Clinical Practice Question and Literature Review

Running Head: PSYCHOTHERAPY TREATS PTSD IN IMMIGRANT PATIENTS 1

PSYCHOTHERAPY TREATS PTSD IN IMMIGRANT PATIENTS 5

Clinical Practice Question and Literature Review

Student Name

Course Title & Course Code

Institute Name (Department + Affiliation)

Instructor Name

Date

Clinical Practice Question and Literature Review

Abstract

The progression in the ratio of immigrant patients brings about a surge in post-traumatic stress disorder (PTSD) cases due to the evident relationship between migration and PTSD. The psychological health caregivers should be informed with advanced knowledge regarding the treatment option of PTSD in immigrant patients. The inception of non-pharmacological psychotherapy can mitigate the impacts of PTSD in immigrant patients. This research aims to systematically review the studies relevant to the clinical question and present an all-inclusive summary of evidence-informed knowledge. The research-informed summary helps nurses and policy-makers to assemble good choices effectual for the situation to integrate psychotherapy into their practice for the benefit of patients.

Keywords: PTSD, psychotherapy, immigrant patients, and mental health issues.

Introduction

In your introduction (Why is this a problem? provide shocking statistics)

This research is based on the Picot question that is stated as

In (P) Immigrant patients

(I) Psychotherapy

C: Psychotherapy vs no Psychotherapy

O: mitigates the effects of PTSD

T: Ten Years

“In immigrant patients, how does psychotherapy upon migration compare to no psychotherapy mitigates the effects of PTSD over ten years?” In this study, psychotherapy is manipulated by researchers, and the consequences are observed in PTSD. Therefore, PTSD is a dependent variable and shows effects. Psychotherapy is the cause of outcomes and is an independent variable. The population and setting of the research are dependent on the topic or area selected for research. The formulated clinical question reflects the area of interest, i.e. PTSD in immigrant patients. Therefore, the immigrant patients who have faced episodes of PTSD are taken as the population of the study. Furthermore, the experimental context suitable for the study is the community setting. PTSD is a real-life phenomenon that cannot be studied in laboratories. That is why a natural, environment-based setting is preferred for the study.

Theoretical framework and Organizational model

Look at relationships between nurse and patient as it relates to a nursing theorist; (eg) Florence Nightingale, Hildegard Peplau, Callista Roy, Jean Watson etc….. Identify which theorist’s theory will best align with your PICO, and how does it relate. Organizational Model example, PSDA model. GOOD SOURCE OF INFORMATION includes https://nurseslabs.com/nursing-theories/ , and EBP text book pdf attached.

A theoretical framework provides the structure supporting a research study. It recognizes and explains way the study is conducted. In this study, the immigrant patients having post-traumatic stress disorder are divided into two groups. One is the experimental group, and the other is the control group. Psychotherapy as an interventional therapy is given to the experimental group patients, whereas the control group patients do not receive any therapy. The outcomes of both groups are compared to assess whether the psychotherapy mitigates the symptoms of PTSD in immigrant patients or not. Migration is a stressful event and leads to a long-standing PTSD in migrants. The findings of available studies document psychotherapy as a potential interventional therapy for the treatment of PTSD. It mitigates the effects of PTSD as compared to no therapy. Additionally, psychotherapy is a comprehensive approach that addresses the past traumatic events and the current psychosocial issues experienced by the patient. The formulation and integration of holistic psychotherapy guidelines is the need of the hour. The guide enables nurses to promote health and prevent PTSD sufferings in immigrant patients. In this paper, previous studies conducted on psychotherapy in the management of PTSD among immigrant patients are critically reviewed to evaluate the effectiveness of psychotherapy.

Introduction to Literature Review

An electronic keywords-based search is done through validated search engines like PubMed, Medscape, CINAHL, Healthline, etc. The databases accessing the peer-reviewed journal articles in healthcare and nursing domains are generated through search engines—a comprehensive inclusion and exclusion criteria aids in selecting studies. About 19 articles are identified for this and 13 are utilized in the project. The freely available, peer-reviewed, recent primary studies, having at least one keyword in title or abstract, and published in the English language are selected.

Literature Review (Identify themes and trends in your articles)

The pervasiveness of psychological problems in immigrants is considerably high because of unfavorable experiences interlinked with migration. The literature is gathered from different primary studies and systematic reviews to give a substantial guide and theoretical frame for treating PTSD in immigrant patients. Pre and post-traumatic stress disorder are prominent psychological issues (Unterhitzenberger et al., 2019). The mental health of patients who came from abroad is the critical issue and focus zone for researchers due to a substantial increase in the incident rate of mental health issues among immigrant patients. Millions of patients travel to other countries for better survival facilities, but immigration has turned into a traumatic event for them. They went through various stressors interlinked with the migration. These stressors are the psychosocial surrounding elements that set off unusual physical and emotional distress among the patients (Drožđek, 2015).

Immigrant patients are more prone to psychological health problems as compared to native patients. There are several reasons behind other than traveling and flights that trigger post-traumatic stress disorder (Kananian et al., 2017). For instance, acculturation, wars, somatic discomfort, language difference, and violence. Post-traumatic stress disorder (PTSD) is the most common psychotic issue experienced by the majority of migrants. PTSD adversely impacts the health status of a person and requires effective therapy for management (Kobel, Erim, & Morawa, 2021). The inception of other psychological issues (depression, anxiety) and PTSD is a normal event in general. They adopt the wrong way to get out of it. In order to prevent the adverse outcomes of PTSD, psychotherapy is initiated to rescue the mental health of patients in primary care settings (Rafieifar & Macgowan, 2021).

We know that culture and religion are vital in determining a patient's viewpoint of ailment and suffering, either physical, psychological, or behavioral. So, interventional psychotherapy should be within the cultural safety of patients. The particularities of assuring culturally safe psychological care for immigrants is the key to effective management of PTSD. The stressful events are new to the patients, so they often did not cope with the emerging distress. They require practitioners' psychotherapeutic assistance to adapt to the situation (Haagen et al., 2017). Additionally, nurse practitioners also require satisfactory knowledge to make an informed decision about the coping strategies. Therefore, numerous evidence-based studies are carried to anticipate the factors contributing to mental instability during flights or traveling. The shreds of evidence, patients' interviews, and surveys allow policy-makers and healthcare organizations to assess the efficacy of psychotherapy. Also, the formulation of new holistic psychotherapy is needed to improve the situation of existing PTSD cases and prevent future events of PTSD. It is found that one in three immigrants has been reported to have PTSD. In addition, approximately 4% of the immigrant population encountered PTSD during their survival (Gurner et al., 2020).

PTSD has long-standing impacts on the wellbeing of patients. They are psychologically injured and require assistance to get out of it. Otherwise, they remain anxious for the rest of their life. Reportedly, 80% of patients having long-term PTSD experience unnecessary fear, worries, and sadness. They start using illicit substances, become alcoholics or smokers to lessen their suffering. The difference in culture is the central social factor that stimulates PTSD. Immigrant patients experience excessive discomfort to adjust within the culture of the host country. There is an ongoing requirement to advance PTSD management services. However, psychologists and nurse practitioners in healthcare settings need interventional therapies to treat PTSD in patients from different cultures (Kronick, 2018). Psychotherapy is the effective most evidence-based intervention for PTSD in immigrants. Generally, psychotherapy refers to the treatment of mental/psychological health issues. It is a universal term having five predominant categories. 1. Behavior therapy 2. Cognitive therapy 3. Humanistic therapy 4. Narrative exposure therapy and 5. Integrative therapy.

The healthcare giver appraises patients' behavior, thinking, mood, and emotions and chooses the suitable interventional therapy accordingly. Cognitive behavior therapy refers to verbal psychotherapy that works on the emotions and behaviors of psychologically ill individuals. It is the widely used psychotherapy practiced by psychologists all across the world. During the intervention, the therapist emphasizes how a patient understands a situation and gets the cognitive beliefs of the patient. Hence, this therapy improves the maladaptive thoughts and behaviors of a patient with collaborative efforts (Lawton et al., 2021). In addition, the therapist explores the psychosocial determinants contributing to traumatization by communicating with patients in this therapy. Integrative therapy is the integration of various therapeutic methods suitable for the therapy (Tay et al., 2020). Psychotherapists integrate different options to produce most of the next level and potent therapy. Narrative exposure therapy is a short-standing approach that enables the patient to develop a logical survival narrative against the traumas (de la Rie et al., 2020). In a 2017 published study, the American Psychological Association stated the clinical practice guidelines for PTSD treatment in which narrative exposure therapy is declared best for immigrant patients (APA, 2017).

Critique and Synthesis

The results and findings in key studies demonstrated that intervention helped lessen the sufferings of post-traumatic stress disorder. A total of ten studies are critically evaluated. The first study reported that all the participants of the interventional group provided with psychotherapy showed improvement in PTSD effects, whereas the control group patients did not show any improvement (Rafieifar & Macgowan, 2021). The second study observed predictors for successful psychotherapy focusing on somatization (Kobel, Erim, & Morawa, 2021). The third study has explored important information for practitioners regarding PTSD treatment. The traumatized immigrant patients exhibit a distinct response to psychotherapy. Additionally, the requirement for treatment adaptations was demonstrated in this study (Haagener et al., 2017).

The fourth study was a systematic review that stated that cognitive behavior therapy was safe and effective in treating PTSD effects in children immigrant patients. Also, the same study was edged with the World Health Organization guidelines to deliver cognitive behavior therapy for reducing PTSD symptoms(Lawton & Spencer, 2021). The fifth study reported psychotherapy as the best option to treat PTSD in immigrants (Unterhitzenberger et al., 2019). The sixth study was a pilot study in which pre and post-interventional effects were observed in the same group(Ooi et al., 2016). 84% of the patients restored their stable psychological status with the initiation of intervention. The seventh study was another pilot study in which a questionnaire-based approach was maintained to find the improvement of PTSD symptoms after cognitive therapy. All the questionnaires showed improvement and recognized acculturation as a critical detriment to provoke improvement (Kananian et al., 2017).

The eighth study has demonstrated the effectiveness of community-based psychotherapy(Gruner et al., 2020). The ninth study was the most important of all studies. The outcomes of integrative and cognitive therapy were compared in this control randomized research. Comparatively, integrative therapy has exhibited better outcomes than cognitive therapy. The author also mentioned further research is required to confirm and validate the findings of this study(Tay et al., 2020). Lastly, the tenth study has discussed the narrative exposure psychotherapy significant for the culturally varied immigrant population(de la Rie et al., 2020).

Cognitive-behavioural therapy is the most commonly used psychotherapy. It is observed as the priority of psychiatrists in different cases. For all studies, the potential was significant enough to mitigate PTSD. After that, numerous recent controlled-randomized trials appraise and document the efficacy of integrative therapy for PTSD management. Although the studies provide shreds of evidence, there are some weaknesses and strengths in the key studies. The vigilant literature evaluation explores that trauma-focused psychosocial complexities and PTSD association with comorbidities are not well-addressed in most studies. Moreover, many studies give small-scale details about the intervention and variables instead of the exact plan. Lack of sufficient language expertise hinders the patient’s interview during inpatient interviews. These are the limitations found in the studies. However, satisfactory numeric and non-numeric data is mentioned in the results of studies, and there was a good impact on the symptoms of PTSD. These are the strengths found in the studies.

Further Research

Ex: (Gap in research articles, what is lacking in the study)

First and foremost, the psychosocially all-inclusive guidelines for psychotherapy need to be further researched. Seemingly, the worldwide immigrant population in absolute digits is 244 000,000. It is estimated that America is the state with the largest immigrant population, approximated to 47,000,000, about 14% of the American population and 19.1% of the global immigrant population. A high ratio of population that is vulnerable to psychotic illness is considered responsible for elevated cases of depression, anxiety, and use of illicit substances in the United States.

In a recently published report, the center for Disease Control and Prevention explains the holistic guidelines to screen PTSD in immigrants (CDC, 2021). However, the treatment and management guidelines are not formulated and by the healthcare organization. Healthcare policy-makers should emphasize developing comprehensive management guidelines. Secondly, some migrants are usually illiterate. They are not familiar with the English language. Apart from acculturation, language is also one of the principal issues. Primary caregivers should be trained to understand different languages if possible.

Additionally, the training program for competitive nursing or psychiatric services needs to be further researched. Psychiatrists should have the basic knowledge of immigrants' cultural beliefs, religious beliefs, ethnicities, and varied languages. Thirdly, there are few studies carried on humanistic psychotherapy in the past. During the literature search, we did not find any study concerning the management of PTSD in immigrants by humanistic therapy published within the past five to seven-year. Therefore, humanistic therapy-controlled randomized trials need to be further researched.

Conclusion

Missing

References

American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.https://www.apa.org/ptsd-guideline

Center for Disease Prevention and Control. (2021). Guidance for Mental Health Screening during the Domestic Medical Examination for Newly Arrived Refugees.https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/mental-health-screening-guidelines.html

de la Rie, S. M., Smid, G. E., van der Aa, N., van Est, L. A. C., Bisseling, E., & Boelen, P. A. (2020). Feasibility of narrative exposure therapy in an outpatient day treatment programme for refugees: improvement in symptoms and global functioning. European Journal of Psychotraumatology, 11(1), 1759983. doi:10.1080/20008198.2020.1759983

Drožđek, B. (2015). Challenges in the treatment of post-traumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives. European Journal of Psychotraumatology, 6, 24750-24750. doi:10.3402/ejpt.v6.24750

Gruner, D., Magwood, O., Bair, L., Duff, L., Adel, S., & Pottie, K. (2020). Understanding Supporting and Hindering Factors in Community-Based Psychotherapy for Refugees: A Realist-Informed Systematic Review. International journal of environmental research and public health, 17(13), 4618. doi:10.3390/ijerph17134618

Haagen, J. F. G., ter Heide, F. J. J., Mooren, T. M., Knipscheer, J. W., & Kleber, R. J. (2017). Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis. British Journal of Clinical Psychology, 56(1), 69-83. doi:https://doi.org/10.1111/bjc.12121

Canadian, S., Ayoughi, S., Farugie, A., Hinton, D., & Stangier, U. (2017). Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study. European Journal of Psychotraumatology, 8(sup2), 1390362. doi:10.1080/20008198.2017.1390362

Kobel, F., Erim, Y., & Morawa, E. (2021). Predictors for successful psychotherapy: Does migration status matter? PloS one, 16(9), e0257387. doi:10.1371/journal.pone.0257387

Kronick, R. (2018). Mental Health of Refugees and Asylum Seekers: Assessment and Intervention. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 63(5), 290-296. doi:10.1177/0706743717746665

Lawton, K., & Spencer, A. (2021). A Full Systematic Review on the Effects of Cognitive Behavioural Therapy for Mental Health Symptoms in Child Refugees. Journal of Immigrant and Minority Health, 23(3), 624-639. doi:10.1007/s10903-021-01151-5

Ooi, C. S., Rooney, R. M., Roberts, C., Kane, R. T., Wright, B., & Chatzisarantis, N. (2016). The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial. Frontiers in Psychology, 7, 1641-1641. doi:10.3389/fpsyg.2016.01641

Rafieifar, M., & Macgowan, M. J. (2021). A Meta-Analysis of Group Interventions for Trauma and Depression Among Immigrant and Refugee Children. Research on Social Work Practice, 10497315211022812. doi:10.1177/10497315211022812

Tay, A. K., Mung, H. K., Miah, M. A. A., Balasundaram, S., Ventevogel, P., Badrudduza, M., . . . Silove, D. (2020). An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLOS Medicine, 17(3), e1003073. doi:10.1371/journal.pmed.1003073

Unterhitzenberger, J., Wintersohl, S., Lang, M., König, J., & Rosner, R. (2019). Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: a pilot study. Child and Adolescent Psychiatry and Mental Health, 13(1), 22. doi:10.1186/s13034-019-0282-3