A qualitative study of clinicians' use of the cultural formulation model in assessing posttraumatic stress disorder (original) (raw)
Cultural Clinical Psychology and PTSD
Cultural Clinical Psychology and PTSD, 2019
How to provide culturally sensitive care for clients with posttraumatic stress disorder (PTSD) and related disorders This book, written and edited by leading experts from around the world, looks critically at how culture impacts on the way posttraumatic stress disorder (PTSD) and related disorders are diagnosed and treated. There have been important advances in clinical treatment and research on PTSD, partly as a result of researchers and clinicians increasingly taking into account how "culture matters." For mental health professionals who strive to respond to the needs of people from diverse cultures who have experienced traumatic events, this book is invaluable. It presents recent research and and practical approaches on key topics, including: • How culture shapes mental health and recovery • How to integrate culture and context into PTSD theory • How trauma-related distress is experienced and expressed in different cultures, reflecting local values, idioms, and metaphors • How to integrate cultural dimensions into psychological interventions Providing new theoretical insights as well as practical advice, it will be of interest to clinical psychologists, psychiatrists, and other health professionals, as well as researchers and students engaged with mental health issues, both globally and locally.
Clinical Psychology: Science and Practice, 2008
Cultural context is a relevant factor in understanding the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Evidence suggests that the reexperiencing and arousal symptoms of PTSD represent a universal response to trauma observable across many ethnocultural groups. Variation in the expression of this response may be related to the influence of culture on the avoidance and numbing reactions to trauma. Thus, a central challenge for culturally competent treatment of PTSD does not appear to be whether to utilize empirically supported treatments for PTSD, but rather how to effectively engage individuals of various cultures in these interventions and how to address ethnocultural sources of avoidance in the maintenance of PTSD. The enormity of cultural diversity, however, presents a challenge to the task of adapting and empirically testing empirically supported treatments. An ideographic transcultural approach to cultural competency is proposed.
Children around the world are exposed to traumatic events and research confirms that cultural factors play a central role in the psychological experience of trauma and the manifestation of symptoms in trauma and stress-related disorders. The DSM-5 and ICD-11 call on practitioners to consider the role of culture and context in the manifestation, assessment, and treatment of mental health disorders. This article analyzes peer-reviewed literature involving youth and adolescent PTSD screening in non-Western contexts, revealing only few instruments that have undergone validation for cultural contexts outside those for which they were developed. Studies that include cultural validation show marked differences in methodology and conceptual framework for adaptation, translation, and validation, and disagreement on the scale and scope of tools necessary to assess the impact of trauma in non-Western youth. The discussed studies reveal a need to debate a uniform methodology for cultural adaptation and validation of PTSD screening instruments.
Clinical Psychologist, 2018
Objective: Cognitive appraisals have a central role in the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Accumulating cross-cultural psychology research has demonstrated that culture affects the way in which an individual cognitively appraises an everyday experience. However, to date, there is little empirical work considering the influence of culture on cognitive appraisals in PTSD and the implications for treatment. The objective of this review article was to consider how culture may impact on the cognitive appraisals central to PTSD. Method: First, we reviewed the role of appraisals in the prominent cognitive models of PTSD. Second, we discussed the cross-culture psychology literature on the influence of culture on appraisals. Third, we considered the impact of culture on trauma-related appraisals and associated clinical implications. Finally, we considered implications for the tailoring of clinical treatment for individuals from diverse cultural backgrounds. Results: It was found that culture influences appraisals; a key psychological process highlighted by cognitive models as predictive of PTSD. In particular, cultural differences in self-understanding influence how individuals appraise experiences in terms of agency, control, mental defeat, and negative independent appraisals of self; appraisals central to PTSD. Conclusions: Empirical work is needed in order to investigate the influence of culture on trauma-related appraisals in the context of PTSD in order to improve theoretical models and clinical approaches. Key Points 1 Cognitive appraisals are central to the understanding of posttraumatic stress disorder (PTSD). Crosscultural psychology research has shown culture affects the way in which an individual cognitively appraises an experience. 2 This review article considered how culture may impact on the cognitive appraisals central to the development, maintenance, and treatment of PTSD symptoms. 3 Assessment and treatment implications for individuals from diverse cultural backgrounds were considered. Cognitive factors are one of the best predictors for identifying posttraumatic stress disorder (PTSD) (Kleim, Ehlers, & Glucksman, 2007) and are targeted in evidence-based interventions for PTSD (Resick, 2001). The important role of appraisals in PTSD was emphasised by the inclusion of Criterion D-negative alterations in Funding: None. Conflict of interest: None.
Culture and Posttraumatic Stress Disorder (PTSD): A Proposed Conceptual Framework
South African Journal of Psychology, 2012
It is widely accepted that the understanding of any psychological disorder needs to be contextualised within cultural parameters. The notion that current diagnostic taxonomies are not always universally applicable does not mean that all symptoms are not applicable. We present a framework that is aimed at being a starting point from which to delineate universal and culture specific elements of PTSD. The framework follows the possible influence of cultural factors on (a) the formation of an intrusive memory, (b) an understanding of how such a memory becomes pathological, and (c) how symptoms are expressed from the intrusive memory core of PTSD. While the framework presents certain elements (e.g. intrusive memory and core schemas) as centrally important, the focus is on a heuristic framework that allows for the study of the dynamic interaction between potentially universal and cultural factors and how this interaction may produce the symptom profile generally seen with PTSD. Tentative recommendations are made for a research agenda and are presented after a brief exploration of the strengths and weaknesses of such a framework.
Posttraumatic stress disorder (PTSD) is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE) in particular has the most empirical support for the treatment of PTSD. This article discusses culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include adding more sessions at the front end to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment OPEN ACCESS Behav. Sci. 2014, 4 103 and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE.
Improving assessment of race, ethnicity, and culture to further veteran PTSD research
Psychological Trauma: Theory, Research, Practice, and Policy, 2017
Objective: Racial and ethnic disparities in posttraumatic stress disorder (PTSD) and its treatment have been documented for both civilians and military veterans. To better understand the presence of disparities and factors that might contribute to them, accurate assessment of race and ethnicity is critical; however there still remains unstandardized assessment and challenges to implementation. The authors highlight specific problems in the assessment of race and ethnicity in research, such as missing data, misclassification, classification categories too limited to reflect many people's social identities, and inappropriate aggregation of ethnoracial subgroups. Conclusions: A proposal is made for a minimal uniform assessment standard of race and ethnicity. Additional recommendations incorporate principles proposed by the Institute of Medicine that allow for more granular assessment of race and ethnicity to better capture individual identity and cultural factors as they relate to the assessment, experience and management of PTSD.
Psychological trauma : theory, research, practice and policy, 2017
It is uncertain whether ethnoracial factors should be considered by clinicians assessing and treating posttraumatic stress disorder (PTSD) among service members. The purpose of this study was to shed light on ethnoracial variation in the presentation of PTSD symptoms, trauma-related cognitions, and emotions among treatment-seeking active duty military personnel. Participants were 303 male active duty military members with PTSD participating in a clinical trial (60% were self-identified as White, 19% as African American, and 21% as Hispanic/Latino). In the parent study, participants completed a baseline assessment that included clinician-administered and self-report measures of PTSD, trauma-related cognitions, and emotions. Multivariate hierarchical regression models were used to examine ethnoracial differences in these variables, covarying age, education, military grade, combat exposure, and exposure to other potentially traumatic events. Hispanic/Latino and African American partici...
Culturally-shaped manifestations of PTSD
Definition of culture in the contemporary literature is quite diverse and sometimes controversial. For the purposes of this chapter, we are using the concept proposed by Anthony Marsella: "Shared learned behavior and meanings acquired in life activity contexts that are passed on from generation to another for purposes of promoting survival, adaptation, and adjustment. These behaviors and meanings are dynamic, and are responsive to change and modification in response to individual, societal, and environmental demands and pressures. Culture is represented externally in artifacts, roles, settings, and institutions. Culture is represented internally in values, beliefs, expectations, consciousness, epistemology (i.e.