Life stress and resilience: Developing an MHPSS intervention for improved functioning among crisis-affected adults

Principal Investigators: Jessica E. Lambert PhD and Joop de Jong MD PhD

What did the study set out to achieve?

This formative study aimed to adapt and test a group-based mental health and psychosocial support (MHPSS) intervention for Syrian refugees in Jordan. Led by DIGNITY – Danish Institute Against Torture, the project focused on:  

• Culturally adapting the Life Stress and Resilience (LSR) intervention manual;  
• Developing tools to measure emotional and somatic distress and daily functioning;  
• Piloting the intervention with non-specialist providers to assess feasibility and acceptability.  

The study was conducted in three phases: qualitative research and co-design workshops; quantitative testing of new tools with 300 refugees; and a pilot of the adapted intervention delivered to 80 participants by trained non-specialists.

What were the key findings?

The study revealed how Syrian refugees experience and express distress in deeply personal and culturally specific ways. One phrase – “Let it stay in the heart and injure, rather than going out and exposing me” – reflected the internalisation of distress and stigma around emotional expression.  

These findings informed the adaptation of the intervention, which was revised from eight to six sessions for feasibility. The adapted version balanced experiential exercises with simplified, locally resonant language.  

The intervention was well received. Female participants reported strong engagement and satisfaction, while male participants showed greater symptom reduction, despite more reserved feedback. Both groups requested more explanatory content and techniques to manage negative thinking.  

Attempts to validate new distress and functioning measures based on local expressions were less successful. The tools performed inconsistently across gender and age, suggesting that cultural concepts of distress may not fit easily into standardised psychometric formats.  

Somatic distress was common, with many participants reporting chronic pain or physical symptoms. While the intervention addressed these partially, findings indicated the need for more focused content in this area.

What does this mean for policymakers and practitioners?

This study highlights the importance of culturally grounded MHPSS interventions that reflect how people understand and talk about distress. It shows that:  

• Structured group interventions can be delivered effectively by trained non-specialist providers in humanitarian settings;  
• Standardised tools may not capture the full complexity of distress in crisis contexts, and mixed-method approaches may be more appropriate;  
• Interventions should be sensitive to gender, stigma, and the overlap between emotional and physical symptoms of distress.

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