title: Challenges in treatment of posttraumatic stress disorder in refugees: towards integration of evidence-based treatments with contextual and culture-sensitive perspectives.
abstract: BACKGROUND
  Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions.
  
  
  OBJECTIVE
  To draw clinicians' attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma.
  
  
  METHODS
  Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed.
  
  
  RESULTS
  The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments.
  
  
  CONCLUSIONS
  The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and developmental models for assessment and conceptualization of posttrauma sequelae. Multimodal and trauma-focused interventions may be applied sequentially in a course of the treatment trajectory.
authors.affiliation: Psychotrauma Centrum Zuid Nederland, Reinier van Arkel groep, Den Bosch, The Netherlands; drozdek@telfort.nl.
authors.forename: Boris
authors.initials: B
authors.lastname: Drožđek
keywords: Cultural Formulation Interview; PTSD; context; culture; intervention; organized violence; refugees; therapy