Effective evidence-based intervention for traumatic bereavement is one of the current major research issues in the field of Post Traumatic Stress Disorder (PTSD) in children and adolescents. The "Writing for Recovery" group intervention is a new treatment approach developed by the Children and War Foundation for traumatized and bereaved children and adolescents after disasters. The purpose of this project was an empirical examination of this intervention with 12- to 18-year-old war bereaved Afghani refugees. Eighty-eight war bereaved Afghani refugees were screened using the Traumatic Grief Inventory for Children (TGIC). From those with the highest total score, 61 were randomly assigned to either an experimental (n = 29) or control group (n = 32). The experimental group received six sessions of group training on 3 consecutive days in their school. The difference of TGIC scores between the experimental group in pretest and posttest was significant (p = 0.001). Results of analysis of covariance also showed a significant effect of Writing for Recovery on the experimental group (p < 0.001). It is concluded that "Writing for Recovery" is an effective group intervention for bereaved children and adolescents after disasters.

The objective of this study was to investigate the efficacy of memory specificity training (MEST) on autobiographical memory recall and depression. Afghan adolescents with depression were randomly assigned to a MEST group or to a control group. At baseline, both groups completed Persian versions of the Autobiographical Memory Test (AMT) and the Mood and Feelings Questionnaire (MFQ). The MEST group then had five weekly group sessions of MEST. The control group had no additional contact. The AMT and MFQ were then readministered to all participants, and the MFQ was readministered at 2-month follow-up. The MEST group retrieved a higher proportion of specific memories following training and had lower levels of depression at 2-month follow-up than did the control group. Change in memory specificity predicted follow-up depression over and above baseline depression and mediated the relationship between receipt of MEST and reduction in later depression. The results suggest that MEST can improve autobiographical memory performance and drive subsequent reduction in depression symptoms.

BackgroundThe aim of this study was to assess the efficacy, acceptability and feasibility of using modified written exposure therapy (m-WET) to treat symptoms of posttraumatic stress disorder (PTSD) in Afghan adolescent girls in the aftermath of a terrorist attack.Methods120 Afghan (Hazara) adolescent girls who had been exposed to the Sayed al-Shuhada school terrorist attack were randomly assigned to the m-WET (n = 40), trauma-focused cognitive behavior therapy (TF-CBT) (n = 40), or control groups (n = 40). m-WET involved five consecutive daily group sessions where participants simply wrote about the terrorist attack including thoughts and feelings. TF-CBT was an intensive five-session group intervention. The control group had no additional contact. The trial was undertaken at a local non-government organization in Kabul. The primary analysis was comparing PTSD symptoms (Child Revised Impact of Event Scale-13) in the three groups at post-intervention and three-month follow-up.ResultsOverall, participant and facilitator satisfaction with m-WET was high. Acceptability of m-WET was relatively high, with 15% drop-out in the m-WET group and all m-WET sessions were attended. While the groups did not differ significantly in PTSD symptoms at baseline, the m-WET group had significantly lower levels of PTSD symptoms compared to the control group at post-intervention and follow-up. There was no significant difference between the m-WET and TF-CBT groups.ConclusionThe findings suggest m-WET may be promising intervention for the treatment of PTSD among adolescent girls in humanitarian settings. Further research in the area is warranted.

This study has some limitations. Owing to heightened security, we were unable to adopt a random-sampling design, we could only recruit from Kabul, it was difficult to recruit girls, the sample size was limited, and the cross-sectional design precluded any inference of causation. Follow-up studies are needed to monitor the chronicity of psychiatric disorders among adolescents in Afghanistan.Adolescents in Afghanistan, especially girls, are experiencing significant mental health problems. However, Afghanistan's health system is struggling, and foreign humanitarian aid has diminished substantially. 1 There is a need for mental health interventions that are tailored to the current political and social environment in Afghanistan. Furthermore, clinicians treating recently arrived adolescent refugees from Afghanistan must consider the emotional and behavioral presentations within the context of the political, historical, and social experiences of this population.

ImportanceAdolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions.ObjectiveTo investigate the efficacy of Memory Training for Recovery–Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan.Design, Setting, and ParticipantsThis randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used.InterventionsParticipants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks.Main Outcomes and MeasuresPrimary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment.ResultsThe 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, −20.38 to −14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, −8.50 to −4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, −6.05 to −0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, −0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P &amp;lt; .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants).Conclusions and RelevanceIn this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts.Trial Registrationanzctr.org.au Identifier: ACTRN12621001160820