A Tailored Approach to Trauma Intervention

Thousands of Somali refugees have moved to Seattle in search of opportunity and security. Many, haunted by their past, suffer from posttraumatic stress disorder (PTSD) and related problems. A new program developed by UW psychology professor Lori Zoellner and Duniya Lang, founder and director of the Somali Reconciliation Institute (SRI), provides a trauma-focused intervention tailored for the Somali community.  

Whether trauma is caused by a sexual assault, natural disaster, or war atrocities, PTSD symptoms tend to be consistent across populations. They include avoidance of potential reminders of the trauma and episodes of re-experiencing the event through nightmares and other disturbing images. Traditional treatment involves up to a dozen one-on-one sessions with a skilled therapist. “After short-term interventions, people often maintain their gains for many years,” says Zoellner, who specializes in PTSD research. “It’s pretty amazing.”

So why not offer existing therapies to Somalis with PTSD? “We felt that individual psychotherapy probably wasn’t the best approach, given their emphasis on community,” says Zoellner, “and that with a good portion of the Somali community identifying as Muslim, having a program that was embedded in the faith would be critical for success.”

Lang approached Zoellner to help develop an empirically supported intervention for Somalis suffering in the aftermath of war-torn conflict.  The result is a six-week PTSD program — Islahul Qulub: Islamic Trauma Healing — that combines prayer, prophet narratives, and guided discussion. Sessions are led by members of the community trained as lay leaders, with separate groups offered for men and women.  Dr. Sheikh Ahmed Nuur, the Imam at the Abu-Bakr Islamic Center in Seattle, agreed to host the program at the mosque and reviewed the program manual to ensure religious integrity. He even wrote supplications to bookend each group session.

“Early on it became really clear to us that if this was going to work, it had to be endorsed by the Imam and had to be embedded within the mosque,” says Zoellner. “Duniya worked quite hard to make that happen. We knew there would be some degree of concern or suspicion if the program was done anywhere else.”

Even with the mosque’s approval, adapting individual psychotherapy to a group setting was no small challenge. Much PTSD therapy addresses re-experiencing and avoidance by having people talk about their trauma event repeatedly. But in groups, sharing stories can lead to comparisons about whose trauma is worse, or can increase stress at hearing more atrocities described.  Zoellner and Lang solved this by having participants pray to Allah privately about their trauma experience and then discuss their prayer experience with the rest of the group.

“They pray to Allah about what happened, how it happened, and how it affected them,” says Zoellner. “With the group, they talk about their experience of prayer with Allah but not about the trauma event itself.”

While the prayer to Allah addresses re-experiencing and avoidance, prophet narratives help with “cognitive restructuring,” or getting people to think differently about their traumatic experiences. Each week the lay leaders share the story of a prophet, then pose carefully worded questions to encourage discussion. After reading about Job, for example, they ask the group about Job’s life before and after his afflictions, and about the role of suffering in faith.

“Through these stories, the group sees how other people have moved through suffering,” says Zoellner. “The narratives shift over six weeks. First they focus on what we learn through suffering, then how we overcome suffering, then how we reconcile with ourselves, others, Allah, and the community.”

The prayers to Allah change along with the prophet narratives.  In the final session, after discussing a prophet narrative about reconciliation, the participants pray to Allah about being thankful for the trials they have been given and what they have learned from those trials. “It takes what we know are the empirically supported principles of trauma-focused cognitive behavioral treatment and puts them in the context of a group format that has faith as an integral part,” says Zoellner.

All of the prophet narratives, questions, and prayer prompts are included in a manual that Zoellner and Lang developed with the help of UW postdoctoral scholar Belinda Graham, psychology doctoral student Libby Marks, and professor Norah Feeny at Case Western Reserve University. The lay leaders, trained by the team, use the manual to guide discussion. Those leaders will help train future lay leaders, with the goal of a self-sustaining program within the Somali community.

A small pilot of the program, completed in March with support from The Seattle Foundation and the Catherine Holmes Wilkins Foundation, was well received. Zoellner and Lang are eager to expand the pilot and run a randomized control trial to demonstrate the program’s effectiveness. Lang is so optimistic that she reached out to Somali’s former prime minister about introducing the program in Somalia. The prime minister visited the UW to discuss the project and has pledged his support.

“No other PTSD treatments have an Islamic focus, despite approximately 23 percent of the world’s population practicing this religion,” says Zoellner. “That, plus the individual nature of most PTSD therapy, have been significant barriers to dissemination of these effective therapies. What has been most encouraging about this project has been how enthusiastic the group members and lay leaders have been. They see it as a way that they can make change. It’s exciting to see how well it seems to fit their needs.”