Acupuncture as an adjunct therapy to Counselling for Refugee Survivors at NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

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Exposure to high levels of cumulative trauma such as war, torture and human rights violations places refugees at significant risk of psychological complications. In addition, subsequent refugee and resettlement experiences have a substantial impact on the physical and psychological health and wellbeing of those affected. This study used a randomised, repeated measure design in a pragmatic setting to evaluate the effectiveness of Acupuncture as an adjunct therapy to Cognitive Behavioural Therapy (CBT) for refugees attending NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS). Participants were randomised into three treatment groups: Acupuncture, CBT, and Combined (Acupuncture and CBT). Participants received treatment in eight weekly sessions, at STARTTS, by experienced counsellors and/or an acupuncturist. Primary outcome measures from Hopkins Symptoms Check List 25 (HSCL-25), Harvard Trauma Questionnaire (HTQ), Credibility and Expectancy Questionnaire and a Numeric Pain Scale (NRS) as a secondary measure were applied at baseline pre-treatment, post-treatment assessment and a two-month follow-up. The HSCL-25 was used for measuring anxiety and depression in refugee participants. The HTQ was used for measuring degrees of trauma in refugee participants. The Credibility and Expectancy Questionnaire was used for measuring beliefs and expectancy each refugee participant had for the treatment therapy they were receiving. As indiscriminate pain was a common presentation amongst refugees suffering with PTSD, the NRS was used to score the participants level of pain during the study. The study found that on average there were signs of improvements in PTSD, anxiety and depression within each treatment groups – Acupuncture, CBT and Combined. CBT group showed significant improvements in PTSD. Both Acupuncture and Combined groups showed significant improvements not only in PTSD but also in anxiety, depression and pain. Psychometric measures (PTSD, anxiety and depression) improvements were significant in the Combined group occurred at 2-month follow-up. The data from this study show initial trends that indicate acupuncture may be an effective standalone therapy or adjunct therapy to CBT, particularly in respect of the treatment of pain, retention of participants in CBT when combined with acupuncture and may be a more culturally acceptable practice for segments of the sub-population of refugee clients at STARTTS. Results indicated that a combination of modalities yielded significant results and improved treatment compliance, suggesting the value of integrating alternative and conventional treatment modalities to maximise psychological gain and pain reduction. Larger studies of refugee populations are required to determine definitive results.
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