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Development and Piloting the MMMM Ecological Interactive Open Systems Model: A Prospective One-Year Treatment Outcome of Children of Tortured Refugees

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DOI: 10.4236/psych.2015.610125    2,190 Downloads   2,718 Views   Citations


Children of refugee torture survivors present a compelling case of cumulative and continuous chronic past and current traumas and complex post-cumulative trauma symptoms. Traditional models of interventions with victims of single past traumas may not be effective with such victims. The goal is to develop and initially test a new open multi-systemic, multi-component and multi-modal intervention model (MMMM) as applied in the context of Summer Day Treatment and After School (SDTAS) program, and to determine its potential effectiveness as well as the feasibility of a larger study with more rigorous experimental design. A total of 27 secondary torture survivor Iraqi refugee children (13 males and 14 females, age between 11-16), living in the US, who suffered from serious symptoms and were non-responsive to treatment as usual for at least the previous six months, completed the planned interventions and three times follow-up assessments of five domains: PTSD, complex PTSD, anxiety, depression, and global level of functioning (GAF). Repeated measure analysis of variance was used to analyze changes over the three time points. Results indicated significant decrease in symptoms, and increased GAF with high effect sized (Partial Eta Squared ranged between 0.85 - 0.93). The amount of change displayed by the treated individuals was large enough to be clinically meaningful. Current study provides evidence of potential effectiveness of this novel intervention and of the feasibility of more rigorous and larger future controlled clinical trials to help develop evidence-based treatments for the multiply traumatized children who suffer past and present ongoing adversities. We suggest that the model is cost effective, and can be conducted with children of torture survivors and refugees in different settings world-wide by professionals or by trained supervised para-professionals.

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Kira, I. , Lewandowski, L. , Ashby, J. and Omidy, A. (2015) Development and Piloting the MMMM Ecological Interactive Open Systems Model: A Prospective One-Year Treatment Outcome of Children of Tortured Refugees. Psychology, 6, 1277-1296. doi: 10.4236/psych.2015.610125.


[1] Altshuler, B. (1981). Modeling of Dose-Response Relationships. Environmental Health Perspectives, 42, 23-27.
[2] Berger, M., & Sarnya, Z. (2014). “More Than Skin Deep”: Stress Neurobiology and Mental Health Consequences of Racial Discrimination. Stress, Online First.
[3] Bhugra, D. (2004). Migration and Mental Health. Acta Psychiatrica Scandinavica, 109, 243-258.
[4] Bracken, P. J., Giller, J. E., & Summerfield, D. (1997). Rethinking Mental Health Work with Survivors of Wartime Violence and Refugees. Journal of Refugee Studies, 10, 431-442.
[5] Brookman-Frazee, L., Stahmer, A., Baker-Ericzen, M., & Tsai, K. (2006). Parenting Interventions for Children with Autism Spectrum and Disruptive Behavior Disorders: Opportunities for Cross-Fertilization. Clinical Child and Family Psychology Review, 9, 181-200.
[6] Bruns, E. J., Pullmann, M. D., Sather, A., Brinson, R. D., & Ramey, M. (2015). Effectiveness of Wraparound versus Case Management for Children and Adolescents: Results of a Randomized Study. Administration and Policy in Mental Health and Mental Health Services Research, 42, 309-322.
[7] Campbell, N. C., Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F. et al. (2007). Designing and Evaluating Complex Interventions to Improve Health Care. British Medical Journal, 334, 455-459.
[8] Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S. et al. (2014). The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders? Clinical Psychological Science, 2, 119-137.
[9] Chapman, L., Morabito, D., Ladakakos, C., Schreier, H., & Knudson, M. M. (2001). The Effectiveness of Art Therapy Interventions in Reducing Post-Traumatic Stress Disorder (PTSD) Symptoms in Pediatric Trauma Patients. Art Therapy: Journal of the American Art Therapy Association, 18, 100-104.
[10] Chu, B. C., Merson, R. A., Zandberg, L. J., & Areizaga, M. (2012). Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety. Cognitive and Behavioral Practice, 19, 5-16.
[11] Cicchetti, D., & Cohen, D. (1995). Perspectives on Developmental Psychopathology. In D. Cicchetti, & D. Cohen (Eds.), Developmental Psychopathology: Volume 1. Theory and Methods (pp. 3-22). New York: John Wiley.
[12] Classen, C. C., Palesh, O. G., Cavanaugh, C. E., Koopman, C., Kaupp, J. W., Kraemer, H. C. et al. (2011). A Comparison of Trauma-Focused and Present-Focused Group Therapy for Survivors of Childhood Sexual Abuse: A Randomized Controlled Trial. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 84-93.
[13] Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: Guilford Press.
[14] Courtois, C. A., & Ford, J. D. (2013). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. New York: Guilford Press.
[15] Cox, K., Baker, D., & Wong, M. A. (2010). Wraparound Retrospective Factors Predicting Positive Outcomes. Journal of Emotional and Behavioral Disorders, 18, 3-13.
[16] Ellis, B. H., Miller, A. B., Abdi, S., Barrett, C., Blood, E. A., & Betancourt, T. S. (2013). Multi-Tier Mental Health Program for Refugee Youth. Journal of Consulting and Clinical Psychology, 81, 129-140.
[17] Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of Serious Mental Disorder in 7000 Refugees Resettled in Western Countries: A Systematic Review. The Lancet, 365, 1309-1314.
[18] Figley, C. R. (1988). A Five-Phase Treatment of Post-Traumatic Stress Disorder in Families. Journal of Traumatic Stress, 1, 127-141.
[19] Ford, J. D., & Courtois, C. A. (Eds.) (2013). Treating Complex Traumatic Stress Disorder in Children and Adolescents. New York: Guilford Press.
[20] Ford, J. D., & Russo, E. (2006). Trauma-Focused, Present-Centered, Emotional Self-Regulation Approach to Integrated Treatment for Posttraumatic Stress and Addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET). American Journal of Psychotherapy, 60, 335-355.
[21] Gaertner, S. L., & Dovidio, J. F. (2005). Categorization, Re-Cateogrization and Intergroup Bias. In J. F. Dovidio, P. Glick, & L. Rudman (Eds.), Reflecting on the Nature of Prejudice (pp. 71-88). Philadelphia, PA: Psychology Press.
[22] Gerger, H., Munder, T., & Barth, J. (2013). Specific and Nonspecific Psychological Interventions for PTSD Symptoms: A Meta-Analysis with Problem Complexity as a Moderator. Journal of Clinical Psychology, Advance Online Publication.
[23] Goodman, R. D., & West-Olatunji, C. A. (2009). Applying Critical Consciousness: Culturally Competent Disaster Response Outcomes. Journal of Counseling & Development, 87, 458-465.
[24] Goodman, R., & Gorski, P. C. (Eds.) (2015). Decolonizing “Multicultural” Counseling through Social Justice (International and Cultural Psychology). New York: Springer.
[25] Grist, R., & Cavanagh, K. (2013). Computerized Cognitive Behavioral Therapy for Common Mental Health Disorders, What Works, for Whom under What Circumstances? A Systematic Review and Meta-Analysis. Journal of Contemporary Psychotherapy, 43, 243-251.
[26] Gunderson, J. G. (1978). Defining the Therapeutic Process in Psychiatric Milieus. Psychiatry: Journal for the Study of Interpersonal Processes, 41, 327-335.
[27] Huang, D., & Cho, J. (2009). Academic Enrichment in High Functioning Homework After-School Programs. Journal of Research in Childhood Education, 23, 382-392.
[28] IRC Commission on Iraqi Refugees Report (2009). Iraqi Refugees in the US in Dire Straits.
[29] Keeley, J. W., Chmielewski, M. S., & Bagby, R. M. (2015). Interaction Effects in Comorbid Psychopathology. Comprehensive Psychiatry, 60, 35-39.
[30] Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication (NCSR). Archives of General Psychiatry, 62, 617-627.
[31] Kira, I. (2002). Torture Assessment and Treatment: The Wraparound Approach. Traumatology, 8, 54-86.
[32] Kira, I. (2004). Secondary Trauma in Treating Refugee Survivors of Torture: Assessing and Responding to Secondary Traumatization in the Survivors’ Families. Torture, 14, 38-44.
[33] Kira, I. (2013). Interventions with Continuous Traumatic Stress of Discrimination in Youth. Proceedings of the International Symposium on Arab Youth: Developmental Pathways for Identity, Windsor, 29-30 May 2013.
[34] Kira, I. A. (2001). Taxonomy of Trauma and Trauma Assessment. Traumatology, 7, 73-86.
[35] Kira, I. A. (2010). Etiology and Treatments of Post-Cumulative Traumatic Stress Disorders in Different Cultures. Traumatology: An International Journal, 16, 128-141.
[36] Kira, I. A., Amer, M. M., & Wrobel, N. H. (2014). Arab Refugees: Trauma, Resilience, and Recovery. In S. C. Nassar-McMillan, K. J. Ajrouch, & J. Hakim-Larson (Eds.), Biopsychosocial Perspectives on Arab Americans: Culture, Development, and Health (pp.175-195). New York: Springer.
[37] Kira, I. A., Ashby J. S., Lewandowski, L., Alawneh, A. W. N., Mohanesh, J., & Odenat, L. (2013). Advances in Continuous Traumatic Stress Theory: Traumatogenic Dynamics and Consequences of Intergroup Conflict: The Palestinian Adolescent’s Case. Psychology, 4, 396-409.
[38] Kira, I. A., Ashby, J. S., Odenat, L., & Lewandowski, L. (2013). The Mental Health Effects of Torture Trauma and Its Severity: A Replication and Extension. Psychology, 4, 472-482.
[39] Kira, I. A., Fawzi, M. H., & Fawzi, M. M. (2013). The Dynamics of Cumulative Trauma and Trauma Types in Adults Patients with Psychiatric Disorders: Two Cross-Cultural Studies. Traumatology, 19, 179-195.
[40] Kira, I. A., Lewandowsi, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2010). The Effects of Perceived Discrimination and Backlash on Iraqi Refugees’ Physical and Mental Health. Journal of Muslim Mental Health, 5, 59-81.
[41] Kira, I. A., Lewandowsk, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2008). Measuring Cumulative Trauma Dose, Types and Profiles Using a Development-Based Taxonomy of Trauma. Traumatology, 14, 62-87.
[42] Kira, I. A., Lewandowski, L., Ashby, J. S., Somers, C., Chiodo, L., & Odenat, L. (2014). Does Bullying Victimization Suppress IQ? The Effects of Bullying Victimization on IQ in Iraqi and African American Adolescents: A Traumatology Perspective. Journal of Aggression, Maltreatment, and Trauma, 23, 431-453.
[43] Kira, I. A., Omidy, A. Z., & Ashby, J. S. (2014). Cumulative Trauma, Appraisal and Coping in Palestinian and American Indian Adults: Two Cross-Cultural Studies. Traumatology: An International Journal, 20, 119-133.
[44] Kira, I. A., Omidy, A. Z., Fawzi, M., Rice, K. G., Fawzi, M., Lewandowski, L., & Bujold-Bugeaud, M. (2015). Are the Negative Mental Health Effects of Gender Discrimination (GD) Salient across Cultures? Does Self-Esteem Mediate These Effects: GD as a Continuous Traumatic Stress and the Pathways to Its Negative Dynamics? Psychology, 6, 93-116.
[45] Kira, I. A., Smith, I., Lewandowski, L., &Templin, T. (2010). The Effects of Perceived Gender Discrimination on Refugee Torture Survivors: A Cross-Cultural Traumatology Perspective. Journal of the American Psychiatric Nurses Association, 16, 299-306.
[46] Kira, I. A., Templin, T., Lewandowski, L., Ashby, J. S., Oladele, A., & Odenat, L. (2012). Cumulative Trauma Disorder Scale (CTD): Two Studies. Psychology, 3, 643-656.
[47] Kira, I. A., Templin, T., Lewandowski, L., Clifford, D., Wiencek, P., Hammad, A., & Al-Haidar, A. M. (2006). The Effects of Torture: Two Community Studies. Peace and Conflict: Journal of Peace Psychology, 12, 205-228.
[48] Kira, I. A., Wroble, N. H. (In Press). Trauma: Stress, Coping, and Emerging Treatment Models. In M. M. Amer, & G. H. Awad (Eds.), Handbook of Arab American Psychology. New York: Routledge.
[49] Kira, I., & Tummala-Narra, P. (2014). Psychotherapy with Refugees: Emerging Paradigms. Journal of Loss and Trauma: International Perspectives on Stress & Coping, Online First Publication.
[50] Kira, I., Alawneh, A., Aboumediene, S., Lewandowski, L., & Laddis, A. (2014). Dynamics of Oppression and Coping from Traumatology Perspective: The Example of Palestinian Youth. Peace and Conflict: Journal of Peace Psychology, 20, 385-411.
[51] Kira, I., Ashby, J. S., Omidy, A. Z., & Lewandowski, L. Current, Continuous, and Cumulative Trauma-Focused Cognitive Behavior Therapy (CCC-TF-CBT). Journal of Mental Health Counseling, Invited Paper Submitted for Publication, in Press.
[52] Kira, I., Ashby, J., Lewandowski, L., Smith, I., & Odenat, L. (2012). Gender Inequality and Its Effects in Females Torture Survivors. Psychology, 3, 352-363.
[53] Kira, I., Hammad, A., Lewandowski, L., Templin, T., Ramswamy, V., Ozkan, B., & Mohanesh, J. (2007). The Physical and Mental Status of Iraqi Refugees and Its Etiology. Ethnicity & Disease, 17, 79-82.
[54] Kira, I., Lewandowki, L., Chiodo, L., & Ibrahim, A. (2014). Advances in Systemic Trauma Theory: Traumatogenic Dynamics and Consequences of Backlash as a Multi-Systemic Trauma on Iraqi Refugee Muslim Adolescents. Psychology, 5, 389-412.
[55] Kira, I., Templin, T., Lewandowski, L., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2008). The Physical and Mental Health Effects of Watching Reports of the Iraqi War on Iraqi Refugees. Journal of Muslim Mental Health, 3, 193-215.
[56] Krueger, R. F., & Markon, K. E. (2006). Reinterpreting Comorbidity: A Model-Based Approach to Understanding and Classifying Psychopathology. Annual Review of Clinical Psychology, 2, 111-133.
[57] Laceulle, O., Vollebergh, W., & Ormel, J. (2015). The Structure of Psychopathology in Adolescence: Replication of a General Psychopathology Factor in the TRAILS Study. Clinical Psychological Science, On Line First.
[58] Lambert, J. E., Engh, R., Hasbun, A., & Holzer, J. (2012). Impact of Posttraumatic Stress Disorder on the Relationship Quality and Psychological Distress of Intimate Partners: A Meta-Analytic Review. Journal of Family Psychology, 26, 729-737.
[59] Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the Lens of Evidence-Based Practice in Psychotherapy: A Common Factors Perspective. Psychotherapy, 51, 467-481.
[60] Lavoria, P. W., & Dawson, R. (2014). Introduction to Dynamic Treatment Strategies and Sequential Multiple Assignment Randomization. Clinical Trials, 11, 393-399.
[61] Levitt, J. T., Malta, L. S., Martin, A., Davis, L., & Cloitre, M. (2007). The Flexible Application of a Manualized Treatment for PTSD Symptoms and Functional Impairment Related to the 9/11 World Trade Center Attack. Behaviour Research & Therapy, 45, 1419-1433.
[62] Lewis, G., Rice, F., Harold, G. T., Collishaw, S., & Thapar, A. (2011). Investigating Environmental Links between Parent Depression and Child Depressive/Anxiety Symptoms Using an Assisted Conception Design. Journal of American Academy of Child and Adolescent Psychiatry, 50, 451-459.
[63] Liu, S., Huang, J. L., & Wang, M. (2014). Effectiveness of Job Search Interventions: A Meta-Analytic Review. Psychological Bulletin, 140, 1009-1041.
[64] Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation of Australia.
[65] Lyman, D. R., Kurtz, M. M., Farkas, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S., & Delphin-Rittmon, M. (2014). Skill Building: Assessing the Evidence. Psychiatric Services, 65, 727-738.
[66] Mallinckrodt, B., Miles, J. R., & Levy, J. J. (2014). The Scientist-Practitioner-Advocate Model: Addressing Contemporary Training Needs for Social Justice Advocacy. Training and Education in Professional Psychology, Advance Online Publication.
[67] McColl, H., Higson-Smith, C., Gjerding, S., Omar, M. H., Rahman, B. A., Hamed, M., & Awad, Z. (2010). Research Rehabilitation of Torture Survivors in Five Countries: Common Themes and Challenges. International Journal of Mental Health Systems, 4, 1-10.
[68] McEvoy, P. M., Nathan, P., & Norton P. J. (2009). Efficacy of Transdiagnostic Treatments: A Review of Published Outcome Studies and Future Research Directions. Journal of Cognitive Psychotherapy, 23, 20-33.
[69] McFarlane, C. A., & Kaplan, I. (2012). Evidence-Based Psychological Interventions for Adult Survivors of Torture and Trauma: A 30-Year Review. Transcultural Psychiatry, 49, 539-567.
[70] McGhee, S. A., Groff, D. G., & Russoniello, C. V. (2005). We Care Too: Providing Community-Based Therapeutic Recreation Services for Youth with Emotional and Behavioral Disorders. Therapeutic Recreation Journal, 39, 32-46.
[71] Montgomery, E. C., Kunik, M. E., Wilson, N., Stanley, M. A., & Weiss, B. (2010). Can Paraprofessionals Deliver Cognitive-Behavioral Therapy to Treat Anxiety and Depressive Symptoms? Bulletin of Menninger Clinic, 74, 45-62.
[72] Moses, E. B., & Barlow, H. (2006). A New Unified Treatment Approach for Emotional Disorders Based on Emotion Science. Current Directions in Psychological Science, 15, 146-150.
[73] Murray, L. K., Cohen, J. A., & Mannarino, A. P. (2013). Trauma-Focused Cognitive Behavioral Therapy for Youth Who Experience Continuous Traumatic Exposure. Peace and Conflict: Journal of Peace Psychology, 19, 180-195.
[74] Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press.
[75] Najavits, L. M. (2006). Present versus Past-Focused Therapy for Posttraumatic Stress Disorder/Substance Abuse. Brief Treatment and Crisis Intervention, 6, 248-254.
[76] Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A Critical Review of Psychological Treatments of Posttraumatic Stress Disorder in Refugees. Clinical Psychology Review, 31, 399-417.
[77] North, C. S., Pollio, D. E., Hong, B. A., Pandya, A., Smith, R., & Pfefferbaum, B. (2015). The Post-Disaster Prevalence of Major Depression Relative to PTSD in Survivors of the 9/11 Attacks on the World Trade Center Selected from Affected Workplaces. Comprehensive Psychiatry, 60, 119-125.
[78] Painter, K. (2012). Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care. Child & Youth Care Forum, 41, 407-425.
[79] Papas, R. K., Sidle, J. E., Gakinya, B. N., Baliddawa, J. B., Martino, S., Mwaniki, M. M. et al. (2011). Treatment Outcomes of a Stage 1 Cognitive-Behavioral Trial to Reduce Alcohol Use among Human Immunodeficiency Virus Infected Out-Patients in Western Kenya. Addiction, 106, 2156-2166.
[80] Pascoe, E. A., & Richman, S. L. (2009). Perceived Discrimination and Health: A Meta-Analytic Review. Psychological Bulletin, 135, 531-554.
[81] Pearlin, L. I., Aneshensel, C. S., & Leblanc, A. J. (1997). The Forms and Mechanisms of Stress Proliferation: The Case of AIDS Caregivers. Journal of Health and Social Behavior, 38, 223-236.
[82] Radloff, L. S. (1991). The Use of the Center for Epidemiologic Studies Depression Scale in Adolescents and Young Adults. Journal of Youth and Adolescence, 20, 149-166.
[83] Raghavan, S., Rasmussen, A., Rosenfeld, B., & Keller, A. S. (2013). Correlates of Symptom Reduction in Treatment-Seeking Survivors of Torture. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 377-393.
[84] Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative Exposure Therapy for 7-to 16-Year- Olds: A Randomized Controlled Trial with Traumatized Refugee Children. Journal of Traumatic Stress, 23, 437-445.
[85] Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach. New York: Guilford Press.
[86] Scheepers, D., Spears, R., Manstead, A. S., & Doosje, B. (2009). The Influence of Discrimination and Fairness on Collective Self-Esteem. Personality and Social Psychology Bulletin, 35, 505-515.
[87] Selten, J., Cantor-Graae, E., & Kahn, R. (2007). Migration and Schizophrenia. Current Opinion in Psychiatry, 20, 111-115.
[88] Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. et al. (2013). A Wraparound Treatment Engagement Intervention for Homeless Veterans with Co-Occurring Disorders. Psychological Services, 10, 161-167.
[89] Springer, K., & Diffily, D. (2012). The Relationship between Intensity and Breadth of After-School Program Participation and Academic Achievement: Evidence from a Short-Term Longitudinal Study. Journal of Community Psychology, 40, 785-798
[90] Stensland, M., Watson, P. R., & Grazier, K. L. (2012). An Examination of Costs, Charges, and Payments for Inpatient Psychiatric Treatment in Community Hospitals. Psychiatric Services, 63, 666-671.
[91] Summerfield, D. (1999). A Critique of Seven Assumptions behind Psychological Trauma Programs in War-Affected Areas. Social Science and Medicine, 48, 1449-1462.
[92] Suter, J. C., & Bruns, E. J. (2009). Effectiveness of the Wraparound Process for Children with Emotional and Behavioral Disorders: A Meta-Analysis. Clinical Child and Family Psychology Review, 12, 336-351.
[93] Tabachnick, B. G., & Fidell, L. S. (2013). Using Multivariate Statistics (6th ed.). Boston, MA: Pearson.
[94] Terr, L. C. (1991). Childhood Traumas: An Outline and Overview. American Journal of Psychiatry, 148, 10-20.
[95] Tong, H. (1978). On a Threshold Model. In: C. Chen (Ed.), Pattern Recognition and Signal Processing (pp. 575-586). Alphen aan den Rijn, The Netherlands: Sijthoff & Noordhoff.
[96] Travagina, G., Margolaa, D., &. Revensonb, T. A. (2015). How Effective Are Expressive Writing Interventions for Adolescents? A Meta-Analytic Review. Clinical Psychology Review, 36, 42-55.
[97] Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001). Clinician-Administered PTSD Scale: A Review of the First Ten Years of Research. Depression and Anxiety, 13, 132-156.
[98] Weinfurt, K. (2000). Repeated Measures Analysis: ANOVA, MANOVA, and HLM. In L. Grimm, & R. Yarnold (Eds.), Reading and Understanding MORE Multivariate Statistics (pp. 317-361). Washington DC: American Psychological Association.
[99] Zhang, L., Wang, H. J., & Zhu1, Z. (2014). Testing for Change Points Due to Covariate Threshold in Quantile Regression. Statistica Sinica, 24, 1859-1877.

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