Civilians traumatized by Libya's civil war in 2011 -- which left many homeless, poor and grieving -- have virtually no access to mental health professionals, but many have found healing through small groups led by Libyan volunteers who were trained by American professionals, according to a Baylor University study.
The finding has implications for traumatized people elsewhere, including in Somalia and Ethiopia, where similar efforts have begun; and in Egypt and Uganda, where such training is to begin soon, said Matthew Stanford, Ph.D., a professor of psychology and neuroscience in Baylor's College of Arts & Sciences, who led the research. The study is published online in the South African Journal of Psychology.
"The American Psychological Association over the past few years has called for psychologists to develop new ways to deliver mental health services, because there simply aren't enough providers in the United States -- and it's even worse elsewhere," Stanford said. "Taking basic therapeutic principles and putting them into a format peers can deliver has been very effective."
In November 2012, shortly after the eight-month war's end, Stanford and a team from Acts of Mercy International, a Christian relief organization, traveled to Libya and found an inadequate mental health system -- fewer than 30 psychiatrists and no licensed psychologists or social workers in a country of more than 6 million people.
Libyans are struggling to cope with the aftermath of the war as well as 42 years under the brutal rule of dictator Moammar Gadhafi, a regime in which many were tortured or systematically raped. As many as 15,000 Libyans were killed and more than 50,000 injured in the war, and thousands live as "internally displaced persons (IDPs)" in camps throughout the country, Stanford said.
Team members focused on a camp for about 2,500 people near Benghazi. They recruited 10 volunteer civilians, who completed an intensive four-hour training -- including lectures and role-playing -- translated into Arabic and led by Acts of Mercy International staff. The peer-led "Hope Groups" met regularly for 10 weeks with 149 participants in 17 groups of friends and relatives in the camp. The average group size was eight people.
After 10 weeks, members anonymously completed the Posttraumatic Stress Disorder Checklist, a 17-item self-report broadly used within the mental health community. The report showed that the groups were helpful, with interaction among members, and most of the civilian leaders said they felt they could successfully train someone else to be a leader.
While prior research has shown that outcomes through mutual help groups -- such as Alcoholics Anonymous -- are comparable to much more costly professional treatments, use of peer-led groups for war-related trauma in civilians had not been investigated until the Baylor study.
"A lot of times, people think, 'I'm just going to tough it out.' But sometimes, that's just not possible," Stanford said.
While the program's content was simplified, it was challenging for translators unfamiliar with mental health concepts.
But "despite cultural and language differences, there are a lot of universal things that cut across cultures," Stanford said. "In an ideal world, the people would be seeing licensed therapists and getting medications, but this is different. It's simplified, but they do get a dramatic reduction in symptoms."
In the sessions, participants learned about such common symptoms of trauma as depression, sleep problems, anger and guilt. They learned ways to cope with crises and rebuild emotional closeness that had been disrupted by trauma.
For leaders, overseeing groups has "really given them a purpose," Stanford said. "They want to be trained as leaders in towns that have been destroyed and go to other camps and begin training others. That's what you hope for -- that they'll take ownership of it."
Stanford is executive director and co-founder of the Mental Health Grace Alliance, with bases in Waco and Los Angeles. Other researchers were Jose Padilla, co-founder of Mental Health Grace Alliance, who has lived and worked for more than 10 years in Arabic-speaking Muslim countries and who edited the material; Timothy M. Elverson of Acts of Mercy International's United Kingdom office; and Edward B. Rogers, a doctoral candidate at Baylor.