Colorado Medicare Fee Schedule 2023, Who Pays Your Health Insurance While On Workers' Compensation, Articles B

However, finding evidence of a disorder predefined this way does not mean that these are the most important reactions to evaluate in this context (3) or that they form the same cohesive syndrome (e.g., PTSD) within the cultural group. ER HHS Vulnerability Disclosure, Help DE Researchers and clinicians should be aware of historical events occurring between cultural groups, as these may shape expectations and activate stereotypes that may not be helpful for the assessment process. , By incorporating culturally relevant reactions, such instruments can become more holistic assessment tools and have greater sensitivity to detect suffering (16). As these expressions hold cultural meaning, they are also less stigmatizing than Western psychiatric concepts (27), which may not possess cultural salience and could be interpreted incorrectly. K Accessibility Thomas (56) conducted a direct-comparison meta-analysis with 21 studies. For example, studies have used images of people carrying larger weights on their heads (43), facial images that range from smiles to frowns (47), or circles filled in by quarters to show how much of a symptom is present (42). Tol , The application of etic approaches assumes that psychopathology is a universally experienced phenomenon, regardless of culture, and this largely follows a biological view. , de Jong BJ , In some cultures, response options such as not at all, somewhat, a little bit, moderately, and so on are not well-defined or meaningful gradients. Bui et al. JW : Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. , , Hinton : Enhanced life distress inventory: Development and validation in two African countries. Cultural Competence in Trauma Therapy: Beyond the Flashback de Jong on August 1, 2022, There are no reviews yet. Ethical and Cultural Considerations in Trauma Treatment: , : Pan-cultural elements in facial displays of emotion, Tseng , Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to K-T BEYOND TRAUMA - Hazelden Finally, cultural groups experiencing ongoing adversity may not fit into Western biomedical diagnoses such as PTSD. Chen Most psychological research is premised on studies sampling a minority of the global population. Validation takes several forms, including structural and factorial validity, largely assessed using confirmatory factor analysis; convergent and discriminant validity, which is assessed by evaluating the test against other constructs that are known to correlate (or not correlate) with the construct under study; and criterion validity, which is the examination of whether the instrument performs against a gold standard and to establish a clinical screening cutoff score to assess the disorder. AS , Keller R : Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers, DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees, Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. , BJ , MJD Kleinman et al. Cambodian refugees, who survived human rights violations and extensive trauma during the Pol Pot regime, represent an illustrative case in point. Jarvis (PDF) Beyond Trauma: Cultural and Societal Dynamics Hall , discussed in their 2010 Nature article Most People Are Not WEIRD, most psychological research draws from subject pools whose demographic characteristics are westernized, including being more educated, more industrialized, rich, and from democratic nations that do not represent the vast majority of the world, such as individuals from the Global South. M When considering the style and stance of the assessor, the concept of cultural humility bears consideration. , , WebCLINICAL SYNTHESIS Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions Anushka R. Patel, Ph.D., and Brian J. et al. When available, clinicians can append their assessment batteries with assessments incorporating idioms of distress to assess culturally relevant trauma reactions. DE One study found that 65% of Cambodian refugees diagnosed as having PTSD reported a sleep paralysis episode in the past year, compared with 15% without PTSD (14). KE Rasmussen : Third, explanations attributed to trauma-related suffering vary by cultural setting, and such explanations shape distinct illness experiences. Sharma Idioms of distress often do not map cleanly onto Western psychiatric diagnoses. Reed W , Notably, the DSM-5 Cultural Formulation Interview is a semi-structured interview. : Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. A critical stage during instrument validation is to conduct cognitive interviews (46), which is a think-aloud method of ensuring that items are conceptually clear, nonoffensive, relevant, appropriate, and meaningful. Put differently, if we define suffering using a Western lens and seek to find corresponding reactions of this suffering, we will likely find this evidence. A recent study used this approach to measure pre- and postmigration stressors among Filipino migrants, providing more context for interpreting PTSD and anxiety findings (49). These dynamics present a complex task for clinical judgment: Clinicians must untangle the attributions of trauma that may be unhelpful to healing while appreciating the culturally normative interpretations of reactions and precipitating events (32). Idioms of distress are not included in Western psychiatric diagnoses precisely because of their localrather than universalrelevance. The curriculum Eisenberg Overall, the privilege given to Western psychiatric diagnoses across cultural settings may have the unintended consequence of collective forgetting about how culture may affect mental health. Quintana Quraishy With humility comes respect for other cultures, and a consequence of this respect is an openness to other perspectives. , W , Eng Lin WV The editors of Beyond Trauma: Cultural and Societal Dynamics have created a volume that goes beyond the individual's psychological dynamics of trauma, As PTSD reactions can vary across cultures, idioms of distress offer an alternative lens into cultural manifestations of trauma-related distress. When such assessments are not available, clinicians can listen for idioms of distress and use their clinical assessment skills to probe into the lived experience for each patient. BN Benish Ron Eyers argues that a cultural trauma is a tear in the social fabric, which LJ and transmitted securely. , This finding is a relatively new addition to the literature and provides important information for aging-related research, which could contribute to mapping Validating the instruments and assess their psychometric properties. M In fact, mounting evidence suggests that PTSD is just one type of trauma-related disorder and that trauma reactions are quite culturally variable (4). AV LT Aggarwal , Applied to trauma reactions, explanatory models may also include a cultural groups view of why a traumatic event occurred. : The validity and clinical utility of post-traumatic stress disorder in AFhanistan, The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. The suggestions that we provide in this article can be used in routine clinical settings. Tol Although avoidance-numbing reactions are not universally endorsed, somatic complaints are frequently reported across cultures but remain excluded from the diagnostic descriptions of PTSD (1113). Capture a web page as it appears now for use as a trusted citation in the future. I , Kohrt , H Beyond the DSM-5 Diagnoses: A Cross-Cultural van Ommeren Aguilar-Gaxiola For instance, the widely reported idiom thinking too much can be associated with depression and PTSD, but it does not always correspond to any one Western psychiatric diagnosis (21). , D et al. government site. V However, given the cultural relevance of idioms of distress and explanatory models of illness, these concepts should also be addressed in treatment. , , Kulkarni Finally, because determining PTSD is complicated in conditions of ongoing stress and adversity, instrument findings can be strengthened by querying for experiences of ongoing stress and adversity at the time of the assessment. A culturally relativistic view suggests that culture is essential in understanding psychopathology and that, at the extreme, culture is a mediating force through which all pathology is defined and expressed. According to cultural betrayal trauma theory, within-group violence confers a cultural betrayal that contributes to outcomes, including symptoms of posttraumatic WebBeyond Trauma: A Healing Journey for Women, a twelve-session curriculum, is designed to help women and girls recover from the effects of trauma in their lives. , GM For example, some cultural groups may believe that a trauma occurred because supernatural forces punished them or their community for a transgression or a trauma occurred as part of their karma (29, 30). , Cultural Betrayal as a Dimension of Traumatic Harm: Violence and Western psychiatric diagnoses, such as posttraumatic stress disorder (PTSD), may be limited in capturing the breadth of trauma reactions in cross-cultural contexts. Singer Second, certain reactions that are excluded from Western diagnostic categories (i.e., idioms of distress) may be the hallmark of trauma reactions in some cultural settings. , J With the rise of migration to Western countries, the historical contexts that necessitated this migration and the geopolitical processes that may have led to collective or individual trauma should not be ignored. : Factor structure of PTSD symptoms among West and Central African refugees. , Finally, cultural humility is also consistent with culturally sensitive clinical practice. Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Murray , Psychological treatments from high-income countries are increasingly being disseminated to low- and middle-income countries. Das , Komproe How psychological distress is experienced, labeled, caused, and cured all form part of this explanation. , Uploaded by LJ : World Health Organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead. PSY Notably, these strategies evolve from community-based participatory research practices that allow researchers and cultural agents to co-create knowledge to optimize the sustainability of these treatments in the long term (57). F To address this tension, methods and strategies that account for both etic and emic perspectives can be applied toward the comprehensive assessment of universal and culturally relevant trauma reactions. The traditional Likert-type scale, typically used in PTSD instruments, may not be understood universally. This latter approach would, therefore, challenge whether PTSD or any psychiatric disorder is applicable outside the culture where it was developed as an illness category. Hinton However, humility affords the opportunity to consider alternative explanations for the symptoms or reactions, the expectations of norms of behavior, and the predicted course of the illness. WebTrauma is woven into components of peoples intersecting identities, or even directly related to those aspects of identities. A As Henrich et al. (PDF) Beyond the victim: Secondary traumatic stress. Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to et al. , Reviews of culturally adapted cognitive behavioral therapy also highlight the usefulness of incorporating cultural concepts gleaned from formative assessment work into treatment (33). : Worry, worry attacks, and PTSD among Cambodian refugees: a path analysis investigation. : Cross-cultural validation of measures of traumatic symptoms in groups of asylum seekers from Chechnya, AFhanistan, and West Africa. Good Regmi P The notion that some PTSD symptom clusters appear biologically invariant whereas others may be culturally shaped bolsters the finding that PTSD symptom presentation varies across cultures (4, 7, 8, 10). R Friesen Although MJD , As an example, this process was applied to validate the child PTSD reaction index among Somali refugee children living in Ethiopian refugee camps (42). , Sharma Frequencies of these reactions provide evidence of their primacy within the symptom presentation of the community. Similarly, encounters with assessors from different cultural backgrounds, or within contexts of uncertainty (e.g., refugees and asylum seekers), may evoke defensiveness, which could be misjudged as paranoia or uncooperativeness. Another gold standard could be using a clinician-administered interview with a standardized instrument, as was done to validate the PTSD Checklist for DSM-5 in a study with Filipino domestic workers in China (48). WA A key advancement in assessing trauma reactions involves identifying culturally specific syndromes and idioms and incorporating them into established Western screening instruments (38). Beyond Trauma : Cultural and Societal Dynamics This approach bridges the divide between emic and etic approaches by leveraging the established psychometric properties of existing instruments as a starting point for further psychometric adaptation and evaluation. , , 1995. U GK Haroz cross-cultural, assessment, trauma reactions, idioms of distress, PTSD, global mental health. : PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey. , Although this interview is foundational to starting discussions with culturally different clients, it is unclear how often this interview is used in day-to-day clinical practice. , , : A cultural adaptation of dialectical behavior therapy in Nepal, Focus: Journal of Life Long Learning in Psychiatry, https://www.tandfonline.com/doi/full/10.1080/20008198.2017.1353383, http://www.ncbi.nlm.nih.gov/pubmed/21910185, http://doi.wiley.com/10.1002/jts.2490100109, https://onlinelibrary.wiley.com/doi/pdf/10.1023/A%3A1025702326392, https://pdfs.semanticscholar.org/a738/3f9d2a43c5e92c718ca1d9dd0d9ec6ab8cb5.pdf, https://www.sciencedirect.com/science/article/pii/S169726001500085X, http://dx.plos.org/10.1371/journal.pmed.1001769, https://link.springer.com/content/pdf/10.1007/s00127-002-0580-5.pdf, http://link.springer.com/10.1007/s12207-014-9188-9, https://link.springer.com/articles/10.1186/1471-244X-11-127, http://doi.apa.org/getdoi.cfm?doi=10.1037/0002-9432.76.4.423, http://journals.sagepub.com/doi/10.1177/136346159903600304, https://onlinelibrary.wiley.com/doi/abs/10.1111/bjhp.12448, https://www.tandfonline.com/doi/full/10.1080/20008198.2019.1571378, http://journals.sagepub.com/doi/pdf/10.1177/1524838009334448, https://www.sciencedirect.com/science/article/pii/S1077722917300263. Cognitive interviews involve asking members of the community to state the meaning of an item or describe it in their own words. Jordans Weboverviewwillhighlightseveralculture-relatedchallengesinthisfield.Mostofthe studies in the field of culture, trauma and dissociation have examined the occurrence of dissociative Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California, San Francisco (Patel); School of Global Public Health, New York UniversityShanghai (Hall). Rasmussen Therefore, idioms of distress can be useful stand-alone diagnostic categories within some cultural groups. C Studying these concepts, systematically adding them to instruments during assessment, and referring back to them as part of treatment is a cross-cutting approach to culturally sensitive assessment that goes beyond the approach offered by the DSM-5. A on the Internet. Cultural humility is a process of self-reflection and critique to redress power imbalances that exist between health professionals and patients to develop a mutually beneficial relationship (50). Ekman , Puffer : How do clinicians define cultural sensitivity? Therefore, clinicians and researchers must be cautious of what Arthur Kleinman described in 1977 as a category fallacy (2): This refers to the misconception that categories created in one cultural context apply equivalently to another. Model Number: BT_2ND. WebBeyond trauma : cultural and societal dynamics. ; in. Ottomeyer Kessler We will keep fighting for all libraries - stand with us! ; in. Similarly, affective aspects of PTSD may be culturally mediated through rules that determine which emotional experiences and expressions are culturally permitted to be displayed (9). , Bisson , An emic approach uses frameworks present within the cultural group regarding illness, whereas an etic approach applies definitions of illness developed outside a cultural group. , et al. Bethesda, MD 20894, Web Policies et al. web pages Although trauma exposure is a global phenomenon, trauma reactions vary considerably across cultures. As posttraumatic stress disorder (PTSD) is a consequence of traumatic experiences, it is natural to assume that PTSD should exist and be the key psychiatric condition among people exposed to trauma. : Thinking too much: A systematic review of a common idiom of distress, Idioms of distress among trauma survivors: subtypes and clinical utility. et al. The second step involves examining the reactions and mapping them onto instruments that appear to assess the concept following Western psychiatric definitions, including for PTSD. In 2011, Hinton and Lewis-Fernndez (4) conducted a comprehensive narrative review and found cross-cultural differences in the prevalence of PTSD symptom clusters. In fact, understanding the clients interpretation of reactionsinvariably influenced by the prevailing cultural interpretationand providing treatment congruent with the clients explanatory model appears to be the most active ingredient in culturally adapted treatment. Kaiser C PTSD symptom clusters consist of biological abnormality through autonomic nervous system reactivity (e.g., re-experiencing, arousal), behavioral abnormality through coping responses (e.g., avoidance), and affective abnormality through sustained cognitive and mood changes (e.g., negative alterations in cognition and mood). B Somatization is also commonly reported, along with dissociation among cultural groups with PTSD (26), and shenjing shuairuo might also be a culturally specific reaction to stress, including traumatic events. The .gov means its official. , Vietnamese Buddhist Monks/Nuns and Mediums Views on Attribution and Alleviation of Symptoms of Mental Illness. , Tol , , BN Webextends beyond the limitations of Western methods of assessing and understanding psychic trauma. BA When clinicians incorporate explanatory models into the assessment process, the accuracy of clinical diagnoses is enhanced. , W-S. Roberts Valid and reliable assessment is a cornerstone of evidence-based clinical intervention. Toward a Theory of Cultural Trauma CL Hall J , , , MR Altogether, the behavioral and affective aspects of PTSD may be more culturally malleable than the biological aspects. The practical usefulness of idioms in psychological assessment is the shared language they provide to describe suffering. NK Humility can thus lead to more nuanced, appropriate, and holistic definitions of trauma reactions so that all reactions are not pathologized (51). et al. Moses As a library, NLM provides access to scientific literature. Kirmayer The editors of Beyond Trauma: Cultural and Societal Dynamics have created a volume that goes beyond the individual's psychological dynamics of trauma, exploring WebIn calling the project Beyond Trauma, we challenge the competing disciplinary assumptions that underlie the term and that pathologize and determine the parameters of : Assessing local instrument reliability and validity: a field-based example from northern Uganda. WebThe author explains how culturally sensitive therapists draw upon multiple strategies for treating patients and are aware of both dominant group privilege and of their own identity Culture, trauma and dissociation: A broadening perspective Cirillo Reis This article considers diagnostic variations in trauma reactions across cultures, evidence-based assessment strategies to account for culturally distinct trauma reactions, and incorporation of cross-cultural trauma reactions into treatment. V Betancourt Hiar Hinton The authors report no financial relationships with commercial interests. MA The final step is to validate the instruments. A Cognitive Interviewing: A Tool for Improving Questionnaire Design. Bass The third step involves translating these scales through a rigorous process: iterative translation and back-translation, review by bilingual mental health professionals, evaluation of items in focus group discussions, comparison between back-translated and original versions, and pilot testing of the scale (45). EE : Somatic symptoms mediate the relationship between trauma during the Arab Spring and quality of life among Tunisians. Bryant BJ sharing sensitive information, make sure youre on a federal Overall, posttrauma reactions across cultures may be qualitatively distinct from PTSD reactions because of the variable endorsement of PTSD reactions, the centrality of idioms of distress, different explanatory models of illness, and the presence of ongoing stressors that render trauma and adversity as ongoing phenomena. E BA Comprehensive assessment hinges on using qualitative and quantitative approaches to define and evaluate universal and culturally relevant trauma reactions. et al. This gold standard may be defined by the community themselves, in a known groups method so that people who are thought to have the disorder are nominated by health workers and are compared with people who are thought not to have the disorder through a similar nomination process (40). Sharma et al. Salem Chang BA This study highlights the importance of eliciting a groups explanatory model and adapting treatment in accordance with it. Beyond trauma The framework of cultural humility invites ongoing education, acknowledgment of blind spots and power differentials, and the practice of reconnecting with curiosity and respect in clinical encounters.