RecruitingACTRN12622001048774

Psychological Treatment of Posttraumatic Stress Disorder and Moral Injury in Refugees

Evaluation of a psychological intervention for the treatment of PTSD and moral injury-related symptoms in Arabic, Dari, Farsi and English-speaking adult refugees.

Sponsor

Professor Angela Nickerson

Enrollment

12 participants

Start Date

Jan 16, 2023

Study Type

Interventional

Conditions

Posttraumatic Stress Disorder Moral Injury

Summary

The purpose of this study is to evaluate the effectiveness of the Moral Injury Treatment for Refugees (MIT-R) in reducing posttraumatic stress symptoms (PTS) and symptoms associated with moral injury (i.e., heightened moral emotions of anger, shame and guilt, and disconnection with others) in a group of Arabic, Dari, Farsi and English-speaking refugees. This study will use a case series design where participants are randomised to different baseline lengths (4, 6, or 8 weeks) before receiving the intervention. It is hypothesized that participants will show reductions in PTS symptoms and negative moral emotions when compared to symptoms pre-treatment. It is also hypothesized that participants will endorse greater social functioning at post-treatment completion compared to pre-treatment. Clinically, this project will represent a critical first step in trialling a novel psychological intervention for moral injury in refugees.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Plain Language Summary

Simplified for easier understanding

Refugees and asylum seekers are at high risk of post-traumatic stress disorder (PTSD), often stemming from violence, persecution, and displacement. For many, this trauma is also morally injurious — meaning they witnessed or were forced to participate in events that deeply violated their values, leaving lasting feelings of guilt, shame, and anger that standard PTSD treatments do not always address well. This study tests a new psychological therapy called Moral Injury Treatment for Refugees (MIT-R), adapted specifically for Arabic, Dari, Farsi, and English-speaking refugees. The 10-session program is delivered via telehealth on Zoom and focuses on processing morally injurious experiences alongside trauma symptoms. Participants are randomly assigned to different waiting periods before starting therapy, which allows researchers to clearly identify whether improvement is due to the treatment itself. You may be eligible if you are 18 or older, have a PTSD diagnosis, have experienced a morally injurious event, have elevated trauma-related anger, shame, or guilt, come from a refugee or asylum seeker background, and speak Arabic, Dari, Farsi, or English. You must have access to a smartphone or computer for telehealth sessions. People with active psychosis, substance dependence, recent suicidal intent, or those already receiving regular psychological therapy are not eligible.

This summary was AI-generated to explain the trial in plain language. It is not medical advice. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

The intervention used in this study will be the Moral Injury Treatment for Refugees (MIT-R). The aim of this clinical study is to assess if MIT-R is effective in reducing post-traumatic stress disorder symptoms, reducing negative moral emotions (i.e., anger, shame, and guilt) and increasing social functioning in a group of Arabic, Dari, Farsi and English-speaking refugees. MIT-R was developed in consultation with refugee community leaders and service providers. We drew on evidence-based strategies from existing interventions focused on moral injury, anger, guilt and shame, as well as interventions adapted to the refugee context. This study will utilise a randomised multiple baseline case series design, where participants will be randomised to a baseline length of 4, 6, or 8 weeks before receiving the intervention. MIT-R comprises 12 weekly sessions (1.5 hours each session) for individuals and will be delivered online via Zoom. This intervention comprises four phases: Psychoeducation- in this phase, participants’ symptoms are normalised and participants learn about the psychological effects of traumatic events and morally injurious events for refugees; Narrative Exposure Therapy: in this phase, participants’ autobiographical narrative is constructed, key morally injurious/traumatic events are identified and processed. Narrative Exposure Therapy is the leading evidence-based trauma-focused intervention for PTSD in refugees and has been evaluated in more than 20 studies; Culturally-Informed Cognitive Therapy: In this phase, moral injury appraisals are situated within participants’ personal and cultural moral frameworks and addressed using evidence-based cognitive techniques for reducing negative emotions; Reconnecting with Community: In this phase, functional implications of moral injury appraisals are identified; participants re-connect with important relationships and cultural values; an action plan is developed to facilitate increased future engagement in life and with community, consistent with existing treatments of moral injury in non-refugee populations. The treatment manual for MIT-R has been adapted to suit Arabic, Dari, Farsi and English-speaking refugees. Psychologists trained in the delivery of MIT-R and Narrative Exposure Therapy will facilitate the interventions. Trial therapists will undergo specific training in delivering all treatment sessions including the use of a protocol-based treatment manual. The following protocols will be followed to ensure close therapeutic compliance with the treatment manual: (i) therapists will receive regular clinical supervision; (ii) participant attendance will be recorded by the clinician as part of routine care; (iii) the treatment manual will be used in all treatment sessions; (iv) with participant consent all treatment sessions will be video recorded and 15% will be randomly selected and rated for therapist adherence to the manual.