mindfulness-sos: stress reduction for refugees

Conditions: Stress Disorders, Post-Traumatic; Stress Related Disorder

Summary: the covid-19 pandemic crisis is associated with a wide range of stressors for the general population. for forcibly displaced persons (fdps), the turmoil of this crisis is magnified significantly, and elevated pre-existing post-migration stressors and trauma-related mental health problems are acutely amplified. in a recent randomized control trial, mindfulness-based trauma recovery for refugees (mbtr-r) led to large acute stress-buffering effects among eritrean asylum seekers in israel. the investigators thus developed mindfulness-sos for refugees - a brief internet-based mobile-supported adaptation of the mbtr-r mental health intervention program - specifically designed to mitigate acute stress and related mental health symptoms among fdps. the investigators will conduct a nonrandomized single-group intervention trial of the efficacy, safety, utilization, and related feasibility of mindfulness-sos for refugees among a traumatized chronically stressed sample of east african asylum seekers in an urban post-displacement setting in the middle east (israel). the study will be carried out during an acutely stressful period of time for this population due to a covid-19 pandemic national lockdown.

brief background: the covid-19 pandemic is associated with a range of stressors and consequent mental health problems. for tens of millions of fdps, stressors and sequelae of the pandemic are particularly magnified and severe, as their preexisting stress-related mental health problems are acutely exacerbated. in a recent randomized control trial prior to the covid-19 pandemic, the investigators found significant therapeutic effects of mbtr-r - a 9-week, mindfulness- and compassion-based, trauma-sensitive, and socio-culturally adapted group intervention program designed for fdps - for stress- and trauma-related mental health outcomes among eritrean asylum seekers in israel. in light of the covid-19 pandemic, and to facilitate access, reach, and flexibility of mental health care among fdps, the investigators developed mindfulness-sos for refugees - a brief internet-based mobile-supported adaptation of the mbtr-r mental health intervention program - specifically designed to mitigate acute stress and related mental health symptoms among fdps. study aims: broadly, the study aims are: i) to test the efficacy of the mindfulness-sos for refugees intervention program on stress- and trauma-related mental health outcomes (e.g. posttraumatic stress, depression), ii) to test intervention safety - including rates of clinically significant deterioration in primary outcomes in response to the intervention, iii) to assess participant utilization of the mindfulness-sos for refugees intervention program, iv) to test whether mindfulness-sos for refugees will lead to changes in targeted processes or mechanisms of change including mindful awareness and self-compassion, and v) to test whether expected pre-to-post intervention change in the targeted processes will predict expected pre-to-post intervention change in stress- and trauma-related mental health outcomes. study overview: accordingly, the investigators will conduct a nonrandomized single-group intervention trial among a community sample of traumatized and chronically stressed east african asylum seekers (n=60, 50% female), residing in israel in an urban post-displacement setting, during the covid-19 pandemic. over the course of three successive months, participants will be recruited from the community via public flyers, social networks, local non-governmental- (ngos), and municipal- organizations working with fdps. participants will be assigned to mindfulness-sos for refugees - a brief internet-based mobile-supported intervention program, entailing 8 brief sessions as well as 9 mindfulness meditation practice exercises - delivered via audio recordings using participants' personal smartphones. over the course of the mindfulness-sos for refugees intervention program, participants will receive administrative guidance (e.g. technical support in case of mobile phone and internet platform-related difficulties and relevant information of the internet-based mobile-supported intervention program and assessment); as well as adherence-focused guidance (e.g. adherence monitoring including weekly brief check-in telephone calls and smartphone text-based nudges to remind and prompt weekly adherence and assessment), in the participants' mother tongue, tigrinya. stress- and trauma-related mental health outcomes and targeted change processes will be assessed via self-report questionnaires pre-intervention, brief weekly assessments, and post-intervention. in addition to participants' self-report, participant-level utilization of the mindfulness-sos for refugees intervention program will be digitally monitored. participants will be encouraged to complete 2 sessions per week and practice each day for 4 weeks but can choose to extend this up to 8 weeks. post-intervention assessments will be carried out when participants will complete the 8 sessions of the internet-based mobile-supported intervention program (recommended 4 weeks, a maximum of 8 weeks post-baseline, or when participants will indicate that they are no longer interested in participating in the intervention program). the intervention program and assessments will be completed on participants' smartphones.

Eligibility criteria:
inclusion criteria: * east african refugee or asylum seeker living in israel * tigrinya fluency and literacy * owns a personal smartphone exclusion criteria: * active suicidal ideation or/and past suicide attempt in the last year or/and passive suicidal ideation with clinical indicators of imminent suicide risk (e.g. severe paranoia) * current mental health treatment (i.e. psychotherapy or/and group therapy at least twice a month) * participation in the mbtr-r group in a previous study

Keywords: forcibly displaced persons post-migration stress trauma post-traumatic stress disorder depression anxiety covid-19 pandemic stress online mental health intervention program treatment adherence mindfulness compassion