March 7, 2018 - Cognitive therapies should be considered when addressing the harmful psychological consequences of trauma in victims of human trafficking, according to a review and recommendations in the Journal of Psychiatric Practice. The journal is published by Wolters Kluwer.
The recommendations are based largely on research in other groups of traumatized patients--reflecting the lack of evidence on mental health treatments for human trafficking victims, according to the first of two articles by experts at Baylor College of Medicine: Temilola Salami, PhD (now at Sam Houston State University), Mollie Gordon, MD, John Coverdale, MD, and Phuong Nguyen, PhD. In the second paper, the authors call for psychiatry to take the lead in coordinating an integrated care approach for this large and highly vulnerable group of patients.
Human Trafficking - Initial Recommendations for Mental Health Treatment Sometimes called "modern slavery," human trafficking refers to the use of force, coercion, or fraud for purposes of labor or sexual exploitation. Estimates of the scope of the problem vary widely--by one estimate, there are more than 300,000 human trafficking victims in Texas alone. Victims span all ages, races, genders, and socioeconomic brackets. A US Department of Justice report found that 83 percent of sex trafficking victims were US citizens.
Due to their exposure to traumatic events, human trafficking victims experience distressing psychological consequences. In their review of the research literature, Dr. Salami and colleagues found sparse evidence on mental health treatments for this group of patients. Their recommendations reflect research on other traumatized groups--such as victims of sexual abuse or domestic violence or torture survivors--informed by understanding of the psychological issues faced by human trafficking victims.
The main treatment strategies for PTSD and other trauma symptoms are cognitive processing therapy (CPT) and prolonged exposure therapy (PE). While both treatments are effective, they work in different ways. In CPT, cognitive restructuring techniques are used to change maladaptive, hopeless thoughts regarding the self, the world, and the future. In PE, patients are exposed to internal and external stimuli (thoughts and places) to help them fully process their traumatic experiences.
Available evidence favors CPT for victims of human trafficking, the researchers believe. Cognitive therapies may be more effective in addressing the strong feelings of guilt and shame experienced by survivors. The CPT approach proceeds more slowly and with less exposure to traumatic reminders, which may help keep survivors in therapy.
Dr. Salami and coauthors write, "We believe that cognitive approaches not only show promise in treating trauma and stress-related symptoms that result from trafficking, but that they may also reduce other psychological consequences of trafficking." Common disorders in trafficking victims include anxiety and depression, substance use, dissociation, and psychosis. Victims vary in terms of their background and types of traumatic experiences; care and treatment will differ depending on the individual's situation.
Other critical considerations in working with human trafficking victims include the fear and mistrust that may make it difficult for victims to seek help and treatment. Some victims may be accompanied by their trafficker, or fear being recognized. Mental health professionals need to work closely with others in the community--for example, emergency room staff and police--who may come into contact with victims.
In the companion article, Dr. Gordon and colleagues highlight the pivotal role of psychiatrists and psychologists in developing integrated approaches to caring for human trafficking victim at all stages. They write, "The provision of such a comprehensive and integrated model of care should facilitate the identification of victims, promote their recovery, and reduce the possibility of retraumatization."
About Journal of Psychiatric PracticeJournal of Psychiatric Practice®, a peer reviewed journal, publishes reports on new research, clinically applicable reviews, articles on treatment advances, and case studies, with the goal of providing practical and informative guidance for clinicians. Mental health professionals will want access to this journal¬--for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. John M. Oldham, MD, is the editor in chief and past president of the American Psychiatric Association.
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