DABATEM is an independent research center in Istanbul with expertise in behavioral treatment of anxiety disorders, including posttraumatic stress disorder. It is affiliated with the Trauma Studies at the Institute of Psychiatry, King’s College London. Both DABATEM and Trauma Studies are founded and headed by Metin Basoglu, MD, PhD.

DABATEM conducts research into mental health effects of mass trauma events, such as wars, natural disasters, political violence, and torture. Its aims are:

• To promote a better understanding of various issues in the field of psychological trauma that are of significance to mental and public health professionals, social and political scientists, human rights workers, international law experts, policy makers, and governmental and nongovernmental organizations concerned with care of mass trauma survivors.
  
• To develop a new mental health care model for mass trauma survivors based on self-help principles
  
• To promote evidence-based approach in the field and contribute to the development of expertise in psychological trauma, particularly in developing countries.

Why the need for a better understanding of mass trauma?

The mental health effects of wars, torture, and natural disasters raise important social, political, moral, human rights, and legal issues. The current debate in the U.S. about the definition of torture is a case in point. There are many other unresolved issues concerning refugees, internally displaced people, asylum-seekers, and torture survivors. These issues can be effectively addressed only with an adequate understanding of how such events affect people. This requires an evidence-based approach, which has been largely lacking due to the difficulties in conducting research in this area and relative lack of appropriate research methodologies. DABATEM undertakes research to address various important issues and promotes an evidence-based approach in this field by developing research methodology to facilitate study of mass trauma.

Why the need for a new mental health care model based on self-help?

• The political developments of the last two decades have resulted in an increase in wars, regional conflicts, and political violence of all kinds around the world. Traumatic stress is thus an increasingly serious public health problem, particularly among the already impoverished and disadvantaged populations of third world countries. Developing countries are often the ones that are most severely affected by wars, political violence, and natural disasters.

• Experience with large-scale disasters is limited in the western world. Currently available treatments are of limited value in developing countries because (a) they are too long for post-disaster circumstances where large numbers of survivors need help and (b) their dissemination requires trained therapists – a rather scarce resource in developing countries. Thus, such countries need to develop a cost-effective approach to their problem, rather than uncritically adopting western treatments in survivor care.

• Many survivors recover from stress without any treatment, possibly reflecting an evolutionarily determined resilience in humans against traumatic stress. This implies that the right approach to trauma is one that focuses on resilience, not on pathology. The latter characterizes most western treatments.

• Self-help interventions closely parallel (and possibly enhance) natural processes in recovery from trauma and are thus likely to be highly effective. A self-help approach is essential for developing countries, given their socio-economic and political realities.

Background to DABATEM’s work – Theory and evidence base

In the early 1990s we proposed a theoretical formulation of traumatic stress in torture survivors, based on experimental learning theory models of anxiety in animals. We hypothesized that (a) unpredictability and uncontrollability of stressors plays an important role in traumatic stress and (b) interventions that enhance sense of control increase resilience and reverse the effects of trauma. The first part of this hypothesis was confirmed by a series of studies with torture survivors and later by a study of more than 2,000 war survivors in former Yugoslavia countries, including combat veterans, torture survivors, internally displaced people, refugees, and people exposed to aerial bombardment. Based on this evidence, we developed a behavioral intervention designed to reduce traumatic stress by enhancing sense of control over stressors. This was a largely self-help based intervention involving mainly instructions for self-exposure to feared trauma-related situations.

The 1999 earthquakes in Turkey allowed us an opportunity to test this Control-Focused Behavioral Treatment in natural disaster survivors. A series of treatment studies showed that the treatment is highly effective in reducing traumatic stress, even when delivered in a single session. Preliminary evidence suggested that the treatment could be effectively delivered through media other than a therapist, such as a self-help manual. In addition, a highly effective Earthquake Simulation Treatment was developed, designed to enhance resilience against the traumatic effects of earthquakes by increasing sense of control over simulated earthquake tremors. These interventions were used as part of a mental health care model that was tested with more than 5,000 survivors using an Outreach Treatment Delivery Program. Other treatment dissemination methods included a Treatment Delivery Manual designed to guide lay therapists in delivering treatment in post-disaster circumstances where trained therapists are not available. We are now at a stage where we can begin to consider the idea of disseminating treatment on a much larger scale through mass media channels.

Our work in the last 20 years included more than 40 research projects, which culminated in a large database involving information on more than 2,000 variables in about 15,000 survivors. This database – possibly the largest of its kind in mass trauma survivors – is fairly unique for several reasons:

• It represents the largest body of empirical evidence to date on the applications of experimental learning theory models of traumatic stress in humans. Because this theory deals with evolutionarily determined ‘universals’ in the behavior of organisms, its applications in humans have wide cross-cultural applicability. Furthermore, its focus on behavioral strategies for coping with unpredictable and uncontrollable stressors makes it a highly useful paradigm in developing effective self-help interventions for traumatic stress.

• The data allow comparisons among different trauma groups because all our studies were based on the same methodology. This increases the generalizability of findings.

• The database involves a wide range of studies, including descriptive / phenomenological studies, field surveys / epidemiological studies, experimental case studies, and uncontrolled and randomized controlled trials of various treatments. This allows testing of various hypotheses relating to mechanisms of traumatic stress, which is essential in developing effective interventions.

• The detailed nature of the data allows us to examine a wide range issues that are of significance to legal professionals, international law experts, social and political scientists, and human rights workers. Such data are quite valuable, because of the difficulties in conducting high-quality research with survivors of war and torture trauma.

Why this website?

This website is designed to facilitate dissemination of the knowledge gained from 20 years of work. It contains a summary of all our trauma-related work to date with a focus on our mental health care model. Introductory information is provided on the various components of this model, including the new behavioral treatments, assessment instruments, and treatment dissemination tools. More information about various theoretical and practical issues concerning this model is provided in Frequently Asked Questions.

NEW BOOK ON TREATMENT OF EARTHQUAKE, WAR, AND TORTURE TRAUMA

The information in this website will be presented in more detail in our forthcoming book on A Mental Healthcare Model for Mass Trauma Survivors: Control-Focused Behavioral Treatment of Earthquake, War, and Torture Trauma that will be published by Cambridge University Press in February 2011. See TABLE OF CONTENTS