By: Elizabeth Carll, PhD and Vincenzo Teran, PsyD
As part of the series of interviews conducted by student members with trauma psychologists from various parts of the world, Rayna Sanghvi a student member of the International Committee interviewed, Dr. Leonidas Castro-Camacho a clinical psychologist based in Bogotá, the capital city of Colombia. He is in private practice and also an associate professor at the University of Los Andes.
The interview series with distinguished trauma psychologists from around the world provides our students with the opportunity to meet psychologist role models from many cultures. The interview article, which is below, provides a window into the work of trauma psychologists globally and enables a better understanding of cultural issues relating to psychology.
To encourage participation of international students at the APA convention, the Division approved an annual $1000 student stipend and complimentary convention registration to support travel of a student from a developing country, who has a trauma related poster or paper accepted for the presentation at the convention. The 2018 APA Convention will take place in San Francisco. A free one year membership in Division 56 is also included. Interested candidates for the travel stipend should contact: Dr. Elizabeth Carll, at firstname.lastname@example.org and Dr. Vincenzo Teran at email@example.com.
With the emerging immigration crisis occurring globally, the Refugee Mental Health Resource Network, an APA Interdivisional project is reported in another section of the newsletter.
An International Committee Interview with Leonidas Castro-Camacho, PhD, ABPP
By Rayna Sanghvi, BA
Dr. Leonidas Castro-Camacho is a clinical psychologist based in Bogotá, the capital city of Colombia. Dr. Castro-Camacho received his Ph.D. in clinical psychology from Stony Brook University, in New York, USA and returned to Columbia to develop evidence-based psychological approaches for trauma psychology in his country. After all his years of hard work, Dr. Castro-Camacho is a force to be reckoned with. This is demonstrated by the various professional roles he plays. Dr. Castro-Camacho runs a private practice where he provides therapy to almost 30 patients a week. Additionally, he is an associate professor at the esteemed University of Los Andes where he teaches various undergraduate and graduate psychology classes related to abnormal psychology, introduction to clinical psychology, case formulation, clinical assessment, and mood disorders. At the university, Dr. Castro-Camacho provides clinical supervision and conducts research, where he also functions as a research advisor to eight students.
Currently, Dr. Castro-Camacho is running a large-scale randomized clinical trial (RCT) for over three years. This clinical trial utilizes a culturally adapted version of David Barlow’s Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Barlow’s Unified Protocol focuses on the commonalities of major emotional disorders as a treatment target, rather than the differences. The protocol is targeted towards individuals who have been heavily affected by the many years of civil unrest, which is one of the world’s longest armed conflicts. Various guerrilla groups, paramilitary groups, and the largest rebellion in Colombia, the Revolutionary Armed Forces of Colombia (FARC) has created havoc in the country for over 50 years. In 2016, a significant point of progress was marked as the Colombian government signed a peace agreement with FARC. However, this peace agreement is yet to be completely implemented. The armed conflict has not only results in countless deaths, but has also internally displaced over seven million people resulting in fear and trauma in their lives.
Dr. Castro-Camacho explained that most of the people who had been displaced came from rural villages, leaving their friends, family, agricultural land, etc behind, to move to the cities to live in impoverished conditions. As a psychologist in the capital city, Dr. Castro-Camacho developed the RCT to cater to the mental health needs of this vulnerable population. The RCT has a sample of 100 participants in which 50 participants are provided with the Unified Protocol treatment and 50 participants are placed in the waitlist condition. Dr. Castro-Camacho’s students provide 12 weekly or biweekly sessions to the participants in the treatment condition. One of the original members of the Unified Protocol team visited Bogota from Boston to train the students after which Dr. Castro-Camacho translated the protocol to Spanish, adapted it to Colombian culture, and provided further training to his students. To maintain fidelity to the protocol, ensure high quality of treatment, and monitor its effectiveness on participants, Dr. Castro-Camacho provides weekly clinical supervision to his students.
During our interview, Dr. Castro-Camacho emphasized the nature of the trauma these displaced individuals have endured and how the Unified Protocol has been adapted to address their mental health needs. It is crucial to understand that displaced people have not only suffered from one traumatic event, but in fact are victims of multiple traumas. Multiple traumas relate the harsh and exposed conditions and unsafe neighborhoods in which they live continuing to experience and witness trauma in their environment. Dr. Castro-Camacho indicated that the most common types of trauma he has seen in this population result from sexual violence, multiple rapes, physical torture, and child sexual abuse, witnessing deaths of loved ones or massacres, including seeing a family member being killed or tortured. In addition, enforced disappearances are common as well. This entails having a family member or friend being taken by FARC or members from other guerilla groups and never gaining closure as to what fate that person met with.
Dr. Castro-Camacho explained that while these displaced individuals live in unsafe conditions, they are also dealing with daily stressors such as fending for themselves, work under minimum wage conditions. Usually, in combat and conflict zones, we often see people with posttraumatic stress disorder (PTSD). However, this population, also experiences continuous threat, live with the people who have victimized them, and are at risk for future traumas as the conflict has still not ended. Thus, it is not surprising to learn that 80% of Dr. Castro-Camacho’s sample meets criteria for PTSD. The second most common disorders include generalized anxiety disorder (GAD) and major depressive disorder (MDD). Dr. Castro-Camacho reports that panic disorder with agoraphobia is not uncommon. Obsessive-compulsive disorder (OCD), though rare with this population, is also present. The question arises then, how does the continuity of the armed conflict affect treatment and mitigating symptoms? Therefore, the Unified Protocol is designed not to address each disorder separately, but instead targets the common causes for each disorder, which is suitable for this population.
Dr. Castro-Camacho has been monitoring the trial and finds that the treatment is not only producing decreases in symptoms of PTSD, anxiety, and depression, it has also increased the quality of life for these individuals as they cope with daily survival of finding or keeping a job, maintaining interpersonal relationships, and being able to leave their houses. Dr. Castro-Camacho stated that many participants have avoided returning to their villages due to the atrocities they witnessed.. However, after treatment, some of them have been able to return with the availability of better resources and safer conditions.
It is interesting to note that the attitudes towards seeking mental health treatment differ by region. Dr. Castro-Camacho conveyed that while individuals living in Bogotá are more open to seeking mental health services, there is some stigma around it and it is not as openly accepted as compared to other South American countries, such as Argentina. In the rural areas of Colombia, there are fewer resources and exposure to mental health awareness, which results in people turning to other resources such as shamans, traditional and religious healers for mental health treatment. Therefore, Dr. Castro-Camacho’s adaptation of the Unified Protocol deals with the nuances of specific cultural aspects of treating trauma with this population. It is also paving the way for developing concrete evidence-based treatments for trauma, in Colombia.
Dr. Castro-Camacho hopes to conduct further studies on dissemination if there are positive findings from Unified Protocol treatment study. This would include adapting the protocol to other modalities of treatment, such as group therapy, family therapy, and even integrating technology, so it has a wider reach. We would like to wish Dr. Castro-Camacho and his team the very best as he aims to complete the clinical trial by 2018.
Rayna Sanghvi, B.A., is a Ph.D. student in the Clinical Psychology program at PGSP-Palo Alto University in Palo Alto, California. She is currently a Division 56 student committee member and campus representative. Her research interests are varied and not limited to, the early interventions for trauma, integrating technology into mental health care, and sexual trauma.