Can Lifestyle Change Play a Role in Trauma Treatment Among Refugee Communities?

Abstract

100 words?
Keywords: Refugees, Trauma Treatment; Mental Health; Lifestyle, Resettlement
[Acknowledgement]
[Index/content]
[Glossary]

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1.0 Introduction / Background

The impacts of trauma on the wellbeing of refugees are often long-lasting, both
psychologically and physically. Refugees are people who are usually forced to escape their home
nations because of serious human rights crimes, abuses, and other potential causes of prolonged
emotion and physical distress (George, 2009). Each day, refugees’ basic rights and freedoms are
breached in numerous nations across the globe, and a high number of them are exposed to
harassment, disasters, and extreme trauma due to psychological, sexual, and physical oppression.
At the same time, refugees are also denied autonomy and freedom in their host countries,
rendering them virtually powerless. They are also often considered a threat to the surrounding
communities by the host nations’ authorities.
The effects of trauma on refugees are colossal, immeasurable, and long-lasting. Trauma
can shatter refugees’ outer and inner selves and force them to leave in fear in the host countries.
Many refugees experience extremely stressful events because of migration, war, religious and
political oppression, and resettlement (George, 2009). These experiences often lead to despair
and helplessness, leading to symptoms like PTSD (post-traumatic stress disorder) and other signs
like survival guilt, nightmares, sleeping difficulties, inattention, anxiety, depression, and suicidal
thoughts.
Over the years, psychologists and professionals have attempted to integrate socio-
cultural, lifestyle factors, and cultural competency in psychotherapeutic interventions. According
to Sue et al. (2009), cultural competency practices are preferred in the mental health discipline
because of the differences and disparities in services administered to racial minority
communities, including refugees. Today, many experts and professionals in psychology call for
the adoption of culturally competent professionals and culturally competent health care. These

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calls are prompted by the increasing diversity experienced in the US population, necessitating the
shifts in the mental health framework to meet the varying needs of multicultural populations,
including refugees.
Scientists have developed multiple culturally competent psychotherapies to treat and
relieve trauma symptoms among disenfranchised populations like refugees, including cognitive
behavior therapy (CBT), narrative exposure therapy (NET), and the REIK method. CBT is a
psychotherapeutic technique that targets altering people’s behavior and thought patterns. It is
anchored on the premise that people reason and interpret life’s experiences differently, and these
interpretations and thoughts affect their behavior and feelings.
On the other hand, narrative exposure therapy (NET) is a therapeutic modality that assists
people in creating a coherent life narrative to contextualize their traumatic experiences. Creating
a narrative about their life can help individuals contextualize a network of their trauma’s sensory,
affective, and cognitive memories. In so doing, patients can refine and understand the source and
context of their traumatic episodes. The therapist often begins by asking individuals to describe
their sensory information, thoughts, emotions, and physiological responses. Patients are then
requested to describe or narrate their traumatic experiences and the emotions encountered
without losing a link with the present. Finally, the REIK method aims to encourage spiritual,
emotional, and physical healing by therapists lightly touching the body or placing their hands
slightly off the body. This method is believed to enhance the transmission of the flow of life
energy throughout the patient’s body.
In this regard, scientists are asking whether these lifestyle changes can play an integral
role in treating traumatic symptoms among refugees. This paper explores this question by first
exploring existing literature about the meaning of trauma, its application in the context of

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refugee communities, and the background of the three modalities (CBT, NET, and REIK
method). A search appraisal and analysis (SALSA) technique was used to search, appraise,
synthesize, and analyze the existing literature on the topic.
1.1 Trauma
Trauma is a complex condition that has been defined differently by researchers and
professionals. Trauma originated from the Greek word trauma, meaning defeat, hurt, or wound.
In Proto-Indo-European (PIE), the prefix tera- means to “turn or rub,” with its derivatives
referring to drilling, boring, twisting, and piercing. It also means threshing or rubbing cereal
grains to remove husks. In the 1690s, the word trauma was first described as “physical wound,”
and it was first described as an “unpleasant experience or psychic wound causing abnormal
stress” in 1894.
The American Psychological Association (APA) Dictionary of Psychology defines
trauma as “any disturbing experience resulting in significant fear, helplessness, dissociation,
confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a
person’s attitudes, behavior, and other aspects of functioning.” These traumatic events include
those resulting from human behavior (industrial accidents, war, rape) and nature (tsunamis,
earthquakes, heat waves, and landslides). These events often challenge a person’s perspective of
the globe as a predictable, safe, and just place. The APA Dictionary of Psychology (n.d.) defines
trauma as “any physical injury, such as a widespread burn or a blow to the head.”
Although new definitions of the word trauma have been developed, the concept of
emotional distress and its long-lasting negative impact on an individual’s behavior, attitudes, and
cognitive functions remain the same. For example, the Trauma-Informed Care Implementation

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Resource Center (n.d.) defines trauma as a “pervasive problem resulting from exposure to an
incident or series of events that are emotionally disturbing or life-threatening with lasting
adverse effects on the individual’s functioning and mental, physical, social, emotional, and
spiritual wellbeing.” Traumatic experiences include violence in the community, terrorism, or
war; racism, oppression, and discrimination; poverty; sudden, unexplained separation from
friends and family members; living with a family member with substance use or mental health
disorders; childhood neglect; and emotional, sexual, and physical abuse.
According to the Help Guide (n.d.), psychological or emotional trauma results from
unusually stressful occurrences or events that shatter an individual’s sense of safety and security,
making them feel helpless in a hazardous environment. Mental trauma leaves victims battling
upsetting memories, emotions, and anxiety that persists for extended periods. It can also leave
people feeling disconnected, numb, and unable to trust others. The Help Guide divides sources of
trauma into three: (1) one-time events like violent attacks, injury, or accidents, particularly if
they are unexpected or occurred in childhood, (2) ongoing, relentless stress like residing in a
crime-ridden community, battling a terminal and life-threatening disease, or facing traumatic
incidents that occur habitually like childhood neglect, domestic violence, or bullying, and (3)
commonly overlooked causes like a breakup of a significant relationship, the sudden death of a
family member or someone close, surgery, or deeply disappointing or humiliating experience.
1.2 Trauma in the Context of Refugee Communities
Refugees experience multiple extremely stressful and traumatic events due to war,
religious or political oppression in their home countries, migration, and resettlement in the host
nations. It is unquestionably challenging and quite impossible to describe all the traumatic events
refugees undergo when they decide to flee their countries because refugee trauma usually

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precedes war-related events or extreme violations of human rights. Traditionally, a ‘standard’
review of refugee trauma entails a 17-item part on the HTQ or Harvard Trauma Questionnaire,
which assesses whether the specific event was experienced personally or the individual heard
about or witnessed the traumatic incident (Mollica et al., 1992). Although this tool has been
integral in identifying trauma, it is clear that the depth and breadth of trauma and stress for
refugees is far beyond the seventeen items listed. For instance, in a recent survey, about 67
Kurdish and Vietnamese refugees identified 612 war-related traumatic incidences/events during
the design of the Comprehensive Trauma Inventory-104.
Before being forced out of their home countries, most refugees may experience extreme
fear, physical assault, rape, malnutrition, property loss, torture, imprisonment, and loss of love,
close family members, and friends. The flight process sometimes lasts several days, weeks,
months, and sometimes years. During the flight, refugees are constantly separated from their
friends and family members, forced to kill or inflict pain, robbed, witness killing or torture, lose
close friends and family members, forced to survive without food or proper nutrition, and
withstand environmental conditions. Perhaps the terrifying impact of all of the traumatic events
refugees are forced to endure is a betrayal by their “own” people, enemy troops, or generally the
politics of their home country. In most instances, these misanthropic actions by others become
part and parcel of the daily routine of refugees. They often have significant implications for the
wellbeing and health of refugees and their ability to form trusting interpersonal relationships that
are critical to healing and resettlement in the host countries.
Torture is one of the severe forms of trauma. Historically, torture has been found to vary
with each specific group and event, ranging from 3 percent to 63 percent. However, there is no
medical evidence for a clinical torture syndrome unique from severe trauma’s clinical signs and

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outcomes. Yet, because of torture’s heinous nature, it continues to be recorded as a predictor of
psychiatric and clinical illness in war refugees. Evidence suggests that tortured refugees face
significant physical and emotional healing issues that require careful assessment and treatment
using culturally-competent techniques and lifestyle changes. CBT is one of the techniques that
has been widely applied in treating trauma events, although it has not been extensively tested in
trauma refugees.
When refugees or asylum seekers resettle in the host nation, often in areas or locations
that are not of their choosing, they must adapt to new languages, weather conditions, political
climate, foods, and rules. Besides getting accustomed to the new environments, refugees are also
confronted with uncertain circumstances and futures. Re-building an identity and home while
juggling daily living tasks is another major hurdle refugees must face. Early research indicates
that post-migration stress fundamentally contributes to the poor psychological health and
wellbeing of refugees. Recent research studies have confirmed that post-migration stress impacts
refugees’ mental and emotional health, often presenting a risk equal to or higher than war-related
pain and trauma (Lindencrona, Ekblad, & Hauff, 2008).
New evidence also suggests that pre-and post-migration trauma and stress can predict
unique types of traumatic trauma and distress symptoms differently in children and adults. These
symptoms might be aggravated because refugees are often reminded of past traumatic incidents
during their resettlement as healthcare workers and resettlement agencies are attempting to
provide remedies and therapy to reverse the impacts of trauma by providing culturally sensitive
care. Some experts contend that giving culturally-competent care can expose refugees to their
past traumatic events during resettlement, unearthing past wounds and exacerbating the already
physically and mentally fragile and vulnerable bodies. However, other researchers disagree with

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these notions, arguing that culturally-competent care and lifestyle changes can significantly help
address trauma symptoms among refugees.
1.3 Modalities
A contextual explanation of each modality while relating to literature
1.3.1 Cognitive Behavioral Therapy (CBT)
1.3.2 Narrative Exposure Therapy (NET)
1.3.3 REIK Method

Review Method
Search Appraisal Synthesis and Analysis (SALSA) method.

Search
Databases
Keywords

Appraisal
Criteria: Concept,
locality, date

Synthesis
Reading papers in
full, open coding,
grouping of
papers

Analysis
Identification of
themes and gaps
Thematic analysis

Results

In this section, the researcher will present the results of the review
 The researcher will begin by reporting a critical evaluation of literature in each modality
and then proceed to perform an in-depth comparison of all modalities
 Key benchmarks will be used to standardize the review of each modality
o Each modality will be assessed based on its effectiveness in treating
 Unpredictable emotions

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 Dysfunctional relationships
 Depression
 Anxiety
 Post-traumatic stress disorder


Critical Evaluation of Literature (using SALSA technique)

• Cognitive Behavioral Therapy (CBT)
• Narrative Exposure Therapy (NET)
• REIK Method
  Here, tables will be used to document details of pinpointed studies, including document type,
  summary, keywords, themes, the definition of key terms, notes, and evidence of effectiveness.
  Comparison
  A report of in-depth comparison of the three modalities will be presented.

Discussion

The results of the review will be discussed in relation to scholarly studies and common practices
in the clinical setting.

Conclusion

The conclusion will highlight

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 the potential of lifestyle changes in treating trauma among refugees
 Limitations of research
 Recommendations for future research

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References

APA Dictionary of Psychology. (n.d.). Trauma. https://dictionary.apa.org/trauma
George, M. (2009). A theoretical understanding of refugee trauma. Clinical Social Work Journal,
38, 379-387. https://doi.org/10.1007/s10615-009-0252-y
Help Guide. (n.d.). Emotional and psychological trauma.
https://www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-
psychological-trauma.htm
Lindencrona, F., Ekblad, S., & Hauff, E. (2008). Mental health of recently resettled refugees
from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement
stress and capacity to handle stress. Social Psychiatry and Psychiatric Epidemiology,
43(2). 121-131.
Mollica, R. F., Caspi, Y., Bollini, P., & Truong, T. (1992). The Harvard trauma questionnaire:
Validating a cross-cultural instrument for measuring torture, trauma, and post-traumatic
stress disorder in refugees. The Journal of Nervous and Mental Disease, 180(2), 107-111.
Sue, S., Zane, N., Hall, G. C., & Berger, L. K. (2009). The case for cultural competency in
psychotherapeutic interventions. Annual Review of Psychology, 60, 525-548. doi:
10.1146/annurev.psych.60.110707.163651
The APA Dictionary of Psychology. (n.d.). Trauma. https://dictionary.apa.org/trauma