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BACKGROUND/RATIONALE:
Post-traumatic Stress Disorder (PTSD) is the most prevalent mental disorder arising from combat. Data from over 100,000 returning combat soldiers who served in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom (OEF/OIF) and sought care from VA medical facilities between 2001-2005, show that PTSD was diagnosed in 13 percent of those studied. It was the most common disorder, accounting for 52 percent of mental health diagnoses. As VA faces up to a new generation of combatants and veterans, the existing perspective is to build on the lessons of the past by serving those in present need but also aiming at the future to maximize preparedness and, if possible, prevention. As a step in this direction, VA charged the Institute of Medicine (IOM) Committee on Treatment of Posttraumatic Stress Disorder (PTSD) to review and assess the evidence on the efficacy of pharmacologic and psychologic treatment modalities for PTSD. From their systematic and comprehensive search of the relevant published literature, the Committee concluded that while the evidence was inadequate for most psychological and pharmacologic treatment modalities, there was strong evidence to support the effectiveness of exposure therapies for the treatment of PTSD. In addition they noted that although it could be expected that psychotherapies pose special challenges in different cultural groups they were unable to comment because none of the studies addressed the acceptability, efficacy, or generalizability of treatment in ethnic and cultural minorities. The committee recommends designing specific studies of interventions tailored to these specific subpopulations.
OBJECTIVE(S):
The proposed study focuses on the translation, from English to Spanish, and the cultural adaptation of a manual-guided exposure therapy for Spanish-speaking veterans with PTSD. To accomplish this goal, we propose the following specific aims:
1) To translate therapist and client manuals of an established theoretically-based exposure therapy for PTSD.
2) To evaluate the cultural compatibility of the translated manual guided intervention and culturally adapt the theoretically-based, exposure therapy intervention manuals.
METHODS:
Initial activities will involve the translation from English to Spanish of the therapist and client manual guided interventions by a professional translator. The second phase involves the cultural adaptation of the manual guided interventions. To judge the cultural compatibility of the translated, Spanish PE treatment manuals, we will employ Bernal, Bonilla and Bellidos framework of cultural sensitivity of interventions. Aspects addressed will involve language (whether it is appropriate and culturally syntonic); person (ethnic similarities and differences in situations presented in the manual); metaphors (symbols and concepts); content (cultural relevance for Spanish- speaking veterans); concepts (treatment concepts consonant with culture and context); goals (support of positive and adaptive cultural values); methods (cultural appropriateness of treatment methods); and context (consideration of context in the manual, such as economic and social context). Based on clinicians findings we will prepare a topic guide addressing particular areas to be discussed in focus groups with eight OEF/OIF combat veterans. Focus group discussions will explore the elements of treatment interventions proposed by Bernal, Bonilla and Bellido. Participants will be asked to review sections of the client manual-guided exposure intervention to evaluate the examples offered, the language and metaphors used, and the context to see if it reflects knowledge of Hispanic veteran groups. Procedural and content modifications resulting from the focus group will allow refining the therapist and client manual-guided interventions.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The work proposed to be accomplished in this study, as well as future research efforts grounded in the product of this project, will strongly contribute to address the mental health care of Hispanic veterans with PTSD and advance interventional studies focused on the reduction of health disparities among ethnic minorities, priority topic areas of high relevance for HSR&D. This project lays the groundwork for conducting a culturally compatible effectiveness trial among Spanish-speaking Hispanic veterans with PTSD. Future research efforts will focus on empirically testing the manual-guided exposure therapy intervention with Spanish-speaking veterans to estimate intervention parameters (e.g., effect size, response rates) and perform preliminary power analyses to support an examination of the effectiveness of the intervention with PTSD Spanish-speaking OEF/OIF veterans in a future larger trial. Due to the high prevalence of PTSD, our ultimate goal is to make available a culturally relevant exposure therapy with proven effectiveness that could contribute to increase access to evidence-based mental health care and to eliminate mental health disparities.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Special (Underserved, High Risk) Populations
DRE:
Treatment
Keywords:
Ethnic/cultural, PTSD, Mental health care delivery
MeSH Terms:
none
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