Abstract
BackgroundMeta-analyses of studies on psychological treatment of refugees describe highly varying outcomes, and research on multi-facetted and personalized treatment of refugees with post-traumatic stress disorder (PTSD) is needed. Music therapy has been found to affect arousal regulation and emotional processing, and a pilot study on the music therapy method Trauma-focused Music and Imagery (TMI) with traumatized refugees resulted in significant changes of trauma symptoms, well-being and sleep quality. The aim of the trial is to test the efficacy of TMI compared to verbal psychotherapy.MethodsA randomized controlled study with a non-inferiority design is carried out in three locations of a regional outpatient psychiatric clinic for refugees. Seventy Arabic-, English- or Danish-speaking adult refugees (aged 18–67 years) diagnosed with PTSD are randomized to 16 sessions of either music therapy or verbal therapy (standard treatment). All participants are offered medical treatment, psychoeducation by nurses, physiotherapy or body therapy and social counseling as needed. Outcome measures are performed at baseline, post therapy and at 6 months’ follow-up. A blind assessor measures outcomes post treatment and at follow-up. Questionnaires measuring trauma symptoms (HTQ), quality of life (WHO-5), dissociative symptoms (SDQ-20, DSS-20) and adult attachment (RAAS) are applied, as well as physiological measures (salivary oxytocin, beta-endorphin and substance P) and participant evaluation of each session.DiscussionThe effect of music therapy can be explained by theories on affect regulation and social engagement, and the impact of music on brain regions affected by PTSD. The study will shed light on the role of therapy for the attainment of a safe attachment style, which recently has been shown to be impaired in traumatized refugees. The inclusion of music and imagery in the treatment of traumatized refugees hopefully will inform the choice of treatment method and expand the possibilities for improving refugee health and integration.Trial registrationClinicalTrials.gov ID number NCT03574228, registered retrospectively on 28 June 2016.
Highlights
Meta-analyses of studies on psychological treatment of refugees describe highly varying outcomes, and research on multi-facetted and personalized treatment of refugees with post-traumatic stress disorder (PTSD) is needed
In a systematic review of 29 studies including 16.010 waraffected refugees, significant between-study heterogeneity in prevalence rates of post-traumatic stress disorder (PTSD) (4–86%), unspecified anxiety disorder (20–88%) and depression was identified, prevalence estimates typically were in the range of 20% and above [4]
A regression analysis will be applied to look for predictors of improvement of trauma symptoms (HTQ) and change of attachment style, as well as predictors for improvement connected to treatment
Summary
Meta-analyses of studies on psychological treatment of refugees describe highly varying outcomes, and research on multi-facetted and personalized treatment of refugees with post-traumatic stress disorder (PTSD) is needed. Music therapy has been found to affect arousal regulation and emotional processing, and a pilot study on the music therapy method Trauma-focused Music and Imagery (TMI) with traumatized refugees resulted in significant changes of trauma symptoms, well-being and sleep quality. Reviews of studies on refugee health document a large variation in health status related to country of origin, country of resettlement and the methodological quality of the studies. In a systematic review of 29 studies including 16.010 waraffected refugees, significant between-study heterogeneity in prevalence rates of post-traumatic stress disorder (PTSD) (4–86%), unspecified anxiety disorder (20–88%) and depression (range 2–80%) was identified, prevalence estimates typically were in the range of 20% and above [4]. In a study of 142 newly arrived asylum seekers in Denmark 34% had symptoms corresponding with the PTSD diagnosis [5]
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