PTSD Cognitions for Unaccompanied Latino Minors in a Culturally-Adapted Manualized CBT

• In Event: 1-039 - Addressing Mental Health Needs in Vulnerable Youth

Integrative Statement

For immigrant youth, especially unaccompanied refugee minors (URM), immigration involves multiple losses and complex mental health risks which emerge in the context of high exposure to traumatic experiences. Currently 68.5 million people have been displaced according to the United Nations High Commission for Refugees Statistical Yearbook (UNHCR, 2016). Approximately 60,00 children and adolescents arrived in the US in 2015 (UNHCR, 2016) and the most vulnerable are unaccompanied minors separated from their parents or caregivers (Halvorsen, 2002). More recently, the lines between youth arriving with family and URMs have been blurred with the trauma of family separation at the border and caging of children in detention camps. Experiences of discrimination have been found to be significantly associated with increased risk of depression and anxiety in unaccompanied Latino immigrant youth (Potochnick & Perreira, 2010). Therapies for immigrant and refugee youth need to address diagnoses such as PTSD but also assist these adolescents in emotionally navigating multiple social-contextual stressors.
We report on a therapy development and pilot study of a cognitive behavioral therapy (CBT) for use with immigrant and URM Latino adolescents with posttraumatic symptoms. This URM subsample, within a larger pilot study of 37 youth, aimed at examining a CBT therapy model for treating co-occurring PTSD and drug abuse in adolescents ages 14 to 18. We describe results for 11 URM Latino youth that (1) test for improvement in PTSD, anxiety and depression symptoms as compared to the full study sample; (2) use a cognitive behavioral framework to assist in identifying common trauma, acculturation and stress related cognitions; and (3) examine association between improvements in types of cognitions with PTSD symptom reduction. Our framework for examining PTSD and stress-related cognitions in Latino and URM adolescents is based on the Cognitive Model of Trauma (Ehlers, 2000). Within this cognitive-based model, anxiety is seen as resulting from appraisals of every day events as representing impending threat.
With an open series of 37 subjects, we systematically (1) completed translation of the manual and therapy materials into Spanish and for immigrant youth; (2) tested the acceptability and implementation of the therapy in community settings; and (3) studied the intervention’s potential harmfulness and benefits, including impact on PTSD symptoms, substance use, and treatment retention. With the immigrant subsample of 11 URM we specifically considered common stressors that perpetuated distress, and conducted qualitative analysis of therapy sessions, therapy notes, and participant interviews using grounded theory to identify common cognitive themes and cognitive distortions important to consider as part of the therapy model.
The most common trauma-associated cognitions in this group were related to negative cognitions about the world. Common themes regarding ongoing stressors and coping included coping with discrimination and family separation/problems, spirituality as coping, discerning trust, and suppression of emotions. Improvements in trauma-related cognitions and enhancing coping strategies within the cultural and social context resulted in improvement in overall PTSD symptom severity for immigrant adolescents. We describe ways that trauma-associated cognitions relate to PTSD symptoms in this vulnerable population and consider recommendations for treatment and research.

Authors

• Michelle V. Porche, Boston University
  Presenting Author

• Lisa Fortuna, Boston Medical Center
  Non-Presenting Author