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. 2024 Jun 25;15(1):2364998. doi: 10.1080/20008066.2024.2364998

Cultural psychological factors in posttraumatic symptom development and expression: a study protocol

Factores psicológicos culturales en el desarrollo y expresión de síntomas postraumáticos: un protocolo de estudio

David J Eberle a,CONTACT, Andreas Maercker a, Yafit Levin b, Celestin Mutuyimana c,*, Jun Wen a, Nino Makhashvili d, Darejan Javakhishvili d, Ana Papava d, Xinyi Yu e, Wenli Qian e, Jianping Wang e, Stephen Asatsa f, Rahel Bachem a
PMCID: PMC11207911  PMID: 38916108

ABSTRACT

Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress.

Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events.

Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.

KEYWORDS: Trauma, culture, cultural scripts, cascade model, PTSD

HIGHLIGHTS

  • This paper presents a Network Project that investigates cultural factors in posttraumatic sequelae.

  • The Network Project encompasses an innovative research design with both qualitative and quantitative methods.

  • New developments in the field of cultural clinical psychology are introduced, including cultural scripts of trauma and a cascade model of cultural factors in posttraumatic symptom expression.

1. Introduction

Traumatic life events can result in a broad variety of stress reactions. Research on stress and trauma sequelae has produced an extensive empirical basis for the well-established psychopathological concepts of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD; World Health Organization, 2023). Both PTSD and CPTSD are significant mental disorders following exposure to traumatic events and featuring unique symptoms such as re-experiencing, perceptions of heightened current threat, or disturbances in self-organisation (World Health Organization, 2023). In recent years, the investigation of traumatic stress and (C)PTSD increasingly included cultural psychological factors which demonstrate how culture influences psychological processes (Heim et al., 2022). Culture refers to a set of behavioural patterns, values, rituals, customs, or worldviews that are related to a certain group of individuals (Hofstede, 1998; Kluckhohn & Strodtbeck, 1961). It was shown that an individual’s cultural background influences factors such as norms, beliefs, vulnerability, or resilience, hence unfolding a strong impact on the manifestation of posttraumatic symptom patterns (Heim et al., 2022; Perilla et al., 2002). In the World Mental Health Survey (Dückers & Brewin, 2018), findings even demonstrated that prevalence rates of PTSD are relatively low in countries where stressful life events frequently occur. In contrast, in countries where life-threatening events are less frequent, PTSD rates are relatively high. This paradox strongly suggests that cultural factors are of major importance in the development and manifestation of posttraumatic stress or resilience. Thus, a more profound understanding of traumatic experiences could be achieved by conducting additional research that focuses on factors beyond the diagnostic features of PTSD and CPTSD, including cultural psychological factors.

1.1. Cultural scripts of trauma

More recently, cultural characteristics of posttraumatic reactions have been highlighted in the form of cultural scripts of trauma (Chentsova-Dutton & Maercker, 2019). Cultural scripts refer to specific types of cultural models that depict dynamic sequences of psychological elements (Chentsova-Dutton & Maercker, 2019). Schank and Abelson (1975) also described scripts as predetermined and stereotyped behaviour sequences associated with a specific situation. The cultural context may strongly influence such a situation. For instance, in many regions of the world, individuals going to a restaurant usually follow a specific sequence of culturally concerted actions. People arrive, study the menu, order drinks and food, wait until the meal is served, begin to eat at the same time as the accompanying person, and so on. These behavioural elements form a cultural script. Inspired by such cultural concepts, it is proposed that reactions to traumatic experiences also manifest in the form of cultural scripts (Chentsova-Dutton & Maercker, 2019). More specifically, the authors suggest that trauma expressions might follow causal-temporal patterns that differ between cultures due to local norms and value orientations. This assumption is supported by a study showing that Central European trauma survivors often perceive and express distressing symptoms, which is followed by an urge to control the distress and to function normally. However, many trauma survivors are not able to maintain sufficient control, resulting in self-harming behaviour in the form of substance abuse or self-injury (Stadtmann et al., 2018). Cultural scripts of trauma not only identify important trauma reactions related to culture but also link these elements to behavioural and experiential patterns.

1.2. Models and mechanisms in cultural clinical psychology

Models of cultural psychology suggest that there are cascades of influencing factors to explain differences in the shaping and frequency of phenomena (e.g. Greenfield et al., 2000; Greenfield & Cocking, 2014). Such models are present in various fields and comprise cascade structures with varying levels of complexity and predictive ability (e.g. Gardner et al., 2014). Maercker et al. (2022) also developed a first cascade model in the context of trauma and CPTSD. The authors proposed trauma exposure, socio-interpersonal factors, attachment styles, and disorder-specific characteristics as distinct components of this model. The results showed that the various influencing factors are meaningfully interrelated and trace a model that has added value over previous conceptualizations of CPTSD. This cascade model also aligns with a more holistic perspective on trauma that has been proposed and supported in past studies (e.g. Maercker & Horn, 2013). Similar to this previous work, the current Network Project introduces a cascade model of cultural psychological factors influencing posttraumatic symptom expression (see Figure 1).

Figure 1.

Figure 1.

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The cascade model of culturally relevant factors in posttraumatic symptom expression.

Note: PTSD = posttraumatic stress disorder; CPTSD = Complex PTSD.

In this conceptual cascade model, it is proposed that trauma exposure, demographic differences, and culture are interrelated factors that have a combined influence on trauma reactions and consequences in the form of posttraumatic symptoms, syndromes, cultural scripts of trauma, and (C)PTSD. The influence of demographic characteristics on trauma sequelae is widely supported by studies that demonstrate, for example, that female gender or young age are risk factors for significant posttraumatic stress reactions (e.g. Kessler et al., 1995; Trickey et al., 2012). Furthermore, posttraumatic reactions are influenced by culture-related features, including ethnicity, nationality, or subcultural affiliation, such as membership in a religious group or a youth subculture (Ford et al., 2015; Heim et al., 2022). These cultural characteristics are also interlinked with demographic characteristics, such as age (Arnett Jensen, 2003). As a global phenomenon, traumatic experiences may cause what is usually conceptualised as PTSD or CPTSD, as shown by research studies or the clinical definition of the ICD-11 (e.g. World Health Organization, 2023). Furthermore, being part of a specific culture plays an important role in shaping an individual’s value orientations and social axioms. Social axioms are beliefs about the world and how it works that guide social behaviour (Bond et al., 2004). These axioms are interconnected with and influenced by culture (Bond et al., 2004). In addition, culture influences value orientations and worldviews, as can be demonstrated with the concept of ‘face’ in East Asian cultures such as China (Lindridge & Wang, 2008; Zane & Yeh, 2002). It is to be expected that such worldviews and value orientations also appear in the context of trauma, for instance, saving face by not showing one’s posttraumatic symptoms.

Finally, cultural value orientations and social axioms contribute to the development of cultural scripts of trauma. Cultural value orientations can include pan-cultural value orientations, such as benevolence or autonomy (Schwartz, 2006), or value orientations specifically linked to certain cultures, which we refer to as customised cultural value orientations. For example, in a culture that emphasises productivity and employment, a customised cultural value orientation might entail the belief that an individual has an obligation to work and should continue working at all costs, even in the face of adversity. If an individual is presently unable to work to their full capacity, such a customised cultural value orientation may trigger compensatory behaviours, such as self-medication or forced productivity. As many traumatised individuals are easily overwhelmed by sensory stimuli and emotional triggers, it is eventually not possible for them to maintain an overcompensation behaviour, which could subsequently cause feelings of failure, guilt, or shame (Bachem et al., submitted). Hence, customised cultural value orientations can elicit a set of psychological responses that are uniquely associated with particular cultures.

Trauma-related cultural value orientations and social axioms also contribute to the development of cultural syndromes. Culture-specific norms influence the perception and manifestation of stress on various different levels, leading to specific syndromes such as ‘taijin kyofusho’ in Japan (Ono et al., 2001; Sugimura, 2020) or ‘Baksbat’ in Cambodia (Chhim, 2013). Ultimately, cultural value orientations also play a significant role in the development of PTSD and CPTSD as they influence the interpretation of traumatic life events and the attribution of blame, guilt, or other symptoms (Heim et al., 2022). Despite the significant potential of the cultural scripts approach, there is currently a lack of empirical research investigating cultural scripts of trauma and trauma-related cascade models, highlighting a research gap in this scientific area.

1.3. Network project goals and focus

The goal of the present Network Project is to address the current research gap and to investigate cultural psychological factors in posttraumatic symptom development and expression. This main goal includes the aim to develop a selection of culture-specific trauma reactions and scripts as well as the aim to investigate a cultural and trauma-specific cascade model. The Network Project will be carried out in 5 culturally different study sites, including Switzerland, Georgia, China, Israel, and East Africa consisting of individuals from Rwanda, the Democratic Republic of Congo, Tanzania, Burundi, Uganda, and Kenya. The study sites are chosen because they encompass significant cultural regions with varying sociohistorical contexts. This deliberate choice enables a comprehensive and global exploration of trauma sequelae. Even though each culture is comprised of different ethnicities and subcultures with limited homogeneity, the present Network Project aims to narrow down posttraumatic reactions within these cultures and to achieve an advanced degree of differentiation between cultures. The chosen researchers in the different study sites possess unique expertise in trauma research. This includes scientific contributions on armed conflicts (Saxon et al., 2017; Stein et al., 2018), genocide and historical trauma (Mutuyimana & Maercker, 2022), traumatic grief (Song et al., 2018), as well as diagnostic features of stress-related disorders (Maercker & Eberle, 2022) and culture-dependent risk and protective factors in the face of adversity (Bachem et al., 2023; Levin et al., 2021). All the researchers are cultural experts in the language and contexts of the study sites and are trained to lead quantitative and qualitative research procedures (e.g. focus group discussions). Study staff and researchers will also be coached regarding the study goals and aims of the Network Project.

The Network Project is split up into two sub-studies. Sub-study I aims to identify trauma reactions in the different cultural samples. For this purpose, each study site should conduct focus group interviews with trauma survivors and trauma experts. Trauma reactions are collected and consolidated into culture-specific scales, the cultural scripts of trauma inventories (CSTIs). Sub-study I also aims to derive first trauma scripts (sequential trauma reactions) in each study site. The goal of sub-study II is to validate the respective CSTIs quantitatively and to investigate the presented cascade model (see Figure 1). This model examines cultural as well as diagnostic features of trauma sequelae to provide a holistic view of individuals who suffer from traumatic stress. Despite being structured as two separate sub-studies, sub-study I and II form a cohesive procedure within the Network Project. The combination of qualitative and quantitative research methods provides in-depth insights into cultural factors of posttraumatic symptom expression. More specifically, the qualitative study complements the quantitative approach by generating bottom-up data on post-traumatic sequelae, preparing the ground for broader quantitative explorations of cultural scripts of trauma sequelae. Furthermore, the integration of cultural factors in the investigation of mental disorders is timely as there is a growing recognition of cultural factors among clinical psychological researchers and in mental health guidelines (World Health Organization, 2023). With its comprehensive and multinational approach, we hypothesise that this Network Project will provide new insights into pathological trauma reactions and symptoms that go beyond the study of diagnostic criteria. The findings of this Network Project should not only guide future studies investigating mental disorders and their relation to culture but also provide implications for clinical diagnostics and psychological treatment procedures.

2. Methods

2.1. General network project design

This Network Project implements a mixed methods approach, including qualitative and quantitative research procedures. A multi-centered design using cross-sectional analyses is carried out. The different study sites in Switzerland, East Africa, Georgia, China, and Israel follow the same basic research plan with regular meetings for consensus and coordination, however, the data collection will be conducted independently and in the local languages of the study sites. Table 1 lists the researchers and their study site affiliation.

Table 1.

Study sites and researchers.

Study site Researchers
Switzerland Rahel Bachem, David Eberle, Andreas Maercker
East Africa: Rwanda, Democratic Republic of Congo, Tanzania, Burundi, and Uganda Celestin Mutuyimana
East Africa: Kenya Stephen Asatsa, Celestin Mutuyimana
Georgia Ana Papava, Darejan Javakhishvili, Nino Makhashvili
China Xinyi Yu, Wenli Qian, Jianping Wang
Israel Yafit Levin, Carmit Katz, Bella Klebanov, Michal Aviad
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Sub-study I includes qualitative methods and sub-study II is characterised by quantitative procedures. Demographic information is collected for both sub-studies. Even though the overall Network Project features a detailed research plan and agenda with numerous specifications for the realisation of the study, the current Network Project also aims to incorporate culture-specific procedures. An effective capturing of cultural behaviours and factors requires adapted research procedures (Bartholomew & Brown, 2012). This means that each study site considers adapting the general procedures according to their cultural norms and standards. In all study sites, sub-study I was already subject to an ethical application process in which the procedure and different elements of the research agenda were critically reviewed. All studies were approved, including Switzerland (Ethics Committee of the Faculty of Arts and Social Sciences in the University of Zurich, approval nr. 22.2.2), Georgia (Ethics Committee of the Faculty of Arts and Sciences, Ilia State University, no approval nr. available), East Africa (Ethics Committee of the University of Rwanda, College of Medicine and Health Sciences, approval nr. 396/CMHS IRB/2022 and Ethics Committee of the Daystar University Kenya, approval nr. DU-ISERC/09/05/2023/00086), China (Ethics Committee of Beijing Normal University, approval nr. 202304180076), and Israel (Tel Aviv University ethical board, approval nr. 0003930-2). Ethical approval for sub-study II will follow. The data collection process is expected to be completed in December 2025. A flowchart of the Network Project is presented in Figure 2.

Figure 2.

Figure 2.

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Network project flowchart.

Note: Flowchart of the Network Project. N = sample size.

2.2. Sub-study I

2.2.1. Development of the CSTIs

To investigate cultural factors in posttraumatic symptom expression, sub-study I aims to develop CSTIs which are tailored to the culture of the different study sites. For this purpose, a qualitative approach was chosen, given its appropriateness in exploring new areas of cultural psychology (Maercker & Heim, 2016). As starting point, a theoretical and preliminary item list of the CSTI, the PRE-CSTI, was developed by analysing different theoretical item pools in the area of trauma sequelae. More information about the PRE-CSTI can be found in the supplementary materials.

2.2.2. Focus groups

The PRE-CSTI represents the base for the development of a CSTI in all different study sites. Focus groups are conducted with trauma survivors and trauma experts. The focus groups derive all forms of trauma sequelae in a specific cultural group, beyond diagnostic features of PTSD or CPTSD. More specifically, participants are asked to outline different kinds of reactions specifically associated with the trauma they experienced. This inquiry is structured according to subsections of the PRE-CSTI, including cognitions and affects, worldviews, interpersonal consequences, embitterment, body-related phenomena, and growth. The focus group moderators assist participants in accurately describing and articulating trauma reactions. Participants are also asked to expand on trauma reactions specifically associated with their cultural group and to link these trauma expressions to specific value orientations. Finally, participants are tasked to reflect on sequential behaviour elements to explore cultural scripts of trauma. In the entire focus group process, participants are not only asked to report their individual points of view on trauma sequelae but also to discuss these aspects in the group. The group discussion should ensure an in-depth evaluation of cultural trauma sequelae. All focus groups should be conducted by trained psychologists to ensure professional interviewing, to help participants in articulating their experiences, and to provide support in case of unexpected psychological challenges.

Trauma survivors and experts are subject to the same procedure in their respective groups. However, the experts are tasked to report on their patients’ experiences instead of their own. Trauma survivors and experts are segregated to ensure a discussion on equal footing. The focus groups have a duration of approximately 1–2 h, depending on the setting. As for the entire study, the procedure may vary depending on cultural customs. Focus groups may also involve rituals, ceremonies, or other kinds of procedures best suitable to analyse psychological mechanisms related to trauma and culture. In-person focus groups are encouraged, however, due to some COVID-19 restrictions or other limitations throughout the study sites, the procedure might also be conducted online. The researchers of all study sites organise and moderate the focus groups, however, they do not participate as experts. All focus groups are audio recorded and transcribed or live protocolled by trained transcribers for the subsequent qualitative analyses.

2.2.3. Qualitative analysis

The transcripts of the focus groups are used for the qualitative content analysis (see Kuckartz & Rädiker, 2023) on MAXQDA software (VERBI GmbH, 2023). On each study site, at least two native-speaking coders independently code and analyse all sections of the transcripts in a hierarchical procedure. The coding involves trauma reactions, the cultural context of these reactions, and scripts. Further details on the coding will be presented in the future papers of the Network Project.

2.2.4. Creation of culture-specific CSTIs

Based on the qualitative analysis results, the PRE-CSTI will be updated and tailored to the specific cultural groups. For this purpose, the frequencies and types of codes for specific trauma expressions are analysed and then compared with the PRE-CSTI items. If a frequent code is identical or very similar to an already existing item in the PRE-CSTI, then this item is retained. A low code frequency suggests no inclusion to the new list. PRE-CSTI items which have few or no references in the coding system are deleted. A high frequency of a code, which does not correspond to a PRE-CSTI item and therefore represents a new trauma sequelae element, leads to the inclusion of this code in the form of a new item. The formulation of new items should be appropriately implemented based on the evaluation of the researchers.

Although the frequency of codes is the most important criterion for the inclusion, retention, or exclusion of an item, there are no specific cutoff numbers provided for the code frequencies. At what frequency an item is included, retained, or excluded is based on the nature of the code categories and subject to the evaluation of the researchers who are best able to interpret their code system in its entirety and the significance of the specific codes. High and low code frequencies might profoundly differ between data sets. Therefore, the relative frequency should be considered when deciding if items are included, retained, or excluded. As a result of this process, CSTIs related to the specific cultural groups should be developed. The final number of items is also subject to the researcher’s evaluation. The finalised item pool should properly represent the variety of experiences of the investigated population. However, a parsimonious inclusion of items should be applied.

2.2.5. Analysis of temporal scripts

The codes for the scripts of trauma should be listed, ordered based on their similarities to other codes, and further analysed. The script elements, such as specific emotions related to behaviours sequences, are also linked to similar or identical elements in other scripts. With this procedure, a network of script elements can be created to better understand trauma-related reaction patterns in a specific culture. The examination should result in initial concepts of cultural scripts of traumatic stress, which is also subject to an exploratory comparison between the cultural groups.

2.2.6. Participants

Sub-study I includes adults aged 18 or older who experienced any kind of traumatic life events consistent with the DSM-5 (American Psychiatric Association, 2013). We aim to generate a broad sample variety, including diversity in age, life stressors, and gender. It is furthermore required that participants feel affiliated with their respective cultural groups. This includes that participants are socialised in their culture (e.g. born and raised in the respective culture), have a proficient command of the local language, and perceive a high level of identification with the cultural group. Moreover, trauma survivors should express PTSD or CPTSD symptoms to varying degrees to participate in the study. In sub-study I, trauma experts are also involved, which may be psychotherapists, medical professionals such as psychiatrists or GP’s, but also other experts who are specialised in trauma, such as psychiatric nurses. Acute suicidality and psychosis are employed as exclusionary factors. In sub-study I, each study site should target a minimum of 4 focus groups or 12 individuals (e.g. 4 focus groups, each consisting of 3 participants, aiming at an equal representation of experts and trauma survivors overall) to reach a sufficient amount of data for the qualitative analysis (Hennink & Kaiser, 2022). However, researchers are strongly encouraged to include more participants and to continue data collection until a robust and reliable dataset is generated. Recruitment takes place in psychotherapy inpatient and outpatient centres, victim support organisations, online platforms, or other relevant networks in each study site. Researchers in the different study sites are encouraged to provide some sort of incentive or compensation for the study participation depending on the local resources and norms. Study information and written informed consent should be provided prior to all data collection procedures. This Network Project follows an inclusive and tolerant research agenda. Therefore, no participants are excluded based on their political beliefs, sexual orientation, or any other personal characteristics in any of the study sites.

2.3. Sub-study II

2.3.1. Validation of the CSTIs and investigation of the cascade model

In sub-study II, the validation of the CSTIs takes place in the form of a questionnaire survey. This assessment is informed by the Cascade Model (see Figure 1). In each study site, participants who experienced traumatic life events are asked to complete the CSTI generated from sub-study I and various other measures (see materials below). To investigate and validate the CSTIs, an item reduction procedure is implemented to exclude items that have little or no contribution to the CSTI. Furthermore, the CSTIs from the different cultural groups are descriptively compared to investigate the item overlap. In addition, the collected data will be used for hierarchical regression models to analyze the association of the different cascade model elements.

2.3.2. Participants

Similar to sub-study I, sub-study II is focused on adults (aged 18 or older) who experienced traumatic life events, express PTSD symptoms, and feel affiliated with their respective cultural groups. Table 2 includes all inclusion and exclusion criteria. G*Power software (Faul et al., 2007) was used for the sample size calculation, including a power of 0.80 and an Alpha level of 0.05. Hierarchical regression models with 5 predictors (trauma exposure, age, gender, culture, and cultural value orientations) are performed and require a sample size of at least 263 participants in each study site. Recruitment should be carried out through flyers and online forums and by contacting a broad range of psychosocial institutions and professionals in each study site. In addition, all study sites are encouraged to provide participation incentives. Study information and written informed consent should be provided prior to data collection.

Table 2.

Inclusion and exclusion criteria for participation in sub-study II.

Inclusion criteria Exclusion criteria
Aged 18 or older Acute suicidality
Exposure to traumatic life event(s)
PTSD symptoms Psychosis
Cultural affiliation
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2.3.3. Study materials

In sub-study II, a survey assessment is implemented, containing various different materials. The study format includes online or paper pencil questionnaires. At the beginning of the survey, basic demographic information such as age or gender is assessed. The culture-specific CSTIs, which are developed in sub-study I, are included as an additional assessment tool. (C)PTSD is determined using the International Trauma Questionnaire (ITQ; Cloitre et al., 2018). Value orientations and social axioms are assessed using the value categorisation of Schwartz (2006). The CSTI serves to operationalise cultural scripts of trauma. Lastly, the assessment of cultural syndromes is included depending on the study sites and their corresponding cultural syndromes. Some of the study materials are not yet translated into the languages of the different study sites. In this case, a back translation procedure should be conducted to ensure a valid assessment.

3. Discussion

The present Network Project is one of the first large and global studies on trauma sequelae and their different cultural manifestations. The timing of this Network Project is critical given the current global situation of rising wars, traumatic events, and their consequences. As a result, we expect to find culturally specific trauma reactions within the participant groups involved in this Network Project. We also anticipate that there will be both shared trauma reactions and distinct trauma sequelae occurring in the different regions when comparing the results. However, we also acknowledge various limitations. The different study sites are not homogenous cultural groups. All regions and countries included in this Network Project are comprised of numerous subgroups and individuals with different backgrounds, limiting the implications of our findings. It is also noteworthy that some study elements are based on culture-specific assumptions. For instance, the concepts of PTSD and CPTSD are globally recognised and applicable (World Health Organization, 2023), however, originated in a Western research context, which could confound the results in non-Western study sites. Further limitations include the explorative and partially subjective or biased nature of the qualitative studies and the possibly limited generalisation of the results. Despite these limitations, this research holds significant implications for both the theoretical and practical realms of trauma and culture. We hope that the unique global approach of the current Network Project will serve as a facilitator for further cross-cultural studies in the areas of trauma and psychopathology. In future studies, alternative or supplemental analyses may be implemented and the current cascade model could undergo further investigation and alteration. Moreover, new models or overarching theories may be developed, drawing from the results provided in sub-studies I and II. Future publications of this Network Project will not only address trauma sequelae in a research context but also try to provide implications for diagnostic processes and psychotherapy. The CSTIs will contain trauma-related experiences which allow clinicians to recognise trauma-related symptom patterns more easily in certain cultures. This process also contributes to implementing psychotherapeutic methods. For example, certain cultures may exhibit prevalent distressing physical sensations, allowing clinicians to recognise and tailor treatments according to these psychological challenges and the cultural background of their patients. Therefore, the outcome of this Network Project can be used to improve the screening, assessment, and treatment of individuals affected by trauma.

Supplementary Material

Supplementary_materials.docx
ZEPT_A_2364998_SM3578.docx (168.1KB, docx)

Funding Statement

This Network Project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability statement

No data was collected for this study protocol.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary_materials.docx
ZEPT_A_2364998_SM3578.docx (168.1KB, docx)

Data Availability Statement

No data was collected for this study protocol.

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