Effectiveness of a transdiagnostic group intervention to enhance emotion regulation in young Afghan refugees: A pilot randomized controlled study

Abstract

There are several challenges to providing mental health care for refugees, including high comorbidity and structural barriers. Targeting transdiagnostic processes in a low-threshold group intervention appears particularly promising to meet these challenges. This study examined the feasibility, acceptability and effectiveness of a new transdiagnostic intervention, Skills-Training of Affect Regulation-A Culture-sensitive Approach (STARC), focusing on conveying strategies to improve emotional clarity and to regulate emotions. A parallel-group (STARC vs. waitlist) randomized-controlled study with 44 young male Afghan refugees was conducted in a routine clinical setting (NCT03162679). In intention-to-treat analyses, participants of STARC significantly improved in self-reported difficulties in emotion regulation (Δd_{STARC-Waitlist} = 1.22), transdiagnostic symptom severity (Δd_{STARC-Waitlist} = 1.69), posttraumatic stress symptoms (Δd_{STARC-Waitlist} = 1.19), and caregiver-reported emotional competence (Δd_{STARC-Waitlist} = -0.90), but not anger reactions (Δd_{STARC-Waitlist} = 0.50) compared to waitlist. Effects were maintained over 3 months. STARC is a feasible transdiagnostic intervention in a routine clinical setting and effective for young Afghan refugees. If replicated in large-scale studies with active control groups, it might be promising as an initial low-threshold intervention offered in a phased-based and/or stepped care approach.

Keywords: Afghanistan; Emotion; Group treatment; PTSD; Refugees; Regulation; Transdiagnostic; Trauma.