"Dame Laran- Moris ne'ebe iha Dame" (Peace within - Peaceful life): An integrated (culture specific) therapeutic intervention for the management of Intermittent Explosive Disorder (IED) in Timor Leste (East Timor).

This study is a waitlist controlled intervention. Sixty four participants will take part in the trial. Half of the participants (n=32) will be allocated to receive therapy immediately, the other half (n=32) will be allocated to a waitlist. Both groups will receive the same treatment. The integrated therapy program consists of 7 individual therapy sessions (2 sessions per week) conducted over a 4 week period. Session length will range from 90 -120 minutes per session. Components of the integrated therapy program include: 1.Psycho education through self awareness including physical (somatic), cognitive, social, historical, and political representations of self, incorporating awareness on human rights and a sense of justice; 2.Trauma focused cognitive behaviour therapy, with modified narrative exposure based on the ‘life-line’ technique (Schauer, Neuner et al., 2004); and cognitive restructuring through pictorial representations of at least one story similar to the participant’s own history of trauma related anger and the symbolic representation of anger attacks and related trauma through the use of traditional “Timorese Dolls”; and 3.Cultural and traditional healing practices incorporating existing native healing practices and perspectives. Homework will be given at the end of each session, including anger and anxiety monitoring tools, deep breathing with progressive muscle relaxation exercises and mindfulness training. In addition, culturally adapted assertiveness training for positive anger expression will be reinforced in homework assignments. At the end of the 6th session, a traditional healing/reconciliation technique, that will involve participation of the clients’ ‘most trusted person’, will be recommended to the client by the therapist. The healing process is optional and will depend on the participant’s perspective of its value. The healing process aims to reintegrate the participant back into the extended family and/or immediate community and will be conducted with the family of the participant as well as any parties affected by the participants’ anger. The participant is free to choose or exclude any potential family members or affected parties. Participants assigned to immediate treatment will be assessed at three time points: pre treatment, post treatment completion, and 1 month post treatment completion. Participants assigned to the waitlist will also be assessed at 3 time points which will coincide with assessment time points for a person allocated to the immediate treatment group. Therapy for the immediate treatment group will be provided by one therapist, Hewage ( PhD Candidate )who will be supervised by Professor Derrick Silove ( MBChB, MRANZCP) and Dr Susan Rees (PhD) of UNSW via Skype and/or telephone. The therapist, who is the primary architect of the intervention and qualified Psychologist, has had extensive experience in the provision of psychotherapeutic interventions for over 1200 survivors of trauma with IED in the course of her standard work in the past 5 yrs in Timor Leste ( East Timor). A number of additional case workers from Timor Leste ( East Timor) will be trained by Hewage in the IED intervention. These case workers will provide the IED intervention to participants in the waitlist group with all of these sessions supervised by Hewage (PhD Candidate), Professor Derrick Silove ( MBChB, MRANZCP) and Dr Susan Rees (PhD) via direct observation,skype and/or telephone.