Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal

Abstract

Background: Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster.

Methods: A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks).

Results: Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program.

Conclusion: Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.

Keywords: Nepal; adolescents; dialectical behavior therapy; emotion regulation; global mental health; non-randomized controlled trial; schools.

Figure 1

Nepali Transactional Model of Emotion Dysregulation.

Figure 2

Sample handouts for READY-Nepal curriculum.

Figure 3

CONSORT flow diagram for overall research procedures.

Figure 4

Changes in pre- and post- intervention scores by outcome measure. Note. DERS = Difficulties in Emotion Regulation Scale; DBT-WCCL = DBT Ways of Coping. Checklist; BAI = Beck Anxiety Inventory; CPSS = Child Post-Traumatic Stress Disorder Scale; CFI = Child Functioning Impairment Scale; RES = Resilience Scale.

Figure 4

Changes in pre- and post- intervention scores by outcome measure. Note. DERS = Difficulties in Emotion Regulation Scale; DBT-WCCL = DBT Ways of Coping. Checklist; BAI = Beck Anxiety Inventory; CPSS = Child Post-Traumatic Stress Disorder Scale; CFI = Child Functioning Impairment Scale; RES = Resilience Scale.

Figure 4

Changes in pre- and post- intervention scores by outcome measure. Note. DERS = Difficulties in Emotion Regulation Scale; DBT-WCCL = DBT Ways of Coping. Checklist; BAI = Beck Anxiety Inventory; CPSS = Child Post-Traumatic Stress Disorder Scale; CFI = Child Functioning Impairment Scale; RES = Resilience Scale.