Today there are 25.9 million refugees worldwide, the highest level of displaced persons ever recorded.
These people have been forced to flee their homes to look for safe havens and resettle their lives. Along the way, they have been exposed to some of the most terrifying ordeals a person can endure, from torture to imprisonment, near starvation, sexual assault and separation from their families. Yet, when this vulnerable population finally reaches their destination after surviving these terrors, they receive little to no mental health support.
Sadly too, reaching a safe haven presents new anxieties. Most refugees report daily terrors caused by the constant fear of deportation while seeking asylum, xenophobia in their new home, and isolation.
Research team discovers proof of a disturbing mental health crisis
Dr Amit Bernstein, clinical psychologist from the University of Haifa, and his team at the Observing Minds Lab set in the refugee community in Tel Aviv, work directly with African refugees. During their research to identify psychological mechanisms underlying suffering and resilience in the refugee population, they made a startling discovery:
As many as 55-80% of refugee people suffer from severe and chronic trauma- and stress-related mental health problems.
By talking with the refugees, Bernstein and his team began to conduct a number of epidemiological studies of refugee/asylum seeker communities in Israel to document this mental health crisis. One of the studies included 116 Sudanese men seeking asylum in Israel. The mens’ average age was 32, and they had been living in Israel for an average of 3.5 year. The findings were distressing:
- More than 80% of the men had been subjected to torture or had witnessed torture.
- Around 50% had been raped or had witnessed rape.
After living through these horrific ordeals after the tragedy of leaving their homeland behind, these men exhibited extreme psychological stress:
- Between 55-80% of the men suffered from symptoms of PTSD, such as nightmares and intrusive memories, hyper-arousal, fear and dissociation.
- 40% suffered from depression.
These figures are exorbitantly high compared to the United States. 3.5% of the general population in the USA suffer from PTSD and 7% from depression. Despite these shocking statistics, there is little to no mental health care:
Fewer than 1% of refugees receive mental health support.
While food and shelter is prioritized by the NGO’s who help during humanitarian crises, refugees are expected to resettle while struggling with PTSD and anxiety. “In terms of mental health, millions of the most vulnerable human beings on earth have been abandoned, left to remember the unthinkable, to suffer, and to heal on their own,” says Bernstein.
In their studies, the team at the Observing Minds Lab also found that refugees that are “able to mindfully attend to their experience in the present moment reported less psychological distress and better functioning” and that asylum seekers who can control their attention to emotionally distressing stimuli show less post-traumatic stress that asylum seekers struggling with regulated attention.
Read more: As an publication editor, Dr Amit Bernstein was highly involved in creating the special issue on the science of mindfulness in the esteemed Current Opinions in Psychology journal. Explore this diverse collaboration of scientists in our blog series.
A New Approach: Mindfulness-Based Trauma Recovery for Refugees (MBTR-R)
Thanks to the clinical science team behind the Observing Minds Lab though, there’s hope. The team began a mindfulness-based trauma recovery intervention trial for refugees and studied the effects.
The intervention consists of nine group sessions (2.5-hours/session) and weekly home practice supported by guided meditations. The MBTR-R intervention entails the following:
- Psychoeducation focused on the effects of stress and trauma
- Mindfulness meditation based closely on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT)
- Loving-kindness practices to cultivate compassion for oneself and others
- Trauma-sensitive adaptations of meditation to help ensure the safety of meditation for traumatized refugees
The program also takes into account socio-cultural differences. The researchers have been involving mediators and translators from the refugee communities as well as socio-culturally relevant metaphors and idioms for better communication.
The Outcomes Of MBTR-R
Initially, the researchers hoped the intervention may, at the very least, help the participants find refuge and safety in their own bodies. They hoped it may provide a rare moment of feeling safe, which would then help them recover and heal. But thanks to their experimental study, the research team discovered it did offer that moment of refuge and safety… and so much more.
To reach this conclusion, Bernstein and his team conducted many studies. In one, the researchers investigated the effects of the intervention against a control group who received the standard care for refugee’s mental health: very little.
The change in mental health of those asylum seekers receiving the intervention was astounding. After the MBTR-R intervention, a huge 52% of participants had recovered from PTSD. Of those who still suffered from PTSD, most had statistically significant reductions in PTSD symptoms.
The researchers found the asylum seekers in the control group that did not take part in the MBTR-R program showed the same levels of psychopathology after the trial period. Due to the lack of mental health support, only 9% of those in the control group recovered from PTSD.
After repeating the study many times over, in countless ways, Bernstein summarized his findings in a statement:
“The clinical science of refugee mental health is decades behind its urgent global need. Access to effective mental health interventions can change the fate of millions and save lives, and thus should be a basic right of every human being.”
Why Teaching Refugees To Meditate?
The idea may sound a bit left-field to some, but when examining the scientific motivations it’s clear why Bernstein and his team began studying the effects of meditation and mindfulness practices on refugee communities.
Firstly, there’s a fast growing body of science documenting the curative effects of mindfulness and compassion training on stress and trauma-related side effects. Scientist Anne Reebs partnered with Bernstein on his research, and explains this scientific evidence further:
“Mindfulness training specifically targets key bio-psycho-behavioral processes thought to maintain psychopathology following traumatic stress such as behavioral avoidance, emotion dysregulation and attentional bias to trauma-related information.”
Secondly, the researchers’ initial findings correlated with the existing body of evidence and motivated further trials. Mindfulness also transcends language and culture. It targets universal processes like attention, awareness and compassion.
Lastly, mindfulness and meditation are feasible treatment options. They’re scalable, low cost and can be implemented in many ways from group sessions to teleconference. This scalability suits the researchers’ overarching goal of finding an intervention to address the global mental health crisis refugees face as a whole.
MBTR-R: Goals For The Future
It is a new approach and intervention and there will be countless studies, I hope, in 10 to 20 years time. — Dr Amit Bernstein
Thanks to the scalability, safety of the intervention and the proven positive outcomes of MBTR-R, the Observing Minds Lab has its sites set on expansion. The researchers’ initial aim is a multi-national study on the effects of MBTR on different refugee populations around the world. Not only will this huge scope provide help to thousands more vulnerable populations, it will also encourage further funding for the project after more outcomes and studies are shown to indicate the program’s efficacy.
Due to the mobility and extreme circumstances of many refugee groups, Bernstein and his colleagues also want to develop and test a web-based e-health platform. While the MBTR-R program already utilizes video, further development of a digital platform would allow expansion to the most remote refugee populations. By providing a web-based treatment program, those refugees who absolutely couldn’t access an in-person MBTR-R program would be allowed the chance to recover and heal despite their remote location.
The MBTR-R program is a desperately needed tool to help combat the global mental health crisis of PTSD and anxiety at a time when there are more refugees in the world than ever before. By providing this program, refugees who have lived through the most devastating atrocities can begin to heal, helping them better find peace in their new homes.
Learn more about MBTR-R at www.observingmindslab.com/mbtrr . The Observing Minds Lab are now planning the next big phase of this project—Moments of Refuge Project.
