangements and general support as they approach the age of 18 years, but prospective studies are required to investigate the range of risk and protective factors.
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