The Function of Specialized Vocabulary Development in Psychosocial Rehabilitation in Traumatized Populations

Journal of Human Rights and Social Work, Jan 2018

This paper presents a model for the function of specialized vocabulary schemes in the development, implementation, and dissemination of trauma rehabilitation initiatives. With 65.3 million forcibly displaced people worldwide, of whom 21.3 million are recognized refugees (UNHCR 2016), understanding trauma rehabilitation is timely. This paper takes an interest in the effects of interventions that leverage specialized vocabulary schemes to assist victims of conflict to overcome psychosocial trauma. Lessons are taken from three research studies conducted in conflict and post-conflict environments, which are discussed in the context of literature that demonstrates how vocabulary development is critical to psychosocial rehabilitation. From a review of these studies, a model of the function of specialized vocabulary schemes in the development, implementation, and dissemination of trauma rehabilitation initiatives is presented. Rehabilitation using one's own language is key to the restoration of human rights after ongoing psychological torture as it provides a means for categorizing experiences and developing understandings.

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The Function of Specialized Vocabulary Development in Psychosocial Rehabilitation in Traumatized Populations

Journal of Human Rights and Social Work https://doi.org/10.1007/s41134 The Function of Specialized Vocabulary Development in Psychosocial Rehabilitation in Traumatized Populations Alison S. Willis 0 1 2 Michael C. Nagel 0 1 2 0 School of Education, University of the Sunshine Coast , Sippy Downs Drive, Sippy Downs 4556 , Australia 1 School of Education, University of the Sunshine Coast , Sippy Downs Drive, Sippy Downs, QLD , Australia 2 Alison S. Willis This paper presents a model for the function of specialized vocabulary schemes in the development, implementation, and dissemination of trauma rehabilitation initiatives. With 65.3 million forcibly displaced people worldwide, of whom 21.3 million are recognized refugees (UNHCR 2016), understanding trauma rehabilitation is timely. This paper takes an interest in the effects of interventions that leverage specialized vocabulary schemes to assist victims of conflict to overcome psychosocial trauma. Lessons are taken from three research studies conducted in conflict and post-conflict environments, which are discussed in the context of literature that demonstrates how vocabulary development is critical to psychosocial rehabilitation. From a review of these studies, a model of the function of specialized vocabulary schemes in the development, implementation, and dissemination of trauma rehabilitation initiatives is presented. Rehabilitation using one's own language is key to the restoration of human rights after ongoing psychological torture as it provides a means for categorizing experiences and developing understandings. Language development; Vocabulary schemes; Psychosocial rehabilitation programs; Education for rehabilitation Introduction This paper discusses how human language functions, particularly vocabulary development, are critical to psychosocial rehabilitation in traumatized populations. Human torture and degradation is a violation of Article 5 of the Universal Declaration of Human Rights (UDHR, United Nations 1948) , and is problematic for war-affected populations as the effects of torture and degradation last long after conflict has ceased. Literature pertaining to language learning and vocabulary development is reviewed and applied to three empirical research studies that were conducted in conflict-affected Northern Uganda. Although Northern Uganda has been without conflict since 2006, it is argued that the lessons learnt from research that was conducted during and after the most recent war are applicable to more recent conflict-affected contexts and similarly traumatized * populations. Descriptions of trauma symptoms and their associated meanings are culturally specific (Bolton et al. 2007) . Bolton et al. (2007) found that not all terms in psychological assessment inventories are transferable between cultures. One reason for this is the influence of cultural beliefs and worldviews on conceptions of mental health, and Honwana (2011) asserts that Western notions cannot be directly imported into African contexts. Therefore, the development of specialized vocabulary to (a) describe trauma symptoms, including depression and anxiety symptoms, and pro-social behaviors, and (b) develop interventions that are culturally sensitive, is of utmost importance. Common understandings between patient and clinician and/or carer must be established if help is to be offered and received. For example, three local descriptions of depression were identified in the study by Bolton and associates (2007)—two tam, kumu, and par in the Acholi language. These descriptions were developed through cross-cultural validity and reliability testing (Bolton 2001) . Furthermore, through educational processes and mediated learning experiences (Hari and Kujala 2009) , language acquisition and vocabulary development can be used to facilitate psychosocial rehabilitation in everyday contexts like schools, community groups, and families. A model for the function of vocabulary schemes (including the connotative and denotative meaning of words and phrases) in the development, implementation, and dissemination of trauma rehabilitation is presented in this paper. This was developed from a review of literature that demonstrates how language has the potential to modify brain circuitries and activations and even change aspects of the brain’s neurophysiology as evident via psychotherapy (Hari and Kujala 2009, Pulvermuller 2005) . This synthesis of literature and research makes salient the role of language as an educational tool in psychosocial rehabilitation programs. What Does the Literature Say? Along with providing the primary mechanism for passing information and transmitting aspects of culture from one generation to the next (Ahola and Kovacik 2007) , language organizes, categorizes, and interprets experiences (Marton and Booth 1997; Pinker 2007) . The acquisition of language and the ability to communicate appear deceptively simple while the use of spoken language is one of the most uniquely human parameters that differentiate one human being from another. Significantly, while language is a vehicle for differentiating one person from another, it is also a uniquely human capacity, one that separates humans from all other living organisms (Hari and Kujala 2009). The words we choose and how we choose to express those words are based on a broad spectrum of neural functioning. Language is also our basic vehicle for communication and a fundamental means of expressing emotional states and engaging in social interaction. It allows us to express our thoughts and needs to others, and it is through the acquisition of vocabulary and language structures that we can generate meaning and make sense of our experiences. Trying to understand how language and vocabulary learning occurs has led to a large array of developmental theories; however, a failure to derive a unified understanding of how humans quickly develop their oral capacities and acquire language as a tool for learning has often rendered such theories problematic and debatable (Nagel 2012) . While much of this debate has moved forward via a great deal of empirical research around child development and children’s innate predispositions and incredible abilities to learn when exposed to language systems, we are still in the early stages of unpacking the mechanisms underlying the interplay between language and neural development (Kuhl 2010) . There are, however, some aspects of language and vocabulary development that appear universal and are complemented by our understanding of the brain. One of the most interesting aspects of language development in relation to the brain is that regardless of geography and culture, children develop their language capacities through social interactions and in a universal and sequential fashion resulting in four- or five-year-old children speaking in full and complex grammatical sentences (Kuhl 2010) . Therefore, and barring any injury or impairment to the brain, children will learn and master, without much difficulty and direct instruction, the various rules of language. One of the most prominent reasons to suspect that language is the product of an innate and distinct mental organ can be found in how it is localized in the brain (Eliot 2000) . Before the advent of current neuroimaging technology, researchers identified that regions of the left hemisphere were responsible for important functions of language. Such findings often resulted from studies of individuals of different ages who had suffered some measure of brain injury and/or trauma. For example, Paul Broca and Karl Wernicke, two researchers who studied language and aspects of brain injury, found that syntax and comprehension were largely responsibilities of the regions of the left hemisphere (Nagel 2012) . However, w h i l e t h e w o r k o f B r o c a a n d We r n i c k e h a s b e e n complemented by numerous other types of research acknowledging the left hemisphere as the dominant language hemisphere, there are other aspects of language development associated with verbal communication, such as prosody and inflection, that are not isolated to one specific region of the brain (Gandour et al. 2004) . In other words, contemporary understandings of language development highlight the complexity of such activity in the brain and that language is more appropriately associated with brain networks or circuits rather than specific areas (Ardila et al. 2016) . Concurrently, language is also associated with other important functions of the brain and mind. When discussing the role that language and vocabulary plays in psychosocial rehabilitation, it is important to discern between Bmemory formation^ and Blearning^ (Baddeley 1993) . Memory formation typically is an operation of the hippocampal and temporal lobes, whereas learning is both an internal and external process that results in modification of behavior by experience (Baddeley 1993) . Memory formation and learning are symbiotic; however, a cognitive study of psychological rehabilitation necessitates an understanding of learning experiences as opportunities for the acquisition of specialized vocabulary that can in turn be used to make sense of traumatic experiences. Brain trauma, whether physical or psychological, may indeed negatively impact memory functions; therefore, a therapist or teacher may have to negotiate variables including short-term and long-term memory viability, phonological and visual-spatial processes, prior local language learning, and cultural knowledge. Psychologist Reuven Feuerstein (Feuerstein et al. 2010) described the relationship between internal psychological processes and external social learning experiences in a model he called mediated learning, where a more-knowledgeable person uses language and specialized vocabulary to mediate experiences so that a learner creates informed and educated understandings. Processes of this kind may also occur within an individual, as cognitive resources such as intelligence, creativity, and mental flexibility have been found to be protective factors against psychological difficulties among children living in conflict situations (Tol et al. 2013) . It would seem, therefore, that the cortical systems for language are not independent or autonomous functional systems or modules. In terms of neurological rehabilitation, it becomes evident that language and communication play an integral role. Evidently, a connected approach to rehabilitation, which incorporates psychological views of the mind and social views of learning and language education and development, seems most appropriate. Furthermore, the environment begins to play a significant role in vocabulary language development, especially in terms of social interactions. Social interactions may activate brain mechanisms that invoke a sense of relationship between two individuals, and it is undeniable that language is an important component of such endeavor. In terms of language development, there is also evidence to suggest that the brain systems that link aspects of speech are only engaged when infants experience social interaction (Kuhl 2010) . Social learning theorist Lev Vygotsky (1978, 1986) asserted that learners use language as a cultural tool to make sense of their experiences through the process of socialization. Children both reciprocate and influence their culture by using signs and language (Vialle et al. 2005) . Vygotsky (1978, 1986) espoused the concept of the zone of proximal or potential development, where a child accomplishes much more by symbolic interaction with more competent others than he or she might independently. Many of the scaffolds constructed for a learner involve systems of language so that experiences can be categorized and meaning can be made. Vygotsky’s theory shares commonalities with other socialbased theories like Bandura’s (1986 , 2001) social cognitive theory, Bronfenbrenner’s (1979 ) ecology of human development, or Lave and Wenger’s (1991) situated learning theory. From theory to practice, this paper will now take a closer look at the role of specialized vocabulary and language in psychosocial rehabilitation. What Evidence of the Role of Specialized Vocabulary Development as a Tool for Psychosocial Rehabilitation Can Be Found in Post-war Contexts? The findings of three empirical studies are presented here to demonstrate the pivotal role of language and specialized vocabulary development and communication in psychosocial rehabilitation. These three studies were all conducted in war or post-war contexts in Northern Uganda, and built upon each other as the latter studies used the findings of the former studies. The research studies vary in methodologies, but the salient role of language development through learning as a mechanism for rehabilitation is evident in all three projects. All the facilitators in the Sonderegger et al. (2011) study and all the teachers in the Willis and Nagel (2015) study were local Acholi people. The collective evidence in this paper attests to the resilience of this conflict-affected population. Interventions for Depression Symptoms Among Survivors of War and Displacement in Northern Uganda Bolton et al. (2007) conducted interventions for depression symptoms among adolescent (14–17 years of age) survivors of war and displacement in Northern Uganda. These psychotherapy sessions were conducted in 2005 with 314 participants (N = 210 treatment participants and N = 104 wait-control group). Treatment participants were divided into two groups, the interpersonal psychotherapy group (IPT-G) (N = 105) and the creative play group (N = 105). Participants met weekly for treatment for 1.5–2 h for 16 weeks. The study hinged upon a locally developed screening tool that used local language to define depression-like and anxiety-like syndromes, the Acholi Psychological Assessment Inventory (APAI). Western equivalents were deemed culturally insensitive, so research was undertaken to define depression using local vocabulary and descriptions (Bolton et al. 2007; Bolton 2001) . This process elevated the existing knowledge of the Acholi people, and brought together African and Western understandings to achieve positive outcomes for participants. The Bolton et al. (2007) study found that there were no statistically different improvements in anxiety symptoms in either of the treatment groups, but there were significant improvements in depression-like symptoms among the female population in the IPT-G. In Bolton et al.’s (2007) study, the role of language as a communication tool for defining depression-like and anxietylike syndromes was critical. Verbal language mechanisms enabled communication and learning in IPT-G treatment sessions. IPT-G therapy involves the formation of groups, usually 6–8 participants with a facilitator of the same gender, and focused group discussions. The aim of IPT-G is the improvement of depressive symptoms and functioning by identifying interpersonal problems relevant to depression and facilitating individuals in building skills to manage these problems. Participants used language as a mechanism to share and discuss experiences, and understand their interpersonal problems. It was found that IPT-G in Bolton et al.’s (2007) study was more effective among girls, and concluded that boys may be less willing to discuss emotional problems in a group format. Given the evidence above it appears that the use of local language and specialized vocabulary development played a pivotal role in learning about and understanding emotional problems and depression-like syndromes, and identifying and implementing problem management plans. Later research by Sonderegger, Rombouts, Ocen, and McKeever (2011, below) built upon Bolton et al.’s (2007) research in the treatment of anxiety, offering further evidence of language as a mechanism for psychosocial rehabilitation. Trauma Rehabilitation for War-Affected Persons in Northern Uganda Empirical quantitative research conducted by Sonderegger et al. (2011) demonstrated the efficacy of a cognitive behavior therapy (CBT) intervention for war-affected persons in Northern Uganda that employed language-based activities. This CBT program, EMPOWER, was developed by clinical psychologists in consultation with local community members in Uganda and offered participants a scheme of specialized vocabulary, drawing upon local understandings and cultural references, for understanding the symptoms of trauma. The research study (Sonderegger et al. 2011) had 202 participants (N = 90 treatment participants and N = 112 control participants) from two internally displaced peoples (IDP) camps and was used for the treatment of post-traumatic stress disorder (PTSD) and other war-related mental health issues, including anxiety and depression, that were measured using Bolton et al.’s (2007) locally defined screening tools. Thirteen 2-h sessions were designed to educate participants about emotional resiliency and reconciliation using biopsychosocial methods of intervention. To control for low literacy levels (a result of ongoing consecutive conflicts over four decades), education activities were delivered orally through group conversations, some use of diagrams, playing games, and storytelling. Culturally sensitive metaphors were used to teach psycho-physiological principals. For example, the effect of cortisol was likened to the effects of a snake bite. Facilitators used local discourses to teach participants how to identify and control physical responses to stress and trauma. Local facilitators offered the program in local language. By offering schemes of vocabulary, trauma symptoms were demystified and could be viewed scientifically. These metaphors extended to teach relaxation exercises and protective behaviors, and to challenge negative thoughts. Toward the end of the program, through conversation and storytelling, participants would disclose traumatic events in a one-to-one session with a trained facilitator. The facilitator would later identify one event for each group member to disclose to the whole group at a suitable time. The APAI, a culturally appropriate measure of psychosocial functioning in local language (Bolton et al. 2007) , was used to measure the efficacy of the EMPOWER program in the treatment of depressionlike and anxiety-like syndromes and the promotion of pro-social behaviors (Sonderegger et al. 2011) . The APAI measures were taken pre-intervention, post-intervention, and at a 3-month follow-up. It was found that EMPOWER, a language-based CBT intervention, proved efficacious in significantly lowering the score on three depressive scales and on one anxiety- and trauma-like scale. The program was deemed efficacious in relieving symptoms of stress in conflict zones (Sonderegger et al. 2011) . Furthermore, the local language-based screening instrument—the APAI—was also validated by the Sonderegger et al. study (2011) and further validated by later research conducted after the end of conflict in the Gulu area by McMullen, O’Callaghan, Richards, Eakin, and Rafferty (2012). The salience of language and specialized vocabulary development in rehabilitation is apparent in these studies. The Role that Teachers Play in Overcoming the Effects of Stress and Trauma in Children in Northern Uganda Drawing upon the research experiences of Bolton et al. (2007) and Sonderegger et al. (2011) , further empirical qualitative research was conducted in Northern Uganda by Willis (2012) . This research further demonstrated the pivotal role that vocabulary development plays in psychosocial rehabilitation (Willis and Nagel 2015) as it spotlighted the invaluable role that teachers play in linking the psychological and sociological domains in a child’s learning, thereby positively influencing their neurological programming. The study showed that local teachers have the potential to facilitate psychological rehabilitation and social development in learners by offering children schemes of vocabulary by which to organize and make sense of their experiences. Teachers in Northern Uganda communicate with children in both the local Acholi language and in English. Not only were teachers able to offer schemes of specialized vocabulary to explain trauma symptoms but they were also able to offer vocabulary that defined pro-social behaviors, through modeling safe and functional relationships, organizing secure and stimulating learning environments, and facilitating quality learning experiences. Data from this study demonstrated that one’s capacity to make sense of an experience is proportional to the complexity of one’s prior knowledge and understanding. For example, Ugandan teachers who demonstrated a greater capacity to describe, in depth, their experiences with the effects of trauma upon children’s learning had also had greater exposure to restorative processes in their communities. For example, trauma rehabilitation programs, the restoration of village fireplaces after years of displacement during conflict, or the local rituals for reconciling returned child soldiers. It was evident that teachers with greater breadth of experience had developed more complex schemas of knowledge and understanding and accompanying vocabulary schemes, to make sense of and communicate their experiences, and mediate the experience of their students within the Acholi culture. For example, during wartime, indigenous methods of learning around the fireplace were lost due to night raids and displacement in IDP camps. Teachers who had been involved in the restoration of village fireplaces as places of community and cross-generational learning were able to articulate previously lost cultural understandings to their students. This again demonstrates that language is a cornerstone of learning (Vygotsky 1978, 1986) , as it helps a learner to make meaning from their experiences. This is where the centrality of the teacher’s role in children’s learning becomes axiomatic. Through learning experiences, a teacher may provide a child with building blocks of knowledge and understanding, by offering cultural understandings and schemes of vocabulary so the child has the capacity to construct their own meaning. Local teachers may also be contributing to psychological rehabilitation as a tangential aspect of their pedagogical endeavors. A Model for the Function of Specialized Vocabulary Schemes in the Development, Implementation, and Dissemination of Trauma Rehabilitation Initiatives Synthesizing the findings of the three research projects and in alignment with respected literature, the following model (Fig. 1) has been developed to demonstrate a process for developing locally defined vocabulary schemes to describe trauma symptoms, developing culturally sensitive interventions, and disseminating Fig. 1 A model of the function of specialized vocabulary schemes in the development, implementation, and dissemination of trauma rehabilitation initiatives in postconflict areas vocabulary schemes into everyday conversation for wider effect. According to the model depicted in Figure 1, the development of a locally defined vocabulary scheme for trauma symptoms is the starting point for trauma rehabilitation initiatives (e.g., the APAI). This vocabulary scheme ought to be developed in consultation with local participants. Culturally sensitive interventions can use this language in practice, which over time becomes part of the local discourse, as illustrated in Fig. 1. Conclusions Language and vocabulary development is key to psychosocial rehabilitation, and the restoration of freedom after ongoing psychological torture (Article 5, UDHR, United Nations 1948) , as it provides a means for categorizing experiences and developing understandings. The development of specialized vocabulary involves both internal and external processes, which facilitate learning, psychological reframing, and neurological wiring or rewiring. It seems evident that rehabilitation programs that offer culturally sensitive schemes of vocabulary provide opportunities for participants to overcome the effects of war-related stress and trauma. The studies noted above exemplify the connectivity between language acquisition and vocabulary development and psychosocial rehabilitation through mediated learning experiences, and ratify the discussion of literature that calls for a connected approach in this regard. These findings are timely for policy and practice in an era of growing traumatized populations, and ought to be considered in Vocabulary schemes for locally-defined trauma systems. E.g. Bolton et al.'s (2007) APAI. The measurement of trauma symptoms. The development of culturally and contextuallysensi ve interven ons. The implementa on of randomized control trails to measure the effects of the interven ons. Culturally- and contextually-sensi ve interven ons. E.g. Sonderegger's (2011) EMPOWER program. The use of local defini ons, which may include the use of local metaphors and analogies (for example, cor sol being likened to snake bite poison) and may introduce contextualized psychological knowledge to educate local par cipants about the effects of trauma. The dissemina on of vocabulary schemes into everyday conversa on and contexts for wider effect (as found in Willis & Nagel, 2015). Normalized in everyday communica on between community members (for example, teachers likening the treatment of stress in their students to the treatment of a snake bite, discussing the need for rest and ways to release the ‘an -venom’ hormone serotonin) and disseminated in local community spaces, like schools. view of the mobility of such populations. 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Alison S. Willis, Michael C. Nagel. The Function of Specialized Vocabulary Development in Psychosocial Rehabilitation in Traumatized Populations, Journal of Human Rights and Social Work, 2018, 1-6, DOI: 10.1007/s41134-017-0046-z