Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War

Lori A Zoellner, Jacob A Bentley, Norah C Feeny, Alexandra B Klein, Michael L Dolezal, Dega A Angula, Momin H Egeh, Lori A Zoellner, Jacob A Bentley, Norah C Feeny, Alexandra B Klein, Michael L Dolezal, Dega A Angula, Momin H Egeh

Abstract

Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors (N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD (g = 1.91), depression (g = 2.00), somatic symptoms (g = 2.73), and well-being (g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs. ClinicalTrials.gov Identifier: NCT03761732.

Keywords: Islam; PTSD; community; depression; mosque; psychotherapy; trauma; war.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Zoellner, Bentley, Feeny, Klein, Dolezal, Angula and Egeh.

References

    1. Kolappa K, Henderson DC, Kishore SP. No physical health without mental health: lessons unlearned? Bull Health World Organ. (2013) 91:3–3A. 10.2471/BLT.12.115063
    1. Cole E, Rothblum ED, Espin OM. Refugee Women and Their Mental Health: Shattered Societies, Shattered Lives. New York, NY: Routledge; (2013). 10.4324/9780203729267
    1. World Health Organization (WHO) . A Situation Analysis of Mental Health in Somalia. WHO. (2010). Available online at: (accessed December 18, 2019).
    1. United Nations High Commissioner for Refugees (UNHCR) . Figures at a Glance. UNHCR. (2019). Available online at: (accessed December 18, 2019).
    1. Koenen KC, Ratanatharathorn A, NG L, McLaughlin KA, Bromet EJ, Stein DJ, et al. . Posttraumatic stress disorder in the world mental health surveys. Psychol Med. (2017) 47:2260–74. 10.1017/S0033291717000708
    1. Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. (2019) 394:240–48. 10.1016/S0140-6736(19)30934-1
    1. Song SJ, Kaplan C, Tol WA, Subica A, de Jong J. Psychological distress in torture survivors: pre-and post-migration risk factors in a US sample. Soc Psychiatry Psychiatr Epidemiol. (2015) 50:549–60. 10.1007/s00127-014-0982-1
    1. Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Middleton JC, et al. . Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin Psychol Rev. (2016) 43:128–41. 10.1016/j.cpr.2015.10.003
    1. Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. (2008) 76:686–94. 10.1037/0022-006X.76.4.686
    1. Becker AE, Kleinman A. Mental health and the global agenda. N Engl J Med. (2013) 369:66–73. 10.1056/NEJMra1110827
    1. Bolton P. Global mental health and psychotherapy: importance of task-shifting and a systematic approach to adaptation. In: Stein DJ, Bass JK, Hofmann SG. editors. Global Mental Health and Psychotherapy: Adapting Psychotherapy for Low- and Middle-Income Countries. Cambridge, MA: Academic Press; (2019). p. 11–24. 10.1016/B978-0-12-814932-4.00001-X
    1. Pew Forum on Religion & Public Life . U.S. Religious Landscape Survey. Pew Research Center. (2009). Available online at: (accessed December 18, 2019).
    1. Boynton L, Bentley J, Jackson JC, Gibbs TA. The role of stigma and state in the mental health of Somalis. J Psychiatr Pract. (2010) 16:265–68. 10.1097/01.pra.0000386914.85182.78
    1. Ai AL, Tice TN, Huang B, Ishisaka A. Wartime faith-based reactions among traumatized Kosovar and Bosnian refugees in the United States. Ment Health Relig Cult. (2005) 8:291–308. 10.1080/13674670412331304357
    1. Bentley JA, Feeny NC, Klein A, Dolezal M, Zoellner LA. Trauma healing: integrating faith and empirically-supported principles in a community-based program. Cogn Behav Pract. (2021) 28:167–92. 10.1016/j.cbpra.2020.10.005
    1. Sakaluk JK, Williams A, Kilshaw R, Rhyner KT. Evaluating the evidential value of empirically supported psychological treatments (ESTs): a meta-scientific review. J Abnorm Psych. (2019) 128:500–9. 10.1037/abn0000421
    1. Zoellner L, Graham B, Marks E, Feeny N, Bentley J, Franklin A, et al. . Islamic trauma healing: initial feasibility and pilot data. Societies. (2018) 8:47. 10.3390/soc8030047
    1. Lang D, Zoellner L, Graham B, Marks EH, Feeny NC. Islahul Qulub: Islamic Trauma Healing. Seattle, WA: University of Washington Center for Anxiety & Traumatic Stress; (2016).
    1. Foa E, Hembree E, Rothbaum BO. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide. New York, NY: Oxford University Press; (2007). 10.1093/med:psych/9780195308501.001.0001
    1. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. (2013) 8:117. 10.1186/1748-5908-8-117
    1. Iwelunmor J, Blackstone S, Veira D, Nwaozuru U, Airhihenbuwa C, Munodawafa D, et al. . Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework. Implement Sci. (2016) 11:43. 10.1186/s13012-016-0415-5
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 5th edition, DSM-5. Washington, DC: American Psychiatric Association; (2013). 10.1176/appi.books.9780890425596
    1. Zoellner LA, Telch M, Foa EB, Farach FJ, McLean CP, Gallop R, et al. . Enhancing extinction learning in posttraumatic stress disorder with brief daily imaginal exposure and methylene blue: a randomized controlled trial. J Clin Psychiatry. (2017) 78:782–89. 10.4088/JCP.16m10936
    1. Foa EB, McLean CP, Zang Y, Zhong J, Powers MB, Kauffman BY, et al. . Psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS−5). Psychol Assess. (2016) 28:1166–71. 10.1037/pas0000258
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9. J Gen Intern Med. (2001) 16:606–13. 10.1046/j.1525-1497.2001.016009606.x
    1. Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E, et al. . The somatic symptom scale−8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med. (2014) 174:399–407. 10.1001/jamainternmed.2013.12179
    1. Bech P, Gudex C, Johansen KS. The WHO (ten) well-being index: validation in diabetes. Psychother Psychosom. (1996) 65:183–90. 10.1159/000289073
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. (1979) 2:197–207. 10.1016/0149-7189(79)90094-6
    1. Kleinman A. The Illness Narratives: Suffering, Healing and the Human Condition. New York, NY: Basic Books; (1988).
    1. World Health Organization (WHO) . First Global Conference on Task Shifting. WHO. (2008). Available online at: (accessed December 18, 2019).
    1. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psych. (2000) 68:748–66. 10.1037/0022-006X.68.5.748
    1. Cilliers J, Dube O, Siddiqi B. Reconciling after civil conflict increases social capital but decreases individual well-being. Science. (2016) 352:787–94. 10.1126/science.aad9682
    1. World Health Organization (WHO) . Mental Health Included in the UN Sustainable Development Goals. WHO. (2015). Available online at: (accessed December 18, 2019).
    1. World Health Organization (WHO) . Mental Health Action Plan 2013–2020. WHO. (2013). Available online at: (accessed December 18, 2019).

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する