1. Walter Renner & Marina Ortner
Differential effects of lay interventions for asylum seekers, refugees, and working migrants from Afghanistan, Chechnya, and Turkey on symptoms of post-traumatic stress, anxiety, and depression:
Results from three Austrian randomized controlled studies
Universities of Klagenfurt and Innsbruck, UMIT (Hall in Tirol)

2. Background:
=> Asylum seekers and refugees (Chechnya and Afghanistan) vs. working migrants (Turkey)
=> Acculturative Stress and Post-Traumatic Stress
=> Psychotherapy often unavailable or not accepted
=> Social support by lay people can have powerful effect as a moderating variable - see forthcoming literature review by Laireiter, 2010
=> ethnic (self-help, Study 1 and 3) vs.
=> host culture (sponsorships, Study 2)

3. Study 1: Self-Help Groups for Asylum Seekers and Refugees from Chechnya (Renner, 2008)
=> Most prominent group among refugees in Austria
=> 50% of them suffering from post-traumatic stress and other clinical symptoms - tedious asylum procedure
=> (University of Klagenfurt, Caritas Innsbruck, Provincial Govt. Tyrol)
=> Four Chechens trained as group leaders (10 workshops)
=> Self-Help (SH) vs. Cognitive Behavior Therapy (CBT) vs. EMDR vs. Wait-List (WL) Control Group
=> Total N = 94 (44 Women and 50 Men)

4. Timetable - Interventions and Measurement Occasions

5. Results:
=> SH and CBT only worked with clients who suffered from severe post-traumatic symptoms HTQ > 1.75)
=> SH and CBT significantly reduced post-traumatic stress (HTQ), anxiety and depression (HSCL-25) (d = - 0.9)
=> No "Post-Traumatic Growth" (Tedeschi)
=> SH and CBT were equally effective
=> SH and CBT were significantly superior to WL and EMDR
=> EMDR was not effective
=> Results were stable over time

6. Example 1: Harvard Trauma Questionnaire
Chechen Asylum Seekers and Refugees
(Time p = .000; Time * Group p = 0.000, Total N = 54 with HTQ > 1.75)

7. Study 2: Sponsorships for Asylum Seekers and Refugees from Chechnya and Afghanistan (Renner, 2010b)
=> Afghans are second strongest group among displaced persons in Austria
=> High rate of them suffering from post- traumatic stress, similar to Chechens
=> Post-traumatic stress and acculturative stress are known to interact: traumatized people have more difficulties acculturating

8. =>. Sponsorships for adult refugees by Austrian
=> Sponsorships for adult refugees by Austrian population (six months duration)
=> (University of Innsbruck and UMIT)
=> N = 35 sponsors (10 men, 25 women) and initially N = 63 refugees and asylum seekers (30 men, 38 women) participated
=> Initial training phase: 4 workshops - sponsors carefully selected - closely supervised
=> Effect of sponsorships compared with Wait-List Control Group - timetable similar to previous studies

9. Results:
=> Sponsorships only worked with clients who suffered from severe post-traumatic symptoms (cf., Study 1)
=> Sponsorships significantly reduced anxiety, depression, and psychological symptoms (Effect Sizes = )
=> Positive effects were stable over time (follow- up measurement)
=> But had no effect on living conditions, coping meachanisms or acculturation
=> i.e., effects were palliative, rather than instrumental

10. Example 2: HSCL-25 Anxiety Sub-Scale
Sponsorships for Asylum Seekers and Refugees
(Time p = .030; Time * Group p = 0.004, Total N = 35)

11. Study 3: Self-Help Groups for Women with Recurrent Depression from Turkey (Renner, 2010a)
=> 180,000 people of Turkish descent living in Austria
=> Poor socio-economic status, often married against their will, early marriage, collectivist values, high influence of husbands' families, disappointed expectations, poorly acculturated, xenophobic attitudes of host society
=> 71% of Turkish women in Germany reported somatic symptoms; life time incidence of depression 81% (Cicek, 1990)

12. => Conventional therapy often to no avail or not accepted
=> (University of Innsbruck and UMIT)
=> Four female medical students of Trukish descent trained as group leaders
=> Self-Help (SH) vs. Cognitive Begavior Therapy (CBT) vs. Wait-List (WL)
=> Total N = 66 women with recurrent depression
=> Time-table the same as in first research

13. Results: => Neither SH nor CBT were effective with respect to
=> Depression (CES-D),
=> General Psychopathology (BSI),
=> Post-Traumatic Stress (HTQ) or
=> Somatic symptoms (BL)
Possibly symptoms are reinforced secondarily by extremely adverse and hopeless living conditions
Illness being the only perspective towards gaining a minimum of control over environment

14. Example 3: CES-D Depression Scale
Female Turkish Migrants with Recurrent Depression
(Time p = .081; Time * Group p = 0.401, Total N = 38)

15. Summary and Conclusions
(1) Lay help has been effective for refugees and asylum seekers with post-traumatic symptoms:
=> Effects palliative but not instrumental
=> No effects for participants without post- traumatic symptoms
=> Effects stable over follow-up measurements
=> Thus: lay help can pose an alternative to professional interventions when necessary
=> Differential indication should be considered
=> Sponsorships currently considered nationally and internationally (Caritas Internationalis and International Red Cross/Red Crescent)

16. (2) But: No effects for Turkish migrant women with recurrent depression (as ooposed to refugees):
=> Extreme adverse living conditions (role of husbands and their families); Thus Illness may be the only perspective towards gaining a minimum of control over environment
=> Traditional expectations of Turkish women of being "healed" by an all knowing expert not compatible with typically "Western" self-help approach
=> Problems of confidentiality within groups
=> Lampe & Barbist: Individual therapy more effective
=> Female therapists of Turkish descent (individual setting) suggested as an alternative to self-help

17. We gratefully acknowledge the funding of the three studies by the Austrian Science Fund by Projects Number P18789-G14, P20423-G14 and P20523-G14.

18. References:
Berry, J. W., Kim, U., Minde, T., & Mok, D. (1987). Comparative studies of acculturative stress. International Migration Review, 21,
Cicek., H. (1990). Psychosexuelle Probleme von ausländischen Patienten. Psychomed 2,
Laireiter, A.-R. (2010). Theoretical concepts of social support. Sponsorships for refugees and asylum aeekers. An Austrian research project on social support as a moderator of acculturative stress: Theoretical assumptions, results, and recommendations. Innsbruck: Studia.
Lampe, A. & Barbist, M.-T. (2010). An unintended control group. Psycjodrama in support of Turkish migrant women. In: W. Renner (2010), Female Turkish migrants with recurrent depression. Innsbruck: Studia.
./.

19. Renner, W. (Ed. ). Culture-sensitive and resource oriented peer groups
Renner, W. (Ed.). Culture-sensitive and resource oriented peer groups. Austrian experiences with a self-help approach to coping with trauma in refugees from Chechnya. Innsbruck: Studia.
Renner, W. (2011a) (Ed.), Female Turkish migrants with recurrent depression. Innsbruck: Studia.
Renner, W. (2011b) (Ed.), Sponsorships for refugees and asylum aeekers. An Austrian research project on social support as a moderator of acculturative stress: Theoretical assumptions, results, and recommendations. Innsbruck: Studia.
Renner, W., Salem, I. & Ottomeyer, K. (2006). Cross-cultural validation of psychometric measures of trauma in groups of asylum seekers from Chechnya, Afghanistan and West Africa. Social Behavior and Personality, 35, 1101 – 1114.
Renner, W. Salem, I. & Ottomeyer, K. (2007). Posttraumatic stress in asylum seekers from Chechnya, Afghanistan and West Africa. In J. P. Wilson & C. Tang, (Eds.), The cross-cultural assessment of psychological trauma and PTSD (pp. 239 – 278). New York: Springer.