Predictors of psychotherapy outcome in trauma-affected refugees: secondary analysis of a randomized
2. Project period
1.2.2020 – 30.6.2020
Berglind Bernardsdóttir, MSc Psychology Student and Research Intern at CTP
4. Supervisors and collaborative partners
- Jessica Carlsson, MD, PhD
- Sabina Palic-Kapic, Psychologist, PhD
- Hinuga Sandahl, MD, PhD student
Studies on psychotherapy for trauma-affected refugees have shown therapy outcome to be quite varied
among patients, with some patients benefitting more from therapy than others (Nosè et al., 2017; Turrini
et al., 2019). In pragmatic RCTs at the Competence Centre for Transcultural Psychiatry (CTP), where
representative clinical populations of trauma-affected refugees are studied, psychotherapy tends to show
only small effects (Buhmann et al., 2016; Carlsson et al., 2018). However, little is known about specific
patient factors that predict psychotherapy outcome in this population. Increased awareness of such factors
can help clinicians identify patients who are not likely to benefit from standardized treatment, and help
them take additional measures to tailor treatment to the individual patient.
The objective of this study is to examine whether motivation for therapy, locus of control, cognitive
functioning, and levels of personality functioning assessed prior to psychotherapy can predict
psychotherapy outcomes of PTSD, depression, anxiety, and disability in trauma-affected refugees.
The aim of the study is to identify patient factors that predict psychotherapy outcome in trauma-affected
The study is a secondary analysis of a pragmatic randomized controlled trial at CTP: “Treatment of sleep
disturbances in trauma-affected refugees: a randomised controlled trial” (Sandahl et al., 2017).
7.1 Number of participants (N)
Trauma-affected refugees with a diagnosis of posttraumatic stress disorder, who were referred for
treatment at CTP, and agreed to participate in the RCT
7.3 Description of data and data collection
To identify predictors of psychotherapy outcome we will examine four patient factors assessed by the
psychologists at onset of psychotherapy. These factors are:
- Cognitive functioning measured on the WHO Disability Assessment Schedule (WHODAS 2.0).
- Locus of control measured on the Locus of Control (LoC) scale adjusted to the patient
- Motivation for therapy measured on the Client Motivation for Therapy Scale (CMTS) adjusted
to the patient population.
- Personality-related functioning measured on the Levels of Personality Functioning Scale (LPFS).
The primary outcome in the study are PTSD symptoms measured on the Harvard Trauma Questionnaire
(HTQ). Other outcome measures are the Hamilton anxiety and depression scales (HAM-D and HAM-A),
and the Sheehan Disability Scale (SDS).
7.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on
Health Research Ethics
Structural equation modelling will be used to investigate the association between the predictors and
psychotherapy outcome. The model will adjust for sociodemographic information, treatment condition,
and the use of interpreter-mediated therapy.
Data will be analyzed under the intention to treat paradigm using ML to estimate missing values.
Further exploratory analyses of missing value patterns on the predictors will be conducted.
8. Expected results
The study is expected to add new knowledge on patient factors that predict psychotherapy outcome in
trauma-affected refugees. Identifying those who will benefit from psychotherapy and those who will not
can help clinicians tailor treatment to their patients’ needs and make treatment more effective.
9. Dissemination of results
The results will be disseminated in the form of 1) one scientific article to be submitted to a peer reviewed
journal. 2) a poster with preliminary results to be presented on the Research Day of the Mental Health
Services of the Capital Region in Denmark, 3) feed-back to clinical psychologists about missingness in order
to improve data-quality in present trials.
- Buhmann, C. B., Nordentoft, M., Ekstroem, M., Carlsson, J., & Mortensen, E. L. (2016). The effect of flexible
cognitive–behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical
trial. The British Journal of Psychiatry, 208(3), 252-259.
- Carlsson, J., Sonne, C., Vindbjerg, E., & Mortensen, E. L. (2018). Stress management versus cognitive
restructuring in trauma-affected refugees—A pragmatic randomised study. Psychiatry Research, 266,
- Nosè, M., Ballette, F., Bighelli, I., Turrini, G., Purgato, M., Tol, W., ... & Barbui, C. (2017). Psychosocial
interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in highincome countries: Systematic review and meta-analysis. PloS One, 12(2).
- Turrini, G., Purgato, M., Acarturk, C., Anttila, M., Au, T., Ballette, F., ... & Hall, J. (2019). Efficacy and
acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and
meta-analysis. Epidemiology and Psychiatric Sciences, 28(4), 376-388.
- Sandahl, H., Jennum, P., Baandrup, L., Poschmann, I. S., & Carlsson, J. (2017). Treatment of sleep
disturbances in trauma-affected refugees: Study protocol for a randomised controlled
trial. Trials, 18(1), 520.