| dc.description.abstract | Torture has severe mental health effects, especially in terms of posttraumatic stress
disorder (PTSD) and depression. In order to advance the field of torture rehabilitation and
fulfil torture survivors’ right to an as full psychosocial rehabilitation as possible, we need to
identify (1) substantial correlates and predictors of torture-related psychological distress, (2)
effective treatments and (3) clinically significant moderators of treatment outcome.
The aim of paper 1 was to explore how aspects of detention, social support, political
attitudes and religiousness influence the psychological sequelae of torture and abuse among
South Africans detained for political reasons during the apartheid regime. The main
findings of the study was that the sample displayed elevated levels of psychiatric morbidity
and comorbidity as assessed by self-report instruments, and that the number of times
detained and negative social support emerged as salient risk factors for psychological
distress. The results substantiate existing research as to the severe negative mental health
effects of political imprisonment and torture and extends previous research on torture
survivors, although pending replication, by indicating that negative social support is a
superior predictor of trauma-related distress compared to positive social support.
Despite the well-documented severe mental health effects of torture, there is a conspicuous
lack of clinical trials examining treatment outcomes among torture survivors. Furthermore,
concerns have been raised regarding the appropriateness of empirically-supported
psychological treatments, such as exposure therapy, in the treatment of survivors of
repeated trauma involving gross human rights violations such as torture. For example,
several authors have explicitly questioned whether exposure-based treatments is a feasible
treatment option for PTSD in torture survivors due to high levels of dissociative symptoms
specifically. The aim of paper 2 was to conduct a preliminary investigation of the treatment
outcome of narrative exposure therapy (NET) among torture survivors with a primary
diagnosis of PTSD. Overall, treatment gains were moderate. Between 40% and 65% of the
participants no longer met the diagnostic criteria for PTSD at follow-up, and more than
60% experienced clinically significant symptom remission from pre-treatment to follow-up.
The aim of paper 3 was to examine whether dissociative symptoms, i.e. derealisation and
depersonalisation, influence the treatment outcome of narrative exposure therapy for
posttraumatic stress disorder among severely traumatized refugees and asylum seekers,
including torture survivors. The main result from this exploratory secondary analysis was
that depersonalisation and derealisation did not seem to moderate the treatment outcomes
of NET in this specific patient population. This is contrary to prevalent theoretical
assumptions, but in line with most empirical treatment research to date. Paper 3
substantiates and extends previous research indicating that at present there is limited
empirical support for the notion that dissociative symptoms impede treatment outcomes of
exposure-based treatments for PTSD, such as NET.
Due to several methodological limitations, such as limited statistical power and exploratory
analyses, the results should be interpreted with caution pending replication | nb_NO |
