{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:35:17Z","timestamp":1783528517458,"version":"3.55.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the efficacy of Memory Training for Recovery\u2013Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment.<\/jats:p><\/jats:sec>Results<\/jats:title>The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, \u221220.38 to \u221214.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, \u22128.50 to \u22124.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, \u22126.05 to \u22120.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, \u22120.70 to 2.01 points) in depression symptoms, with the group\u2009\u00d7\u2009time interactions being significant (allP<\/jats:italic>\u2009&amp;lt;\u2009.001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>anzctr.org.au Identifier:ACTRN12621001160820<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.6086","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T15:16:27Z","timestamp":1680189387000},"page":"e236086","source":"Crossref","is-referenced-by-count":12,"title":["Effect of the Memory Training for Recovery\u2013Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan"],"prefix":"10.1001","volume":"6","author":[{"given":"Sayed Jafar","family":"Ahmadi","sequence":"first","affiliation":[{"name":"Bard College, Annandale on Hudson, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Jobson","sequence":"additional","affiliation":[{"name":"Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Musavi","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Rohullah","family":"Rezwani","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farshad Ahmad","family":"Amini","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arul","family":"Earnest","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasratullah","family":"Samim","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Ali Akbar","family":"Sarwary","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed Abbas","family":"Sarwary","sequence":"additional","affiliation":[{"name":"Behrawan Research and Psychology Services Organization, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"McAvoy","sequence":"additional","affiliation":[{"name":"Centre for Humanitarian Leadership, Deakin University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"issue":"1","key":"zoi230205r1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1080\/13623690802568913","article-title":"Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children.","volume":"25","author":"Attanayake","year":"2009","journal-title":"Med Confl Surviv"},{"issue":"7","key":"zoi230205r2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0022140","article-title":"War and bereavement: consequences for mental and physical distress.","volume":"6","author":"Morina","year":"2011","journal-title":"PLoS One"},{"issue":"10194","key":"zoi230205r3","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/S0140-6736(19)30934-1","article-title":"New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis.","volume":"394","author":"Charlson","year":"2019","journal-title":"Lancet"},{"issue":"6","key":"zoi230205r4","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1080\/09658211.2013.817590","article-title":"Reduced autobiographical memory specificity in bereaved Afghan adolescents.","volume":"22","author":"Neshat Doost","year":"2014","journal-title":"Memory"},{"key":"zoi230205r6","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.645073","article-title":"Editorial: strengthening child and adolescent mental health (CAMH) services and systems in lower-and-middle-income countries (LMICs).","volume":"12","author":"Kumar","year":"2021","journal-title":"Front Psychiatry"},{"issue":"9692","key":"zoi230205r10","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/S0140-6736(09)61080-1","article-title":"Violence, suffering, and mental health in Afghanistan: a school-based survey.","volume":"374","author":"Panter-Brick","year":"2009","journal-title":"Lancet"},{"issue":"4","key":"zoi230205r11","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.jaac.2010.12.001","article-title":"Mental health and childhood adversities: a longitudinal study in Kabul, Afghanistan.","volume":"50","author":"Panter-Brick","year":"2011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"zoi230205r12","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s12888-018-1648-4","article-title":"Risk and protective factors associated with the mental health of young adults in Kabul, Afghanistan.","volume":"18","author":"Alemi","year":"2018","journal-title":"BMC Psychiatry"},{"issue":"6","key":"zoi230205r15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.18981","article-title":"Prevalence of poor mental health among adolescents in Kabul, Afghanistan, as of November 2021.","volume":"5","author":"Ahmadi","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi230205r16","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1177\/2167702612454613","article-title":"Enhancing autobiographical memory specificity through cognitive training: an intervention for depression translated from basic science.","volume":"1","author":"Neshat-Doost","year":"2013","journal-title":"Clin Psychol Sci"},{"issue":"2","key":"zoi230205r18","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4103\/2224-3151.206680","article-title":"Opportunities and obstacles in child and adolescent mental health services in low- and middle-income countries: a review of the literature.","volume":"4","author":"Juengsiragulwit","year":"2015","journal-title":"WHO South East Asia J Public Health"},{"issue":"1","key":"zoi230205r19","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1017\/S1352465820000417","article-title":"A brief clinical report documenting a novel therapeutic technique (MEmory Specificity Training, MEST) for depression: a summary of two pilot randomized controlled trials.","volume":"49","author":"Sadat Zia","year":"2021","journal-title":"Behav Cogn Psychother"},{"issue":"6","key":"zoi230205r20","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.3390\/ijerph15061279","article-title":"The role of communities in mental health care in low- and middle-income countries: a meta-review of components and competencies.","volume":"15","author":"Kohrt","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"zoi230205r21","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1146\/clinpsy.2011.7.issue-1","article-title":"The nature and significance of memory disturbance in posttraumatic stress disorder.","volume":"7","author":"Brewin","year":"2011","journal-title":"Annu Rev Clin Psychol"},{"issue":"11","key":"zoi230205r22","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.tics.2014.06.010","article-title":"Disruptions in autobiographical memory processing in depression and the emergence of memory therapeutics.","volume":"18","author":"Dalgleish","year":"2014","journal-title":"Trends Cogn Sci"},{"issue":"1","key":"zoi230205r23","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1037\/0033-2909.133.1.122","article-title":"Autobiographical memory specificity and emotional disorder.","volume":"133","author":"Williams","year":"2007","journal-title":"Psychol Bull"},{"issue":"2","key":"zoi230205r24","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/bjc.2014.53.issue-2","article-title":"A review of overgeneral memory in child psychopathology.","volume":"53","author":"Hitchcock","year":"2014","journal-title":"Br J Clin Psychol"},{"key":"zoi230205r25","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.brat.2014.03.002","article-title":"A pilot randomized controlled trial investigating the efficacy of MEmory Specificity Training in improving symptoms of posttraumatic stress disorder.","volume":"56","author":"Moradi","year":"2014","journal-title":"Behav Res Ther"},{"key":"zoi230205r26","doi-asserted-by":"publisher","first-page":"419","DOI":"10.3389\/fpsyg.2018.00419","article-title":"Memory specificity training for depression and posttraumatic stress disorder: a promising therapeutic intervention.","volume":"9","author":"Erten","year":"2018","journal-title":"Front Psychol"},{"issue":"1","key":"zoi230205r27","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jbtep.2008.03.001","article-title":"Reducing cognitive vulnerability to depression: a preliminary investigation of MEmory Specificity Training (MEST) in inpatients with depressive symptomatology.","volume":"40","author":"Raes","year":"2009","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"zoi230205r29","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.826633","article-title":"Investigating the feasibility, acceptability and efficacy of using modified-written exposure therapy in the aftermath of a terrorist attack on symptoms of posttraumatic stress disorder among Afghan adolescent girls.","volume":"13","author":"Ahmadi","year":"2022","journal-title":"Front Psychiatry"},{"issue":"2","key":"zoi230205r30","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2190\/OM.65.2.d","article-title":"Efficacy of writing for recovery on traumatic grief symptoms of Afghani refugee bereaved adolescents: a randomized control trial.","volume":"65","author":"Kalantari","year":"2012","journal-title":"Omega (Westport)"},{"issue":"3","key":"zoi230205r31","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1001\/jamapsychiatry.2017.4249","article-title":"A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: a randomized noninferiority clinical trial.","volume":"75","author":"Sloan","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"zoi230205r33","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4103\/INTV.INTV_37_18","article-title":"The efficacy of memory specificity training in improving symptoms of post-traumatic stress disorder in bereaved Afghan adolescents.","volume":"16","author":"Ahmadi","year":"2018","journal-title":"Intervention (Amstelveen)"},{"issue":"3","key":"zoi230205r35","doi-asserted-by":"publisher","first-page":"452","DOI":"10.9745\/GHSP-D-16-00017","article-title":"A Randomized controlled trial of a trauma-informed support, skills, and psychoeducation intervention for survivors of torture and related trauma in Kurdistan, Northern Iraq.","volume":"4","author":"Bass","year":"2016","journal-title":"Glob Health Sci Pract"},{"issue":"2","key":"zoi230205r36","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1001\/jamapsychiatry.2019.3474","article-title":"Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial.","volume":"77","author":"Rae Olmsted","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"zoi230205r38","first-page":"237","article-title":"Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents.","volume":"5","author":"Angold","year":"1995","journal-title":"Int J Methods Psychiatr Res"},{"issue":"2","key":"zoi230205r39","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/BF00919131","article-title":"What I think and feel: a revised measure of children\u2019s manifest anxiety.","volume":"6","author":"Reynolds","year":"1978","journal-title":"J Abnorm Child Psychol"},{"issue":"3","key":"zoi230205r40","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s007870050057","article-title":"The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version.","volume":"7","author":"Goodman","year":"1998","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"4","key":"zoi230205r41","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1037\/0002-9432.76.4.423","article-title":"The Afghan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone.","volume":"76","author":"Miller","year":"2006","journal-title":"Am J Orthopsychiatry"},{"key":"zoi230205r42","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1186\/1471-244X-14-206","article-title":"Comparing the validity of the self reporting questionnaire and the Afghan symptom checklist: dysphoria, aggression, and gender in transcultural assessment of mental health.","volume":"14","author":"Rasmussen","year":"2014","journal-title":"BMC Psychiatry"},{"issue":"1","key":"zoi230205r43","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.40911","article-title":"Effect of written exposure therapy vs cognitive processing therapy on increasing treatment efficiency among military service members with posttraumatic stress disorder: a randomized noninferiority trial.","volume":"5","author":"Sloan","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi230205r28","volume-title":"Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies","author":"Foa","year":"2009"},{"key":"zoi230205r32","volume-title":"Written Exposure Therapy for PTSD: A Brief Treatment Approach for Mental Health Professionals","author":"Sloan","year":"2019"},{"key":"zoi230205r37","doi-asserted-by":"crossref","DOI":"10.1057\/9780230583993","volume-title":"Designing Randomised Trials in Health, Education and the Social Sciences: An Introduction","author":"Torgerson","year":"2008"},{"key":"zoi230205r5","unstructured":"What disasters reveal about mental-health care. The Economist. March 16, 2019. Accessed October 12, 2021. https:\/\/www.economist.com\/international\/2019\/03\/16\/what-disasters-reveal-about-mental-health-care"},{"key":"zoi230205r7","unstructured":"ACAPS. Afghanistan. Accessed October 12, 2021. https:\/\/www.acaps.org\/country\/afghanistan\/crisis\/complex-crisis"},{"key":"zoi230205r8","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs. 2018 Afghanistan humanitarian needs overview. December 2, 2017. Accessed October 12, 2021. https:\/\/reliefweb.int\/report\/afghanistan\/2018-afghanistan-humanitarian-needs-overview#"},{"key":"zoi230205r9","unstructured":"UNICEF. Afghanistan: adolescent health and development. Accessed October 12, 2021. https:\/\/www.unicef.org\/afghanistan\/topics\/adolescent-health-and-development"},{"key":"zoi230205r13","unstructured":"UNICEF. \u201cWe cannot abandon the children of Afghanistan in their time of need\u201d: Statement by UNICEF Regional Director for South Asia, George Laryea-Adjei, upon his return from Kabul. August 29, 2021. Accessed October 16, 2021. https:\/\/www.unicef.org\/press-releases\/we-cannot-abandon-children-afghanistan-their-time-need"},{"key":"zoi230205r14","unstructured":"United Nations News. Afghan children are \u201cat greater risk than ever.\u201d August 29, 2021. Accessed on July 28 2022. https:\/\/news.un.org\/en\/story\/2021\/08\/1098692"},{"key":"zoi230205r17","unstructured":"UNHCR: the UN Refugee Agency. Afghanistan. Accessed October 12, 2022. https:\/\/www.unhcr.org\/en-au\/afghanistan.html"},{"key":"zoi230205r34","unstructured":"Child Outcomes Research Consortium. Child Revised Impact of Events Scale. Accessed February 22, 2023. https:\/\/www.corc.uk.net\/outcome-experience-measures\/child-revised-impact-of-events-scale-cries\/"},{"key":"zoi230205r44","unstructured":"Child and War Foundation. Writing for recovery. Accessed September 14, 2020. https:\/\/www.childrenandwar.org\/projectsresources\/manuals\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2802891\/ahmadi_2023_oi_230205_1679406248.06226.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T23:02:15Z","timestamp":1702162935000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2802891"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.6086","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]}}}