title: Complex PTSD and phased treatment in refugees: a debate piece.
abstract: BACKGROUND
  Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD.
  
  
  OBJECTIVE
  The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD.
  
  
  METHODS
  The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees.
  
  
  RESULTS
  Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high.
  
  
  CONCLUSIONS
  Complex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers.
authors.affiliation: Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group; j.ter.heide@centrum45.nl.
authors.forename: F Jackie June
authors.initials: FJ
authors.lastname: Ter Heide
authors.affiliation: Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group.
authors.forename: Trudy M
authors.initials: TM
authors.lastname: Mooren
authors.affiliation: Foundation Centrum'45, Oegstgeest/Diemen, The Netherlands | Partner in Arq Psychotrauma Expert Group.|Department of Clinical & Health Psychology, Utrecht University, The Netherlands.
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Kleber
keywords: ICD-11; ISTSS treatment guidelines; Posttraumatic stress; asylum seekers; culturally adapted cognitive-behaviour therapy; efficacy; narrative exposure therapy; prevalence; torture; trauma