XCEPT Rapid review of evidence: Trauma, PTSD, and psychosocial support interventions in fragile and conflict-affected areas
By Dr Alison Brettle, Dr Pauline Zerla, and Sam Hibbs
The greatest challenge for policymakers and practitioners in any transition out of war is to build peace and trust in communities that have experienced prolonged or repeated violence, and to transform harmful relationships, attitudes, and behaviours forged during conflict, thus reducing the risk of a return to violence. There is increasing recognition that collective and individual trauma can undermine these efforts if it is not identified and addressed.
This Rapid review of evidence (RoE) aims to identify what types of interventions are most effective in mitigating the negative effects of conflict-related trauma amongst civilian and combatant populations in fragile and conflict-affected areas.
Credit: Shutterstock/Anas Alhajj.
Key Findings:
The evidence base of what helps individuals and groups recover from trauma in FCAS is fragmented. The review finds that the following interventions can be effective in mitigating the negative effects of trauma: cognitive processing therapy (CPT), cognitive behavioural therapy (CBT), narrative exposure therapy (NET), and teaching recovery techniques (TRT). In terms of training, integrating external programmatic approaches with local approaches is critical.
The review also identified some elements that are common to the most effective interventions:
- Interventions reduce trauma symptoms more effectively when they (a) provide individuals with access to alternative forms of support beyond their immediate family/friendship group, or (b) strengthen existing relationships (e.g. between partners or between children and parents).
- Creating opportunities for people to socialise, be listened to, and share experiences and advice is important.
- Local, community-based mental health workers can deliver mental health interventions effectively, but only if they are given the latitude to adapt Western models and treatments to the needs of their communities.
- Sustained engagement and involvement of the local community is critical.
- Livelihood provision and support are important, but not sufficient on their own, to ameliorate trauma symptoms at the individual level, but they are more effective at the community level.
- Some individuals who commit violence in the aftermath of violent conflict may have developed an ‘appetite for aggression’ which ‘protects’ them against trauma. Such individuals may benefit from violence/aggression reduction interventions rather than trauma-focused ones.
- Labelling interventions as ‘trauma-focused’ can exacerbate individual and communal stigma for those enrolled.
This publication was produced as part of the XCEPT programme, a programme funded by UK International Development from the UK government. The views expressed do not necessarily reflect the UK government’s official policies.
