Mindfulness-Based Trauma Recovery for Refugees (MBTR-R)
Condition: Stress Disorders, Post-Traumatic; Stress Related Disorder
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Worldwide, refugees and asylum seekers suffer at high rates from trauma- and stress-related
      mental health problems. The investigators thus developed Mindfulness-Based Trauma Recovery
      for Refugees (MBTR-R) - a 9-week, mindfulness- and compassion-based, trauma-sensitive and
      socio-culturally adapted, group intervention for refugees and asylum seekers. The overarching
      aims of the study were to, first, test whether MBTR-R is an efficacious and safe mental
      health intervention for traumatized refugees and asylum seekers with respect to stress- and
      trauma-related mental health outcomes; and, second, to test theorized mechanisms of action of
      MBTR-R. Accordingly, the investigators conducted a randomized waitlist-controlled trial among
      a community sample of female and male Eritrean asylum seekers in an urban post-displacement
      setting in the Middle East (Israel).
    

Detailed description: 
      Broadly, the investigators aimed to assess whether MBTR-R is an efficacious and safe mental
      health intervention for traumatized asylum seekers. Aim I: The investigators predicted that,
      relative to a waitlist control condition, MBTR-R will lead to improved stress-and
      trauma-related mental health outcomes, including lower levels and rates of posttraumatic
      stress, depression, anxiety, and improved subjective well-being at post-intervention and
      5-week follow-up. Aim II: The investigators aimed to test, whether relative to the
      waitlist-control condition, MBTR-R was safe and thus not associated with participant-level
      clinically significant deterioration in any of the monitored primary mental health outcomes
      at post-intervention or at follow-up. In the event of adverse responding, the investigators
      planned to test whether key demographic factors or pre-existing vulnerability factors at
      pre-intervention that may predict participant-level deterioration or adverse responding to
      the intervention - so as to identify candidate contraindications for MBTR-R. Aim III: The
      investigators predicted that, relative to a waitlist control condition, MBTR-R will lead to
      changes in psycho-behavioral processes targeted by the intervention and implicated in
      vulnerability at pre-intervention, from pre-to-post intervention, measured in controlled
      behavioral and cognitive-experimental lab tasks or experience sampling measures, including
      measures of (a) self-compassion and self-criticism, (b) self-referential processing of fear,
      (c) avoidance, (d) emotional reactivity to trauma-related information and autobiographical
      memory, (e) impaired executive functions of trauma-related information processing in working
      memory. Aim IV: The investigators aimed to test whether, among the MBTR-R group,
      pre-to-post-intervention change and pre-intervention to follow-up change in mental health
      outcomes (Aim I) will be predicted or mediated by pre-to-post intervention change in the
      targeted psycho-behavioral processes.
    

Intervention name(s): Mindfulness-Based Trauma Recovery for Refugees (MBTR-R)
Intervention type(s): Behavioral
Intervention description(s): MBTR-R is a mindfulness-based group intervention of nine 2.5-hour weekly sessions. MBTR-R format and structure parallel MBSR (mindfulness-based stress reduction) and MBCT (mindfulness-based cognitive therapy). MBTR-R includes systematic training in formal and informal mindfulness practices with trauma-sensitive adaptations and home practice. Trauma-sensitive adaptations include a "safe place" practice, psychoeducation about posttraumatic stress, stress reactivity, as well as self-compassion practices to cope with fear, self-judgement, guilt and shame. Socio-cultural adaptations include real-time linguistic translation of each session by a cultural mediator from the refugee community and use of socio-culturally specific metaphors. MBTR-R groups were conducted for men and women separately and delivered in an accessible, "safe space" in the local refugee community. Group meetings included a shared meal of traditional Eritrean food and female participants were offered free child care.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Asylum Seekers, Anxiety, Compassion, Depression, Mindfulness, PTSD, Post-Migration Stress, Refugees, Trauma