***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Traumatic stress due to conflict and war causes major mental health problems in many re source -poor countries . The objective of this study was to examine whether trained lay counselors can carry out effective treatment of  posttraumatic stress disorder ( PTSD )  in a refugee settlement . In a r and omized controlled dissemination trial in Ug and a with 277 Rw and an and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors . Strictly manualized narrative exposure therapy ( NET ) was compared with more flexible trauma counseling ( TC ) and a no-treatment monitoring group ( MG ) . Fewer participants ( 4 % ) dropped out of NET treatment than TC ( 21 % ) . Both active treatment groups were statistically and clinical ly superior to MG on PTSD symptoms and physical health but did not differ from each other . At follow-up , a PTSD diagnosis could not be established anymore in 70 % of NET and 65 % TC participants , whereas only 37 % in MG did not meet PTSD criteria anymore . Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement We examined the feasibility , acceptability , and therapeutic efficacy of a culturally adapted cognitive – behavior therapy ( CBT ) for twelve Vietnamese refugees with treatment-resistant posttraumatic stress disorder ( PTSD ) and panic attacks . These patients were treated in two separate cohorts of six with staggered onset of treatment . Repeated measures Group × Time ANOVAs and between-group comparisons indicated significant improvements , with large effect sizes ( Cohen 's d ) for all outcome measures : Harvard Trauma Question naire ( HTQ ; d=2.5 ) ; Anxiety Sensitivity Index ( ASI ; d=4.3 ) ; Hopkins Symptom Checklist-25 ( HSCL-25 ) , anxiety subscale ( d=2.2 ) ; and Hopkins Symptom Checklist-25 , depression subscale ( d=2.0 ) scores . Likewise , the severity of ( culturally related ) headache- and orthostasis-cued panic attacks improved significantly across Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions .  Narrative exposure therapy ( NET ) is a short-term approach based on cognitive-behavioral therapy and testimony therapy . The efficacy of narrative exposure therapy was evaluated in a r and omized controlled trial . Sudanese refugees living in a Ug and an refugee settlement ( N = 43 ) who were diagnosed as suffering from posttraumatic stress disorder ( PTSD ) either received 4 sessions of NET , 4 sessions of supportive counseling ( SC ) , or psychoeducation ( PE ) completed in 1 session . One year after treatment , only 29 % of the NET participants but 79 % of the SC group and 80 % of the PE group still fulfilled PTSD criteria . These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions Concentration camp survivors from Bosnia-Herzegovina , now refugees in the Netherl and s , were given early outpatient treatment for posttraumatic stress disorder ( PTSD ) for 6 months . They were tested with the  Watson Question naire  before entering therapy , after 6 months and 3 years later when a structured interview design ed to obtain information on psychosocial status was administered . Data were analyzed with PCA-STAT 1.1 statistical package . The treatment was effective on a short-term basis with some long-term effects .  Elderly people were no more vulnerable to the onset of PTSD than younger ones but were more resistant to therapy . Psychosocial factors had neither protective nor risk value for the development of PTSD in this group The present study was design ed to evaluate the effects on children ( age : M = 5.5 years ) in war-torn Bosnia and Herzegovina of a psychosocial intervention program consisting of weekly group meetings for mothers for 5 months . An additional aim was to investigate the children 's psychosocial functioning and the mental health of their mothers . Internally displaced mother-child dyads were r and omly assigned to an intervention group receiving psychosocial support and basic medical care ( n = 42 ) or to a control group receiving medical care only ( n = 45 ) . Participants took part in interviews and tests to provide information about war exposure , mental health , psychosocial functioning , intellectual abilities , and physical health . Results showed that although all participants were exposed to severe trauma , their manifestations of distress varied considerably . The intervention program had a positive effect on mothers ' mental health , children 's weight gain , and several measures of children 's psychosocial functioning and mental health , whereas there was no difference between the two groups on other measures . The findings have implication s for policy Rates of posttraumatic stress disorder ( PTSD ) are exceptionally high among asylum-seekers . Reportedly , stressors caused by the asylum procedure and psychological consequences of torture contribute to the maintenance of symptoms and interfere with treatment . In a pilot r and omized controlled trial , the authors examined the efficacy of trauma-focused treatment in 32 asylum-seekers with PTSD result ing from state-sponsored violence and other traumatic events .  Narrative exposure therapy ( NET ) was compared with treatment as usual ( TAU ) , with a focus on stabilization and psychoactive medication . Six months after treatment , a significant reduction of posttraumatic stress symptoms was found in the NET participants but not in the TAU group . Although treatment gains were moderate , these results indicate that NET is a promising approach for the treatment of PTSD in asylum-seekers living in unstable conditions This article examines the ability of the panic attack – posttraumatic stress disorder ( PTSD ) model to predict how panic attacks are generated and how panic attacks worsen PTSD . The article does so by determining the validity of the panic attack – PTSD model in respect to one type of panic attack among traumatized Cambodian refugees : orthostatic panic ( OP ) attacks ( i.e. panic attacks generated by moving from lying or sitting to st and ing ) . Among Cambodian refugees attending a psychiatric clinic , the authors conducted two studies to explore the validity of the panic attack – PTSD model as applied to OP patients ( i.e. patients with at least one episode of OP in the previous month ) . In Study 1 , the panic attack – PTSD model accurately indicated how OP is seemingly generated : among OP patients ( N = 58 ) , orthostasis‐associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious – depressive distress ( Symptom Checklist‐90‐R subscales ) , and OP severity significantly mediated the effect of anxious – depressive distress on Clinician‐Administered PTSD Scale severity . In Study 2 , as predicted by the panic attack – PTSD model , OP had a mediational role in respect to the effect of treatment on PTSD severity :  among Cambodian refugees with PTSD and comorbid OP who participated in a  cognitive behavioural therapy  study ( N = 56 )  , improvement in PTSD severity was partially mediated by improvement in OP severity The present study investigated the efficacy of cognitive-behavior therapy ( CBT ) and exposure therapy ( E ) in the treatment of post-traumatic stress disorder ( PTSD ) in refugees . Sixteen out patients fulfilling the DSM-IV criteria for PTSD were r and omized to one of the two treatments . Assessor and self-report measures of PTSD-symptoms , generalized anxiety , depression , quality of life and cognitive schemas were administered before and after treatment , and at a 6-month follow-up . The patients were treated individually for 16 - 20 weekly sessions . The results showed that both treatments result ed in large improvements on all the measures , which were maintained at the follow-up . There was no difference between E and CBT on any measure . E and CBT led to a 48 and 53 % reduction on PTSD-symptoms , respectively , a 49 and 50 % reduction on generalized anxiety , and a 54 and 57 % reduction on depression . The results were maintained at the 6-month follow-up . The conclusion that can be drawn is that both E and CBT can be effective treatments for PTSD in refugees Based on the results of a r and omized controlled trial , we examined a model of the mechanisms of efficacy of culturally adapted cognitive‐behavior therapy ( CBT ) for Cambodian refugees with pharmacology‐resistant posttraumatic stress disorder ( PTSD ) and comordid orthostatic panic attacks ( PAs ) . Twelve patients were in the initial treatment condition , 12 in the delayed treatment condition . The patients r and omized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure — the systolic blood pressure response to orthostasis ( d = 1.31)—as evaluated by repeated‐ measures MANOVA and planned contrasts . After receiving CBT , the Delayed Treatment Group improved on all measures , including the systolic blood pressure response to orthostasis . The CBT treatment 's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability . The current study supports our model of the generation of PTSD in the Cambodian population , and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population . It also suggests that vagal tone is involved in emotion regulation , and that both vagal tone and emotion regulation improve across treatment Cambodian refugees with posttraumatic stress disorder ( PTSD ) represent a cohort in severe need of treatment , but little information is available to guide treatment choices . We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy ( CBT ) for treating PTSD . Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22 - 26 years during the Pol Pot period ( 1975 - 1979 ) . These patients were r and omly assigned to either sertraline alone or combined treatment . We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms . Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD , and that a program of CBT emphasizing information , exposure , and cognitive-restructuring can be successfully modified for Khmer-speaking refugees 
    Output:
    
Very large effect sizes were obtained in some of the CBT studies , indicating a broad suitability of CBT in the treatment of core symptoms of PTSD in adult refugees .
Empirical evidence also points to the possibility that the maladaptive traumatic reactions in refugees can take shape of more complex reactions than those strictly specified in the diagnostic category of PTSD .
Effectiveness of CBT treatments has as yet not been tested on the whole range of symptoms in these complex cases .