Project
Accelerating the development of effective psychological treatments for traumatized refugees using Bayesian methodology

Traumatized refugees represent a large and growing at-risk group for mental health problems. There is an urgent need to improve treatment options for this group (Djelantik et al., 2022). There is some evidence for the effectiveness of trauma-focused treatments, but this evidence is limited (Nickerson et al., 2011; Nosè et al., 2017). Evidence for the feasibility and effectiveness of the five innovative treatments mentioned above is largely lacking. There is an imperative to increase the evidence-base for interventions improving the mental health of refugees. In addition, there is a need to establish simple, feasible research tools and methods, allowing rigorous evaluation of the effects of (novel) interventions, and the role of within and between person factors moderating these effects. Thus, important questions are:

1. To what extent are BEP-MT, NET-TR, 3MDR, HI-NET, and ST-PTS (in a form in which these treatments are tailored to characteristics, contexts, and problems of western and non-western refugees) feasible and effective?
2. What are effective alternatives for controlled research designs requiring large samples, in evaluating new treatments? We advocate the use of “Bayesian evaluation of single case experimental designs”, explained in detail in the “Proposed Methodology” section below.

The development of treatments for refugee groups and tools and methods to evaluate these treatments should be grounded in theory and research. Simultaneously, it is crucial to consider the desires, needs and capabilities of the professionals who are to work with these interventions and methods in their clinical (research) practice. Thus, what is needed to ensure usability, effectiveness, and uptake of treatments and evaluation methods is to develop them in close collaboration between researchers and clinicians. Accordingly, the proposed research team includes both researchers experienced in treatment development and methods and statistics, and clinicians from ARQ Centrum’45 (a “TopGGZ” institution for specialized care for traumatized people) and is excellently suited for this task. A further question is:

3. How can (“top-down”, theoretical) input about trauma-focused treatments and methods for treatment evaluation from researchers be optimally integrated with (“bottom-up”, practice-based) input about needs, requirements, knowledge, and possibilities from clinicians and clinical researchers.

Our objectives are:To increase knowledge about the feasibility and effects of BEP-MT, NET-TR, 3MDR, HI-NET, and ST-PTS tailored to traumatized refugees.

To develop resources and knowledge that enable evaluation of the effects of the treatment in natural, ecologically valid settings (see the elaboration in the next section).

Our objectives are:

1. To increase knowledge about the feasibility and effects of BEP-MT, NET-TR, 3MDR, HI-NET, and ST-PTS tailored to traumatized refugees.
2. To develop resources and knowledge that enable evaluation of the effects of the treatment in natural, ecologically valid settings (see the elaboration in the next section).
3. To establish trauma-focused treatments and evaluation tools which are grounded in both existing theory and evidence (coming from researchers) and experience-based needs and possibilities (coming from clinicians); and to ensure that clinicians can easily be trained in applying these interventions and evaluation methods.

The treatments and evaluation tools will first be used at ARQ Centrum’45 but may later be used in other places in (mental) health care. This project will therefore accelerate the development of effective (psychological) treatments.

The current project will use Bayesian evaluation of SCEDs to evaluate treatment effectiveness. We will briefly introduce it, using the proof of concept provided in a study from Ghafoerkhan et al. (2023) as an illustration. In that study (performed at ARQ Centrum’45 in collaboration with the present applicants), the effects of a novel body-oriented treatment for migrants exposed to sexual violence and trafficking was evaluated. Over the course of a ten-week treatment, three outcome variables were assessed each week: body awareness, self-efficacy, and body dissociation (subsequently called red, green, and blue, respectively). The data obtained from their Patient A are displayed by coloured circles in the figure below. It shows the data of a patient showing the desired improvement, in this case, green (i.e., self-efficacy) and red (i.e., body awareness) increase and blue (i.e., body dissociation) decreases.

In sum, this project will bring forth evidence-based treatments and Bayesian methods to evaluate SCEDs. These will be developed and evaluated in close collaboration between UU-researchers and clinicians at ARQ Centrum’45, which will boost the quality and dissemination of the project’s outcomes. As such, the project improves options for care for traumatized refugees (first within, but soon also outside ARQ Centrum’45) and eventually may also accelerate treatment development and evaluation outside the field of trauma.

Scientific and/or societal impact:

• Scientific impact of the development and evaluation of treatments for traumatized refugees.
• Scientific impact of Bayesian evaluation of SCEDs.
• Societal impact of the development and evaluation of treatments for traumatized refugees.

Supervisors
Prof. Dr. Herbert Hoijtink
Assoc. Prof. Dr. Rebecca Kuiper

Financed by
NWO

Period
1 November 2024 – 31 October 2028