Examining MEmory Training for Recovery-Adolescent among Afghan adolescent boys: a pilot randomised controlled trial

ABSTRACT

Objective: To conduct a pilot randomised controlled trial examining the feasibility, acceptability and efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychological symptoms among Afghan adolescent boys following a terrorist attack.

Method: A pilot randomised controlled trial compared METRA to a Control Group, with a three-month follow-up. The study occurred in Kabul (June-November 2022). Fifty-eight boys aged 14–19 years (Mage = 16.70, SD = 1.26) with heightened posttraumatic stress disorder (PTSD) symptoms were recruited through a local school that had recently experienced a terrorist attack. Participants were randomised 1:1 to receive METRA (n = 28) (10 session group-intervention) or Control (n = 30) (10 group-sessions of study skills). Primary outcomes were self-reported PTSD symptoms at post-intervention. Secondary outcomes included self-reported anxiety, depression, Afghan-cultural distress symptoms and psychiatric difficulties.

Results: There were challenges in youth participation related to security and competing education demands. For those who did complete METRA, METRA was deemed feasible and acceptable. Following the intent-to-treat principle, linear mixed effects models found at posttreatment the METRA group had a 20.89-point (95%CI −30.66, −11.11) decrease in PTSD symptoms, while the Control Group had a 1.42-point (95%CI −8.11, 5.27) decrease, with the group over time interaction being significant (p < .001). METRA participants had significantly greater reductions in depression, anxiety, Afghan-cultural distress symptoms and psychiatric difficulties than did Controls. All gains were maintained at three-month follow-up.

Conclusions: With some modifications, METRA appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.

HIGHLIGHTS

• Very few adolescents in Afghanistan receive evidence-based psychological interventions.

• MEmory Training for Recovery-Adolescents was associated with significant reductions in psychological symptoms.

• With some modifications, MEmory Training for Recovery-Adolescents appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.

Objetivo: Realizar un ensayo piloto controlado aleatorio que examine la viabilidad, aceptabilidad y eficacia de MEmory Training for Recovery-Adolescent (Entrenamiento de la Memoria para la Recuperación-Adolescente; METRA) para mejorar los síntomas psicológicos entre los adolescentes afganos después de un ataque terrorista.

Método: Un ensayo aleatorizado piloto y controlado comparó METRA con un grupo de control, con un seguimiento de tres meses. El estudio tuvo lugar en Kabul (junio-noviembre de 2022). Cincuenta y ocho niños de 14 a 19 años (Medad = 16.70, SD = 1.26) con síntomas elevados de trastorno de estrés postraumático (TEPT) fueron reclutados a través de una escuela local que recientemente había experimentado un ataque terrorista. Los participantes fueron aleatorizados 1:1 para recibir METRA (n = 28) (10 sesiones grupales de intervención) o Control (n = 30) (10 sesiones grupales de habilidades de estudio). Los resultados primarios fueron síntomas de TEPT auto reportados después de la intervención. Los resultados secundarios incluyeron ansiedad auto reportada, depresión, síntomas de angustia cultural afgana y dificultades psiquiátricas.

Resultados: Hubo desafíos en la participación de los jóvenes relacionados con la seguridad y las demandas de competencias educativas. Para aquellos que completaron METRA, METRA se consideró factible y aceptable. Siguiendo el principio de intención de tratar, los modelos lineales de efectos mixtos encontrados en el postratamiento, el grupo METRA tuvo una disminución de 20.89 puntos (IC 95%: −30,66, −11,11) en los síntomas de TEPT, mientras que el grupo de control tuvo una disminución de 1.42 puntos (95% %IC −8.11, 5.27), siendo significativa la interacción del grupo en el tiempo (p < .001). Los participantes de METRA tuvieron reducciones significativamente mayores en depresión, ansiedad, síntomas de angustia cultural afgana y dificultades psiquiátricas que los controles. Todas las ganancias se mantuvieron a los tres meses de seguimiento.

Conclusiones: Con algunas modificaciones, METRA parece una intervención factible para los adolescentes varones en contextos humanitarios después de un ataque terrorista.

目的：进行一项随机对照试验，考查青少年恢复记忆训练（METRA）在改善阿富汗男孩恐怖袭击后心理症状方面的可行性、可接受性和有效性。

方法：一项随机对照试验将 METRA组 与对照组进行了比较，并进行了三个月的随访。该研究在喀布尔进行（2022 年 6 月至 11 月）。招募了 58 名在当地一所学校最近经历了恐怖袭击、患有严重创伤后应激障碍 (PTSD) 症状的 14–19 岁男孩（平均年龄 = 16.70，SD = 1.26）。 参与者以 1:1 的比例随机分配接受 METRA组 (n = 28)，10 次小组干预）或对照组（n = 30，10 次小组学习技能）。主要结果是干预后自我报告的PTSD症状。次要结果包括自我报告的焦虑、抑郁、阿富汗文化困扰症状和精神困难。

结果：青年参与安全和竞争性教育需求具有挑战。 对于那些完成 METRA 的人来说，METRA 被认为是可行且可接受的。遵循意向治疗原则，线性混合效应模型发现，治疗后 METRA 组的 PTSD 症状减少了 20.89 分（95% CI −30.66，−11.11），而对照组则减少了 1.42 分（95%CI −8.11, 5.27)，随时间与组别交互效应显著 (p < .001)。 与对照组相比，METRA 参与者的抑郁、焦虑、阿富汗文化困扰症状和精神困难显著减少。所有好处均在三个月的随访中得以维持。

结论：在人道主义背景下，经过一些修改的METRA 对恐怖袭击后的青少年男孩来说似乎是一种可行的干预措施。

KEYWORDS:

• Adolescent
• terrorist attack
• Memory Training for Recovery-Adolescent
• trauma
• depression

PALABRAS CLAVE:

• Adolescente
• ataque terrorista
• MEmory for Recovery-Adolescent
• trauma
• depresión

关键词:

• 青少年
• 恐怖袭击
• 青少年恢复记忆训练
• 创伤；抑郁

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The research dataset can be accessed at https://osf.io/f8dbh/.

Notes

1 Registration ACTRN12621001160820 focused on adolescent girls. This is a follow-up study with similar design and measures; however, the focus of the current study was on adolescent boys. The trial protocol can be accessed by contacting the authors.

2 For Ahmadi et al. (2023), between condition effect size (METRA vs Treatment as Usual) for PTSD symptoms was large (d = 1.71) (N = 125). For Ahmadi et al. (2022), those who received Module 2 of METRA had significantly lower PTSD symptom severity than the no-contact control group (η_p²= 0.17) (N = 80). Based on current recommendations for medium to large effect sizes, estimated pilot trial sample size per treatment arm is 10–15 participants (Whitehead et al., 2016).

3 The assessors also had daily access to the clinical psychology team.

4 See Supplemental Material for a summary of Post-Module 1 analyses.

5 The only significant difference observed was for Afghan-cultural distress symptoms, whereby those who completed the Control intervention had significantly higher Afghan-cultural distress symptoms at baseline than those that dropped out of the Control intervention.

Additional information

Funding

This work was supported by Enhancing Learning and Research for Humanitarian Assistance.