Development of a mental healthcare model for mass trauma survivors (1993-2023)

Objectives: To develop a mental health care program for survivors of war, political violence, torture, and natural disasters based on brief treatments that can be cost-effectively disseminated to large survivor populations on a self-help basis. Work involved (1) theoretical conceptualization of the model, (2) studies of mechanisms and phenomenology of traumatic stress, (3) prevalence studies, (4) development of assessment tools and brief diagnostic screening instruments, (5) case studies and clinical trials to test brief interventions, (6) development of treatment tools, and (7) development of an outreach treatment dissemination model.

Research with asylum-seekers and refugees (2009 – 2017)

Treatment studies

• Development of Control-Focused Behavioral Treatment for care of asylum-seekers and refugees –Phase I (2009 – 2017)
• A collaborative study of behavioral treatment of torture survivors in Sweden and Turkey (In collaboration with Assoc. Prof. Solvig Ekblad (Unit for Immigrant Environment and Health, IPM / Karolinska Institute, Sweden) (2001-2002)

Research with survivors of earthquakes (1999-2006)

Development of an outreach treatment delivery model

Work involved the development of a low-cost treatment delivery program using brief assessment and treatment strategies. A team of 11 mental health professionals, based in 13 project sites in survivor camps, prefabricated and permanent housing sites, and two community centers in the disaster region (Avcılar and Degirmendere), served a catchment area about 60,000 survivors. Over 10,000 survivors were provided assessment and / or treatment over 3 years.

Phenomenological studies (2000-2002)

The effects of earthquakes on beliefs about safety, justice, and trust, attributions of responsibility for trauma, appraisal of redress and compensation, and their relationship with posttraumatic stress disorder

Questionnaire development studies (2000-2004)

• Screening Instrument for Traumatic Stress in Earthquake Survivors
• Last 1-month version of the Screening Instrument for Traumatic Stress in Earthquake Survivors
• 5-item and 1-item versions of Screening Instrument for Traumatic Stress in Earthquake Survivors
• Fear and Avoidance Questionnaire’ for earthquake survivors
• Semi-Structured Interview Form for Earthquake Survivors
• Emotions and Beliefs after Trauma Questionnaire – Earthquake version
• Redress for Trauma Survivors Questionnaire – Earthquake version
• Depression Rating Scale
• Semi-Structured Interview for Grief in bereaved earthquake survivors
• Grief Assessment Scale and Grief Behaviour Checklist

Field surveys and epidemiological studies (1999-2003)

• Prevalence of posttraumatic stress disorder and depression among survivors living in shelters (1-year post-disaster, n=1,000)
• Prevalence of posttraumatic stress disorder and depression among treatment seeking survivors of the 1999 Kocaeli earthquake in Turkey
• An epidemiological study of the prevalence of posttraumatic stress disorder and depression among survivors living in the epicenter region of the 1999 Kocaeli earthquake in Turkey (n=530)
• An epidemiological study of PTSD and comorbid depression among survivors living in a suburb of Istanbul (Avcılar) 100 kilometres from the epicenter of the 1999 Kocaeli earthquake in Turkey (n = 420)
• Two-year mental health outcome of the 1999 Kocaeli earthquake in Turkey among survivors living in prefabricated housing compounds
• Long-term mental health outcome of the 1999 Kocaeli earthquake in Turkey among survivors settled in permanent housing compounds (n=769)
• A community-based epidemiological study of the prevalence of posttraumatic stress disorder and depression among survivors living in a town (Yalova) hit by the 1999 Kocaeli earthquake in Turkey (n=849)
• A community-based study of earthquake survivors four years after the Parnitha earthquake in Greece

Clinical and field trials

Development of Control-Focused Behavioral Treatment (2000-2003)

• An open clinical trial for brief behavioral treatment of posttraumatic stress disorder in earthquake survivors (n=231)
• A randomized controlled trial of single-session control-focused behavioral treatment in earthquake survivors (n=59)
• Single case studies of brief behavioral treatment of prolonged grief in earthquake survivors (n=8)

Development of resilience-enhancing interventions (2000-2005)

• The development of protocol for control-focused behavioral treatment involving exposure to simulated earthquake tremors and design and construction of an earthquake simulator in accordance with the treatment protocol
• An open trial of the effectiveness of control-focused behavioral treatment of earthquake survivors using an earthquake simulator (n=10)
• A randomized controlled study of exposure treatment of earthquake-related PTSD using an earthquake simulator (n=31)

Development of treatment dissemination tools (2000-2005)

• Development of a self-help manual based Control-Focused Behavioral Treatment
• Single-case multiple baseline experimental studies of the effectiveness of behavioral treatment in PTSD delivered through a self-help manual
• A community based experimental case studies of the usefulness of behavioral treatment in PTSD delivered through a self-help manual (n=84)

Research with survivors of war (1997-2005)

Community studies

• A multi-site controlled study of psychiatric effects of war and torture trauma (combat, torture, internally displacement, refugee status, aerial bombardment) in 2013 survivors from countries of former Yugoslavia (Sarajevo – Bosnia-Herzegovina, Banja Luka – Republica Sirpska, Rijeka – Croatia, and Belgrade

Phenomenological studies

• Effects of war trauma on beliefs about safety, justice, and trust, attributions of responsibility for trauma, appraisal of redress and compensation, and their relationship with posttraumatic stress disorder in war survivors

Questionnaire development studies

• Screening Instrument for Traumatic Stress in War Survivors
• Semi-Structured Interview Form for Survivors of War
• Emotions and Beliefs after Trauma Questionnaire – War version
• Redress for Trauma Survivors Questionnaire – War version
• Depression Rating Scale

Research with survivors of torture (1993-1999)

Phenomenological studies

• A study of long-term psychological effects of torture in survivors tortured during the period of dictatorship in Greece. Conducted in collaboration with the Medical Rehabilitation Centre for Torture Victims in Athens
• Study of the role of cognitive processes (beliefs about safety, justice, and trust, attributions of responsibility for trauma, appraisal of redress and compensation) in torture-related posttraumatic stress disorder
• Psychological effects of torture in individuals with no history of political involvement and prior preparedness for trauma: A comparison of tortured political activists with tortured non-activists in Turkey
• A study of the psychological effects of torture in political activists in Turkey